Archived: The Beaufort Care Home

Updated 9 January 2020

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: The inspection was conducted by two inspectors, a nurse specialist and an Expert by Experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service. The ExE who supported this inspection had experience of care of older people and those living with dementia.

Service and service type: The Beaufort is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This comprehensive inspection was unannounced and took place on 08 October 2019.

What we did: We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During our inspection visit, we spoke with six people who lived at the home and three relatives. We spoke with the regional manager, registered manager, a bank nurse, a nurse, three care staff, the activities co-ordinator and cook.

We reviewed a range of records about people's care and how the service was managed. This included six people's care records and medicine records to ensure they were reflective of people’s needs. Three staff personnel files to ensure staff had been recruited safely. We also sampled records relating to the management of the service including quality checks and audits, complaints, staff training data and feedback about the service provided.

After the inspection: We were contacted by another relative who shared positive feedback about the service.

Updated 9 January 2020

About the service: The Beaufort Care Home provides nursing and residential care for up to 29 older people, including people living with dementia. At the time of our visit 25 people, most of whom had complex medical needs, lived at the home. This included three people in short term discharge to assessment beds (D2A) which are used to support timely discharges from hospital. Accommodation is provided in an adapted building across two floors, with communal areas on the ground floor.

People’s experience of using this service:

We found there continued to be a lack of effective governance, management and provider oversight. Systems and processes designed to identify shortfalls, and to drive improvement continued to be ineffective. Completed audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

Low staffing levels continued to negatively affect people’s day to day experiences. This meant people did not consistently receive good quality safe care. Despite staff understanding their responsibility to keep people safe, risk assessments did not always contain accurate information to help staff manage risk. Some risks associated with people’s safety and the environment had not been identified or assessed. Medicines were not always managed safely, for example staff did not always follow nationally recognised guidance.

Staff were recruited safely and received support though an induction and on-going programme of training.

People had access to health and social care professionals. However, the advice of health care professionals and changes they made to people’s planned care were not always recorded and followed. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s right to privacy and dignity was not always considered and upheld. Some people’s personal belongings were not treated with respect and low staffing levels limited the choices people made. Staff understood the needs of people who lived at the home permanently but had limited information about people staying in a D2A bed.

Care was not always provided in line with people’s needs and preferences. Care records did not consistently contain accurate and detailed information to help staff provide personalised safe care. Some people had opportunities to engage in meaningful activities. People spoke highly of staff and despite our findings people told us they felt safe. Complaints were managed in line with the provider’s policy and procedure.

People and relatives had opportunities to feedback their views on the service they received. The most recent feedback showed overall people and relatives were satisfied with the service provided and how their home was run.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 28 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following our inspection, we notified the local authority commissioners about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2015 – Person centred care

Regulation 10 Regulated Activities Regulations 2014 – Dignity and respect

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

Enforcement: Full information about CQC's regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.