The inspection took place on the 15 and the 23 June 2016. The inspection was unannounced. The previous inspection was completed in August 2015 and was a focused inspection to look at compliance against a previous breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was compliant with the outcomes assessed.The Beeches is a care home for people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. It can accommodate up to 11 people under the age of 65. The home is located on the outskirts of the village in spacious grounds with parking and is close to local amenities and transport routes.
The Beeches has two registered managers who work as a job share. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People we spoke with were positive about the care and support they received and it was evident from our inspection that care was person centred. People told us they felt safe and we found that staff knew how to protect people from avoidable harm. Staff knew how to recognise different signs of abuse and they were clear about what action to take if they suspected abuse was taking place. The registered provider had a safeguarding policy in place that had been updated to align with local authority guidelines.
We looked at staff rotas. Staff and people living at the home told us there was enough staff on duty and staffing levels were regularly reviewed to ensure that there were sufficient numbers to meet people’s changing needs. However, we saw the registered provider did not have a robust system or process in place to support and record that staff had the required up to date qualifications, skills and experience necessary to ensure they were competent in undertaking their role and that this was regularly reviewed. This was a breach of regulation 17(2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of this report.
People were encouraged to live as independently as possible and we saw detailed risk assessments and risk management plans were in place to enable people to live independently and undertake a variety of daily activities in a safe way.
We saw risk assessments for the home and the environment. However, these did not include personal emergency evacuation plans (PEEPs) for each individual person. PEEPs are documents that advise of the support people need in the event of an emergency evacuation taking place.
We looked at monthly checks on portable appliances, fire extinguishers, water temperatures and saw that these were all up to date and helped to ensure the safety of the premises for people.
The registered provider had a policy and procedure in place for the safe management of medication. However we saw where medication was required to be refrigerated it was stored in the food refrigerator in the kitchen. The registered provider told us a recent medication audit had failed to identify this as a breach of regulations and they told us they would obtain a separate refrigerator from their provider to store medication. We made a recommendation for the registered provider to followed guidance in this respect from The Royal Pharmaceutical Society.
Management and staff had received training in and understood the requirements of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Where people may have lacked capacity the registered provider ensured that the MCA was followed and we saw that prompt application for deprivation of liberty safeguards (DoLS) had been completed. DoLS were regularly reviewed and evaluated. Where an individual had capacity to make decisions in other areas of their lives we saw that they were encouraged by staff to provide their consent.
We saw there was a choice of menu and staff were aware of people’s dietary needs that were recorded in their care plans. The registered service had an environmental health officer food hygiene rating (FHRS) award of five, which was the highest award.
People told us that they were well cared for and had access to a range of health professionals. People told us they could see a GP when they wanted to and they were trialling an electronic software system to self-manage their health and appointments. We saw records of professional contacts with healthcare services documented in people’s care plans. These included the GP, district nurse, community psychiatric nurse, and mental health practitioner.
We saw a variety of activities and seasonal events were organised in line with people’s requests and feedback. These were both individual and group activities and trips.
People and their relatives were involved in the assessment and planning of their care and support. Peoples care plans showed how they were involved in making decisions about their care, treatment and support. Care plans were detailed and included information about peoples likes and dislikes.
Staff told us of a supportive culture by management with a service that focused on the needs of the people living in the home.