Archived: Beeches House

After the home’s last unannounced comprehensive inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to these breaches. We undertook an unannounced focused inspection on 31 March 2016 to check the provider had followed their action plan and now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Beeches House’ on our website at www.cqc.org.uk’

Beeches House is a care home that provides accommodation and personal care for up to 12 people. The home specialises in supporting older adults who have learning disabilities. The home also caters for people living with physical disabilities. There were nine people living at the home when we inspected.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our focused inspection, we found that the provider had followed their action plan, which they had said would be completed by 31 March 2016. We saw legal requirements had been met because the provider now notified the CQC in a timely way about the occurrence of any incidents and events that affected the health, safety and welfare of people using the service.

Beeches House is a care home that can provide accommodation and personal care for up to 12 older people living with a learning disability. There were nine people living at the home when we visited. Four people using the service also lived with a physical disability.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had failed to notify the CQC about all the incidents that had affected the health, safety and welfare of people living at the home, which had included a death, several serious injuries and the outcome of applications made to the local authority to deprive people of their liberty. This meant the CQC could not take appropriate follow up action where needed.

We identified two breaches of the Care Quality Commission (Registration) Regulations 2009 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

In addition, although the homes physical environment was safe, maintenance and refurbishment work did not always take place when needed. This meant some of the homes interiors, which included furniture, soft furnishings and décor, looked worn in places.

People we spoke with told us they were happy living at Beeches House and felt safe there. We saw staff looked after people in a way which was kind and caring. Our discussions with people using the service supported this. People’s rights to privacy and dignity were also respected. When people were nearing the end of their life they received compassionate and supportive care.

Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The home also managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies.

The home continuously reviewed and planned staffing levels to ensure there were enough staff to meet people’s needs. The provider had carried out appropriate checks to ensure they were suitable and fit to work at the home. Staff were suitably trained, well supported and knowledgeable about the individual needs and preferences of people they cared for.

People were supported to maintain social relationships with people who were important to them, such as their relatives. There were no restrictions on visiting times.

People participated in meaningful social, leisure and recreational activities that interested them both at home and in the wider community. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be. We saw people could move freely around the home.

People were supported to keep healthy and well. Staff ensured people were able to access community based health care services quickly when they needed them. Staff also worked closely with other health and social care professionals to ensure people received the care and support they needed. People received their medicines as prescribed and staff knew how to manage medicines safely. There was a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

Staff supported people to make choices about day to day decisions. The manager and other staff were knowledgeable about the Mental Capacity Act (2005) and best interests meetings were held in line with the Act to make important decisions on behalf of people who did not have the capacity to make decisions themselves.

Deprivation of Liberty Safeguards (DoLS) were in place to protect people’s safety, and the staff were aware of what this meant and how to support people appropriately. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had a clear management structure in place. The management team which consisted of the registered manager/owner, operations director, deputy manager and new trainee manager all led by example and demonstrated a good understanding of their various roles and responsibilities.

The views and ideas of people using the service, their relatives, professional representatives and staff were routinely sought by the provider and used to improve the service they provided. People and their relatives felt comfortable raising any issues they might have about the service with staff. The provider had arrangements in place to deal with people’s concerns and complaints appropriately.

There were effective systems in place to monitor the safety and quality of the service provided at the home. The management team reviewed the quality of care provided to people. They ensured any areas that required improvement were actioned and there was a focus within the staff team on continuous improvement of the service.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

We saw staff treated the people who lived at Beeches House with the utmost respect and dignity. People we spoke with told us they felt safe living at the home. The services safeguarding procedures are robust and staff understood how to keep people safe. Staff understood their roles and responsibilities in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS), when an application should be made, and how to submit one. Where DoLS decisions had been made the appropriate procedures were followed. The service was meeting the requirements of DoLS, which helped ensure people's rights were properly recognised and safeguarded. We saw staff regularly assessed potential risks to people's health and welfare both within the home and the wider community. Staff were provided with appropriate guidance on how to prevent, minimise or manage these identified risks and keep people safe. There were enough staff on duty to meet the needs of the people who used the service. The managers set the staff rota and we found they took account of people's care needs and wishes when making decisions about the numbers, skills and experience of the staff required to be on duty in the home at all times. We also observed a culture where staff felt able to spend quality time with people who lived at Beeches House.

Is the service caring?

People we were able to talk with told us they were happy with the care they received and felt their needs were met. Comments we received included, 'I like living here', 'It's an alright place to be' and 'The staff are nice to me. They (staff) treat us alright'. It was clear from what we observed and from speaking with managers and staff that they were familiar with people's needs and preferences and treated people as individuals. People were supported by kind and attentive staff. We saw the way staff interacted with the people who used the service was characterised by patience, warmth and empathy. People's needs, preferences, interests and aspirations had been recorded in their personalised care plan and support was provided by staff in accordance with people's diverse needs and wishes. People had regular opportunities to choose to participate in a range of meaningful social and recreational activities both within their home and the local community.

Is the service responsive?

People's needs were assessed before they moved into the home and were reviewed on a regular basis. Staff continually monitored people's health and where necessary sought the assistance of community based health and social care professionals.

Is the service effective?

People's personal and health care needs were assessed with them, and they and/or their representatives were involved in writing their care plan, which was routinely reviewed and updated to reflect any changes in people's needs and wishes.

It was evident from what we saw and from speaking with people who used the service that their nutritional needs were being met by staff who were familiar with people's food and drink preferences. People told us that they were happy with the food and drink they were offered at Beeches House. Feedback we received included, 'The food is alright', and 'I enjoyed the dessert I had for lunch today'. Staff were suitably trained and supported by their line managers to meet the needs of the people who used the service.

Is the service well-led?

At the time of our inspection the provider did have a registered manager in post who was also the owner, although we are aware that they have not been in day-to-day control of the home for the past eight months. However, at the time of this inspection we found that a suitably experienced and qualified management team had been put in place to run Beeches House in the absence of the registered owner/manager. Staff we spoke with felt the new management arrangements were working well and that Beeches House was a good place to work. Staff demonstrated a good understanding of the ethos of the home and the provider had put effective quality assurance systems in place to regularly assess and monitor the standard of care and support people who lived at the home received. It was clear from records we looked at that where any issues were identified during quality assurance audits prompt action was taken by the provider to address them and continually improve the service. Staff told us they were asked for their views on the service they provided and felt the homes management took into account what they had to say and use their knowledge and experience to continually improve Beeches House. There were also systems in place to make sure staff learnt from incidents and accidents and other untoward events.

We had previously noted that some people had secure lap straps fitted to their wheelchairs. There had not been any been evidence of any discussions to show that the lap straps were used in their best interests, to stop them falling. Therefore we judged at they may have been deprived of their liberty to move around freely. We had also seen that some people had needed bedrails fitted to their beds to prevent them from falling. There had not been any risk assessments in place to identify the potential risk to these people.

At this inspection we saw risk assessments were in place signed and dated by senior staff and the provider. However we did note that there was not always any evidence to show that people, or someone acting on their behalf, had been involved in decisions about the risks involved.

At our last inspection we had noted that not all of the care plans had reflected the support that people had currently needed. This failure to maintain an accurate record had not provided us with an assurance that people were being protected against the risk of inappropriate care. Following our inspection the provider had sent us evidence of the updated care plans.

We observed some people who used wheelchairs were wearing secured lap straps, which could restrict their movement. It was not clear by whom this decision of the use of lap belts had been made.

We observed staff spent time talking with people in a friendly and caring manner. We found that staff had a good understanding of people's interests, hobbies and their likes and dislikes. One person told us they had favourite snacks that we saw staff provided.

People's care plans contained information guided staff to deliver people's care and support in the way they preferred. However, we found that people's care plans had not been signed by them or their representative confirming their agreement to the required care and support.

We found that people who used the service were administered their medicines in a safe way.

Staff told us they received a range of training and they were appraised and supervised.

People had access to a complaints procedure but some of the information was not up date. The home's complaint records could not be located at the home to demonstrate that there were systems in place to deal with people's comments and concerns.

We identified some areas for improvement in respect of record keeping.

We spoke to two people using the service about what they thought about living in the home. They told us they liked the staff, they felt safe and they knew how to make a complaint. One person told us 'I'm very happy with everything. I like the people who look after me'. Another person told us 'I feel safe. I have no complaints. If I did I would tell the owner'.

We looked at two people's care records and saw their individual care and support needs had been assessed and support plans were in place to meet these needs. Risks to their health and wellbeing had been identified and plans were in place to manage these. From the records we looked at, information was reviewed and updated regularly so that staff had up to date information about people's current care and support needs. People using the service and their relatives were involved in regularly reviewing their care and support needs.

It was evident from the practices we observed during our inspection that the people using the service were well supported by the staff that worked there and they were treated with respect. We observed positive interactions between staff and people using the service.