We found the following examples of good practice.
The provider has facilitated ‘window visits’ for residents and their visitors in addition to guaranteed visits for their essential visitor during outbreaks.
Beechcroft Nursing and Residential Home is a single storey care home located in the Palacefields area of Runcorn close to local shops, pubs and the local church. The home provides accommodation for up to 67 people. It is divided into two units, a nursing unit and a residential unit.
At the time of our inspection visit there were 61 people living in the 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.
The service has a registered manager in post. 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 who used the service and relatives had a positive attitude about the service being delivered and the standard of care and support provided by the staff team. People were treated with respect, consideration and kindness.
Staff supported people to take their medicines safely and as prescribed. The provider had taken appropriate on-going actions to show continued improvements to the management of people’s medications.
People were protected from potential harm and abuse by trained staff who were knowledgeable of local safeguarding procedures. Updates were needed for some staff with training and record keeping.
There was mixed feedback regarding staffing levels. The registered manager was confident that staffing levels were increased when they identified a need to do this to meet the needs of people at the service. We recommend the registered provider includes staff, people receiving support and relatives in their assessments of staffing levels so they are fully informed and consulted about the staffing levels provided.
The service was clean and tidy. We recommend the service reviews all areas of the building and refers to published guidance in developing services and their environments to meet people’s needs with dementia.
People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.
People were supported by a team of staff that had received training and support to maintain their skills and knowledge in order to meet the needs of the people they supported.
Information and arrangements were in place for the staff team to respond to concerns or complaints from people using the service and their representatives.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible. Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). The manager submitted notifications following this inspection to show updated information regarding authorisations granted by the local authority.
There were detailed systems in place to monitor the quality and safety of the service. Staff spoke positively about the support they received from the registered manager. They said that the registered manager was supportive and visible around the home and they felt it was well managed.
Beechcroft Nursing and Residential Home is a single storey care home located in the Palacefields area of Runcorn close to local shops, pubs and the local church. The home provides accommodation for up to 67 people. It is divided into two units, a nursing unit and a residential unit.
At the time of our inspection visit there were 51 people living in the home, 23 of whom were in the residential unit and 28 on the nursing unit.
The last inspection took place on the 18 and 19 January 2017 when Beechcroft Nursing and Residential Home was found to require improvement in all domains.
There was a manager who had been in post full time since May 2017 who had applied to the Care Quality Commission to register as the manager of Beechcroft. 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.
Before the inspection Halton Borough Council informed us that they had concerns about the service and that the home had been on an improvement plan and they had restricted placements to one a week. This is the council's usual practice that is designed to ensure improvements are made. They shared their concerns with us and informed us that they had been monitoring the home and had noted some improvement. The Care Quality Commission were fully involved in this process and attended meetings held in relation to these matters.
As a result of these concerns the provider had set up a project plan to improve the service, which included appointing a project manager to oversee the process. An on-going action plan was in place.
At our previous inspection in January 2017 we found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to dignity and respect, safe care and treatment and good governance. At this inspection we found that there had been improvements but there were still breaches in relation to safe care and treatment and good governance.
Whilst the people we spoke with told us that they were well cared for and they were happy in the home, we found that people could be at risk because there had been a lack of effective quality assurance in the home. The registered provider had a system for assessing and monitoring the quality of the service but this was not fully embedded because of frequent changes in management and a lack of clinical leadership on the nursing unit.
On the nursing unit, medicines were not always administered correctly and the recording of medicines required improvement.
Measures to prevent and control the spread of infection had not been fully implemented.
Since the last inspection actions identified to improve the safety of the premises had been actioned.
People were treated with respect and the staff understood how to provide care in a dignified manner and respected people’s right to privacy.
The handling of complaints had also improved.
People that were able to talk to us said they were happy in the home and with the people that cared for them. The interactions we observed between people and staff were positive.
People told us that staff were kind and compassionate and the care they received was good. Comments included: “I’m very happy here, I’m well looked after”; “It’s lovely here, they’re all lovely”; “I am happy and content here, very comfortable”; "The compassion shown is excellent. The staff have really made an effort to get to know Mum and encourage her and it’s fantastic to see her joining in activities”.
The staff ensured people’s privacy and dignity were respected. We saw that bedroom doors were always kept closed when people were being supported with personal care.
People remarked that the food was good and there was plenty of it. One person said, “I can’t complain about the food, its fine”.
People could choose how to spend their day and they took part in activities in the home and the community. The home employed an activity organiser who engaged people in activities in small groups and individually during the day. They also took people out in the local community.People received visitors throughout the day and visitors told us they could visit at any time.
People’s needs were assessed and care plans were developed to identify what care and support people required.
People's health and well-being needs were well monitored. There were regular reviews of people’s health and staff responded promptly to any concerns. People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.
Staff received specific training to meet the needs of people and also received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.
Some people who used the service did not have the ability to make decisions about some aspects of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
We identified breaches of the relevant regulations in respect of safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.
Beechcroft Nursing and Residential Home is a single storey care home located in the Palacefields area of Runcorn close to local shops, pubs and the local church. The home provides accommodation for up to 67 people. It is divided into two units, a nursing unit and a residential unit. At the time of our inspection visit there were 55 people living in the home.
The last inspection took place on the 15 December 2014 and 2 February 2015 when Beechcroft Nursing and Residential Home was found to be meeting all the regulatory requirements looked at and which applied to this kind of home.
There was a registered manager who had been in post since April 2016. 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.
Before the inspection Halton Borough Council informed us that they had concerns about the service and that they had put the home on an improvement plan and suspended placements. This is the council’s usual practice that is designed to ensure improvements are made. They shared their concerns with us and informed us that they had been monitoring the home and had noted some improvement. The Care Quality Commission were fully involved in this process and attended meetings held in relation to these matters.
As a result of these concerns the provider had set up a project plan to improve the service, which included appointing a project manager to oversee the process and a turnaround manager to work with and support the registered manager. An on-going action plan was in place that was regularly updated until the issues were addressed.
Whilst many of the people spoken with told us that they were well cared for and they were happy in the home, we found that people could be at risk because there had been a lack of effective quality assurance in the home. The registered provider had a system for assessing and monitoring the quality of the service but this was not being used effectively so problems were not always identified or addressed in a timely manner.
Some people’s medicines that were time critical were not always administered on time and the recording of medicines required improvement.
Checks on safety of the premises had taken place but not all actions identified to improve the safety had been actioned.
Most staff were observed to be very caring and attentive to the people who lived in the home, but two staff were heard to refer to people who required assistance with feeding as ‘feeders’, which is disrespectful.
People received visitors throughout the day and we saw they were welcomed and included. Visitors told us they could visit at any time.
We could see that staff ensured people’s privacy. We saw that bedroom doors were always kept closed when people were being supported with personal care.
People told us that they enjoyed the food and could choose how to spend their day. The home employed an activity organiser who supported people to take part in activities either individually or in groups, which included going out to places of interest.
Staff received specific training to meet the needs of the people who lived at the home including safeguarding vulnerable people from abuse. All staff spoken with were confident that any allegations made would be fully investigated to ensure people who lived at the home were safe.
Some people who used the service did not have the ability to make decisions about some parts of their care and support. There were systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
We identified breaches of the relevant regulations in respect of safe care and treatment, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of the report.
We had previously carried out an unannounced comprehensive inspection on 15 December 2014 and 2 February 2015, when we found that the provider was meeting all the regulations that apply to this type of service.
This report only covers our findings in relation to staffing. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Beechcroft Nursing and Residential Home’ on our website at www.cqc.org.uk
The home had a registered manager. 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.
On the night of the inspection we found that people were generally settled and in bed asleep. Staff knew the people they were caring for well and worked as a team to deliver the care people needed.
Some improvements could be made around contingency planning for short notice staff absence and emergencies that require additional staff in the night. In addition we found that some staff were unable to take any break because there were no arrangements for cover.
We noted shortfalls in the standard of record keeping, which staff said was due a lack of time; instead of recording medicines and fluids given contemporaneously, they were recording them in retrospect which led to a risk that records were inaccurate.
Beechcroft is a single storey care home located in the Palacefields area of Runcorn close to local shops, pubs and the local church. The home provides accommodation for up to 67 people. It is divided into two units, Oak is a nursing unit and Ash is a residential unit. On the first day of our inspection visit there were 55 people living in the home.
The last inspection took place on the 22 November 2013 when Beechcroft Nursing and Residential Home was found to be meeting all the regulatory requirements looked at and which applied to this kind of home.
This inspection was unannounced and took place on the 15 December 2014. An arranged visit to complete the inspection was then undertaken on the 2 February 2015.
The home is required to have a registered manager. 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. The current registered manager is on sickness leave and on the first day of the inspection the deputy manager was in temporary charge of the home. A peripatetic manager employed by the provider was in day to day charge of the home on the second day of the inspection.
We were made aware of a safeguarding issue on the first day of the inspection and immediately afterwards a number of other safeguarding concerns were made directly to Halton Borough Council. These were dealt with by the council under their safeguarding procedures and the concerns were substantiated. The Care Quality Commission were fully involved in this process and attended meetings held in relation to these matters. The concerns only affected the nursing unit and a suspension of placements was imposed on this unit only. No concerns had been expressed regarding the residential unit.
The safeguarding issues have now been dealt with by the home and they have taken steps to avoid any re-occurrence. The suspension on placements has now been lifted. As part of this process the provider completed an on-going action plan that was continually updated until the immediate issues were addressed. As a consequence of this it was decided to keep the inspection process open and to undertake a second visit to assess the the actions taken. This is the reason why there is a time gap in-between the two inspection dates. The contracts monitoring team from Halton are monitoring the home. This is the council’s usual practice that is designed to ensure any improvements are sustained. The CQC are continuing to work with the council.
We found the home’s most recent action plan received on the 13 February demonstrated that all areas of concern had been addressed and continued improvements were being made. This improvement is reflected within the findings of this report. The peripatetic manager is still in post and will be for the immediate future or until the registered manager returns.
W e asked people if they felt safe and all of the people we spoke with said that they did feel safe in the home. Comments from the people using the service included, “I feel safe here with the staff, when I bath or shower and I feel my possessions are safe” and “Yes, I feel safe here, my personal possessions are safe even with the doors wide open, and they help me in and out of the bath and I feel quite safe then”. A family member told us that the locks on the patio doors had previously not been secure but that they had recently been replaced making her and her relative feel much safer. Another relative told us when asked, “Would I recommend it, Yes I would”.
We also asked the people living in Beechcroft about the home and the staff members working there. They all commented on how kind and caring all the staff were and that they were treated with respect.
We looked at the files for the three most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.
The provider used a computer ‘e’learning package called Touchstone for some of the training and staff were expected to undertake this when required. When we looked at the training records we saw that some staff had not completed all of the relevant training. This has now been addressed.
The care files we looked at throughout the two units contained relevant information regarding background history to ensure the staff had the information they needed to respect the person's preferred wishes, likes and dislikes.
A resident and relatives meeting had been held on the 21 January 2015. In order to gather feedback about the service being provided the peripatetic manager distributed feedback forms entitled, ‘what works, what doesn’t work’ during the meeting. The minutes written since explained that these would be available in the reception area for people to complete and post through the manager’s door.
We spoke to eleven people living at Beechcroft and six visitors during our visit. Comments from the people living in the home included; 'the staff are nice', 'staff are very helpful' and 'the staff are very good', 'the staff are very nice, I have a laugh and a joke with them' and 'I am fine, the staff are looking after me'. Comments from the family members we spoke with included; 'the home is very good, my relative is more relaxed and I am made to feel welcome'.
We saw that policies and procedures were in place to help ensure that people's medication was being managed appropriately and that they were being given their medicines as prescribed.
We looked at the records maintained and could see that staff had received mandatory training in areas such as safeguarding and moving and handling.
Information about the safety and quality of service provided was gathered on a continuous and ongoing basis from feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate.
We asked the people living at Beechcroft about the staff working there, comments included, 'Staff are fine', 'Staff are looking after me' and 'Staff are great.' Visiting relatives told us, 'I take my hat of to how they have looked after my [family member]' and 'The staff are very pleasant.'
Information about the safety and quality of service provided was gathered on a continuous and ongoing basis from feedback from the people who used the service and their representatives, including their relative's and friends, where appropriate. The manager 'walked the floor' on a daily basis to make sure everything was going well.