Bearwood House Residential Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People's risks were managed by staff to keep them safe. There were enough suitably trained staff available and people received their prescribed medicines as required. The service was clean and infection control processes were in place. However, people were not involved in the management of their risks and the processes in place did not always ensure people's risks and needs were up to date and accurately recorded. Improvements were need to staff recruitment processes to ensure suitable checks were completed when staff were employed.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People confirmed their risks were managed well. One person told us, “I get anything I need” another person told us, “The staff definitely look after me here.”

Staff confirmed they knew people well and knew how to manage and monitor any risks they had. Staff members told us they were informed of any change in people’s needs or where someone had deteriorated. Staff also confirmed the process they followed if they were concerned about someone or identified a new or change in their need. One staff member told us one person’s mobility fluctuated and sometimes they required support from two members of staff instead of one. Staff confirmed the person was involved in the level of support they required depending on their mobility.

People were able to move about the home freely and independently with use of equipment aids where required. Some monitoring was in place which was not always required, this meant where people had capacity and risks weren't identified, they weren't always involved to manage their risks. We provided feedback to the provider and they agreed that this needed to be improved.

People’s care records did not always demonstrate people’s involvement in their risk management. We found people’s care was not always person-centred as everyone had food, fluid and bowel monitoring charts in place. When raised the nominated individual and covering manager agreed to review people’s care and ensure monitoring charts were in place only where there was an identified need or risk. Senior carers were responsible for writing people’s care plans and we found where care plans informed staff of checks required, these did not always match the documents. For example, where repositioning was recorded in 1 person’s care plan as required two hourly, this was recorded on the repositioning chart as four hourly. The covering manager informed us there may have been alternative documentation for this, however, we did not see any. A senior carer we spoke with informed us that whilst they wrote people’s care plans, they did not have access to certain documents or paperwork to update or make changes depending on the person’s needs. This might have contributed to why paperwork appeared to be standardised rather than person-centred and did not always correspond to the monitoring requirements in the care plan. People’s care plans did not always provide enough information for staff to follow to support them safely. For example, we found where people were prescribed PRN for their bowel management, further information was required to inform staff once the initial direction had been taken and the person’s bowel had not been opened.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People confirmed there were enough staff and they looked after them well. One person told us, “The staff are brilliant.”

Staff confirmed they had the right training to meet people’s needs. One staff member told us, “I cannot fault the training, and if you want further training or support you can have it.” Another staff member told us, “You have to be trained before you start your role, we all have training regardless of what department we are in.” Staff we spoke with confirmed there were enough staff to support people and meet their needs. Staff felt they worked well as a team particularly in recent weeks since the registered manager has left. Staff members confirmed they had support from the covering manager and the Nominated Individual. One member of the domestic staff team told us, “The staff are attentive to the residents, I am always about and I see quite a lot, staff know how to respond to people’s needs.”

We observed staff, including agency members of staff, caring for people well and they appeared to know them and knew how to support them safely and to meet their needs. For example, we asked 1 person why they had the use of a piece of equipment, they were not aware of the reason, but the member of staff could explain why, and this was reflected in the person’s care records. There were suitable numbers of staff to meet people’s needs and these were deployed effectively.

The covering manager reviewed staff rotas to ensure suitable numbers and skill mix. Agency staff were being used to make up staffing numbers, these were, however, regular members of staff to ensure people’s care and support was consistent. The covering manager spent time with people and staff and observed and supported staff where required. Staff had regular supervisions; the covering manager informed us several members of staff had recently had a supervision with the operations manager and the covering manager planned to include supervision completion dates on the training matrix record, to have a clear view of when supervisions and appraisals were due. Staff training matrix demonstrated a wide variety of training modules suitable for staff roles including equality and diversity and Work in a person-centred way, despite the delivery of care not always demonstrating this training. Staff induction process was clearly recorded with training completion dates, shadowing and sign off. Staff DBS checks were also completed to ensure their suitability to work at the home. Staff files contained missing information within their recruitment checks prior to employment. For example, we found, not all previous job roles were detailed, and some reference requests were not obtained from the most recent employer. One staff member’s record did not contain an application form. When raised with the nominated individual they confirmed they would review staff records to ensure they contained the required recruitment checks.

People did not share any concerns around the cleanliness of the premises.

Staff felt they kept the home clean and tidy and worked together to ensure all areas of the home were clean. Staff confirmed they had access to PPE and confirmed the processes they followed to keep people safe. One staff member told us, “One resident had shingles a while back, she was isolated, staff wore all the PPE, all the things this person used was separated and their washing was done separately.” One staff member told us, “We have training around IPC, it is online training and included wearing of PPE. I think the premises and equipment is clean.” The covering manager confirmed the area manager had completed some audits, however, they could not access these at the time of the inspection. There was no reference to infection control on the audits completed and sent by the nominated individual.

We observed staff wearing PPE when supporting people. The home appeared clean and free from malodour. Following a local authority visit concerns with the malodours in the home were identified, action had been taken as we did not find this during our visit.

Staff followed effective infection prevention and control procedures to keep people safe. Designated staff were assigned to the cleaning of the premises and all staff supported with cleaning of some areas of the home and the equipment.

People did not raise any concerns in relation to their medicine management.

Staff confirmed senior members of staff were trained in to administer people’s medicines, staff members had no concerns with administering people’s medicines, and felt they had the right training.

People’s medicine administration records were completed to show where people had received their medication. We found, however, this was not recorded in people’s daily records in line with best practice. People’s medicines were stored securely and senior staff were trained to administer people’s medicines. We found the provider kept a file for antibiotics to treat infections which detailed the date it was ordered, however, there was no further information to explain why the antibiotics had been prescribed. The entries were recorded on a monthly document, and not by the person, this would make it difficult to identity individual trends.