Archived: Beauchamp House Nursing Home

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Responsive and Well led to at least good.

The provider wrote to us in July 2017 and told us how they would achieve compliance with the regulations. At this inspection we found that improvements had been made in all areas and there was a commitment to on-going improvements.

Beauchamp House Nursing Home 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.

Beauchamp House Nursing Home provides residential and nursing care for up to a maximum 54 people. At the time of our inspection, 43 people were living at the service. The service specialises in caring for older people including those with physical disabilities, people living with a mild dementia or those who require end of life care.

Within the grounds of Beauchamp House Nursing Home there are thirteen sheltered housing units where people can live independently or access personal care. At the time of our inspection, nobody living within these houses was receiving personal care from the staff at the service.

There was a manager in post who was going through the process of applying to be the 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.

People and their relatives spoke highly of the manager and the improvements that had been made since they had been in post. One person told us, “The lovely new matron [manager] has made a difference.”

Staffing levels and the deployment of staff had improved. There were systems in place to ensure suitable staff were recruited. Improvements had been made to the management of medicines; medicines were stored and administered safely.

People felt safe with the staff supporting them. People were supported by staff who knew how to recognise and report abuse. Risks to people were identified and risk management plans were in place. Measures were in place to prevent the risk of the spread of infection. There were systems in place to record and review any accidents or incidents that occurred.

People were supported to receive a diet that met their needs, and their nutritional needs were met. There were a range of choices and options on the menu and our observations of the dining experience was positive.

People received effective care from staff who had the skills and knowledge to meet their needs. Although some staff had not received supervision in line with the providers policy, staff spoken with felt supported by their managers.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People’s rights were protected because the correct procedures were followed where people lacked capacity to make specific decisions for themselves.

People were supported by staff who were kind and caring. Staff spoke positively about people; they demonstrated empathy and were able to tell us about people’s likes, dislikes and what was important to them.

People received care that was responsive to their needs and personalised to their wishes and preferences. Some of the care plans had not been updated following a change in people’s needs; this did not impact on the care people received.

People had access to a range of organised activities and events which provided them with mental and social stimulation. There were links with the local community and the manager was looking at ways to increase these.

People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained.

There were procedures in place to manage complaints. Where complaints had been raised these were responded to and action was taken where required. The manager and provider treated complaints as an opportunity to learn and improve.

The provider had systems in place to monitor the quality of the service, seek people’s views and make on-going improvements.

Beauchamp House Nursing Home provides residential and nursing care for up to a maximum 54 people. At the time of our inspection, 51 people were living at the service. The service specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

Within the grounds of Beauchamp House Nursing Home there are thirteen sheltered housing units where people can live independently or access personal care. At the time of our inspection, nobody living within these houses was receiving personal care from the staff at the service.

There was 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.

During this inspection, we found that people were not always fully protected against the risks associated with medicines. Although people told us they received their medicines on time, people were exposed to risk of not receiving their prescribed medicines as stock balances were not always effectively maintained or monitored. This had not been identified by current governance systems.

People, their relatives and staff commented less positively about the staffing levels at the service and staff told us that people did not always receive quality, person centred care. In addition, during a review of care records, we found a small number of examples of where risk management guidance was not fully completed.

People at the service told us that activities did not meet their needs and relatives we spoke with said the same. Staff told us they felt the current activity provision was poor. We have made a recommendation in relation to activity provision. One person told us they were not told of meetings they wished to attend and relatives told us the provider was not always responsive following the meetings. People, relatives and staff gave mixed feedback on the management and leadership of the service.

People at the service told us they felt safe with the staff that supported them. Staff understood how to safeguard people and recruitment procedures were safe. Incidents and accidents were reviewed. The service was clean and the environment and equipment was maintained.

The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We saw examples of how the service had involved people and their representatives in decision making processes.

People said they received effective care. Staff had received training, supervision and appraisal from the service management. There was an induction aligned to the Care Certificate and staff told us the induction was good. People were supported when needed to eat and drink. Where required, additional healthcare professionals were consulted.

People said that staff were caring. The service had received compliments to this effect and relatives we spoke with commented highly on the staff. People’s privacy and dignity was respected and through our observations we saw people and staff had good relationships. Staff understood the needs of the people they supported and people’s visitors were welcomed. The service was accredited by the Gold Standards Framework (GSF) for providing a high standard of end of life care.

People commented that staff were generally responsive but did tell us they had to wait at times to receive care. A pre-admission process was followed to ensure the service could be responsive to people’s needs. Care records were personalised. There were systems to communicate people’s care and treatment needs between staff. The provider had a complaints procedure. The service had also received positive testimonials from external professionals that were forwarded to us following the inspection. The service received support from the provider and there were some effective governance systems in operation.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. Family members and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management and that they had received regular training.

We looked at the cleanliness and infection control and medicine procedures and found that the provider had adequate systems in place to ensure the safety of the people who used the service regarding the control of substances hazardous to health and the administration of medicines.

Everyone who spoke to us was very positive about the care they had received at the home. We were told by many people that they were "well looked after". One person said "This is a wonderful place. I have been here two years. We don't know how lucky we are.'

There is a thorough system of recorded assessment and monitoring of the service by the provider and the home manager. The home manager's report gave us information about the areas of the home that were reviewed and the actions that were taken to maintain good standards of care.