Archived: Beech Haven Residential Care Home

Beech Haven Residential Care Home is a care home for up to 30 older people. The home is owned and managed by a partnership, which is a family business. At the time of the inspection 25 people were living at the service and one more person was moving into the home on the day of the visit.

People’s experience of using this service and what we found

People were happy living at the home and felt well supported. Some people expressed dissatisfaction with the quality of the food but were otherwise happy. They said the staff were kind and caring, and we saw that the staff interacted well with people, were polite and considerate.

At the previous inspection, we had found problems with the way medicines were managed. These had mostly been addressed and people received their medicines as prescribed. However, further improvements were needed with some records and storage.

The staff felt well supported and had the training and information they needed. The provider carried out checks on their suitability before they started work and assessed their competencies, met with them and gave them guidance about their role and responsibilities.

People were cared for in a way which met their needs and reflected their choices. They were able to make decisions about their lives. They had access to healthcare services and took part in a range of activities.

The service was owned and managed by a family who were involved in the day to day operations. At least one manager was present at the service each day, and people using the service, visitors and staff felt able to speak with them, ask for advice or raise concerns.

There were effective systems for monitoring quality, investigating complaints, incidents and accidents and making improvements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The rating at the last inspection was requires improvement (23 October 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection of the service was on 18 October 2016, when we rated the service good.

At this inspection on 11 September 2018 we rated the service requires improvement overall and for the questions, 'Is the service safe?' and 'Is the service well-led?' We have rated the key questions, 'Is the service effective?', 'Is the service caring?' and 'Is the service responsive?' as good.

Beech Haven Residential Care Home is a care home for up to 30 older people. 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. At the time of our inspection 29 people were living at the service.

The service is owned and managed by a partnership and a family run business. There are four members of the same family who work together to manage the service. One of the partners is also 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 and associated Regulations about how the service is run.

Medicines were not always being safely managed and some of the risks to the health and wellbeing of people who lived at the service had not been mitigated.

The systems for recruiting new staff were not always effective because they did not include thorough checks on their suitability to work with vulnerable people.

Whilst the provider had systems for monitoring the quality of the service, these had failed to identify the risks relating to medicines and health and safety.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, fit and proper persons employed and good governance.

You can see what action we have told the provider to take at the back of this report.

Following our feedback at the end of the inspection visit, the provider made improvements in all areas where we had identified concerns. They sent us information about these improvements.

People living at the service and their relatives were happy there. They felt their needs were being met and they found the staff kind, caring and compassionate. We observed that interactions between staff and people living at the service were caring and demonstrated affection.

The staff felt well supported and had the training they needed to carry out their roles and responsibilities. The staff enjoyed working at the service and appeared confident and knowledgeable about the people who they were caring for.

The atmosphere and culture at the service were reflective of a family run business. The owners and their family were involved in the day to day running of the service and were well known, liked and respected by people who lived there, staff and visitors. People felt reassured that the owners were available whenever they needed. They felt that their concerns were addressed and were happy to raise these with one of the owners.

There had been improvements to some areas of the building, with refurbishment of communal rooms and bedrooms. Further improvements were planned. The home was accessible for people with mobility needs and people were able to access communal rooms, the garden and their bedrooms without restrictions. The home was generally clean, although some areas needed deep cleaning or redecoration. The provider had a plan to address these areas.

People had enough to eat and drink, and most people liked the food.

People's needs were assessed, planned for and being met. These needs were recorded in care plans, which they had been involved in creating. The staff monitored their wellbeing and responded appropriately to changes in their health, wellbeing and following an accident. There were assessments designed to guide the staff on how to minimise risks associated with each person's needs. These had been regularly reviewed and updated.

The provider had systems for monitoring the service and learning from when things went wrong. They had regular management meetings where they discussed service development. These included reflecting on feedback from other agencies, such as visits from the local authority. There was evidence that they planned further improvements to the service.

The inspection took place on 18 October 2016 and was unannounced.

The last inspection took place on 10 and 16 November 2015 when we found breaches of three Regulations relating to safe care and treatment, notifications of significant events and injuries, record keeping and quality monitoring. At the inspection of 18 October 2016 we found these breaches had been met.

Beech Haven Residential Care Home is a care home for up to 30 older people. There were 21 people living at the home at the time of our inspection. The majority of people funded their own care. The service is a family-run business with the owners also overseeing the day-to-day management of the home. One of the owners is the registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they liked living at the service. One person said, “The place is clean and tidy. People are pleasant. The staff are pretty decent and obliging.” Another person told us, “If I wasn’t happy here I would have gone before.” One relative commented, “I am happy with my [relative's] care. It took him a while to settle in. He’s not forced to join in anything. He’s made a couple of friends here.” Another relative told us, “There’s no perfect place but I cannot fault it here. There is nothing I would change.

People found the staff kind and caring. They felt their needs were being met. They looked well cared for and records showed that people had regular showers or baths and were able to see the doctor or other healthcare professionals when needed. People liked the food. Their weight was monitored. There was a variety of activities provided, although people did not always have opportunities to pursue their individual interests or hobbies.

There had been improvements to the cleanliness and safety of the environment. The provider was planning further improvements to the building. Some repairs and refurbishment were needed, and the provider had not completed the requirements of the fire safety officer at the time of our inspection, although they were in the process of completing these. In addition some areas of the building had an unpleasant odour which could not be removed by cleaning and the provider felt that replacement of carpets in these areas was needed.

The staff told us they felt supported. They worked well together and were polite and caring towards the people who they cared for. They told us they were happy working at the home. The family who owned the service worked alongside the staff, supporting people each day and they were available on call at any time. People who lived at the service, their visitors and the staff told us they liked this and felt they could ask for help whenever they needed.

The provider had improved the records used at the service and we found these were accurate and up to date. People received their medicines in a safe way. People told us they felt safe and accidents at the service were rare. The provider had some systems for monitoring the quality of the service, but only minimal recorded audits because they were at the service each day. The provider had worked hard to improve different aspects of the service over the last two years.

The inspection took place on 10 and 16 November 2015 and was unannounced.

The last inspection took place on 28 April 2015 when we rated the service requires improvement and made seven breaches of Regulation.

At this inspection we found there had been improvements to the service and the provider was able to demonstrate plans for further improvements. However, the improvements at the time of the inspection were not sufficient and the provider was in still in breach of some of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Beech Haven Residential Care Home is a care home for up to 30 older people. There were 30 people living at the home at the time of our inspection. The majority of people funded their own care. The service is a family-run business with the owners also overseeing the day-to-day management of the home. One of the owners is the registered manager. 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 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 not always assessed and mitigated the risks of unsafe premise and equipment. Areas of the environment were not clean and the provider had not taken steps to control the spread of infections.

Some people had been asked to consent to their care and treatment. However, relatives and other representatives made decisions about care and treatment on behalf of other people. Although these decisions may have been made in the person’s best interest, the provider had not assessed people’s capacity to make sure they were unable to consent themselves.

The staff felt supported to do their jobs. They received training but some of this required updating.

The provider had not always identified the risks to people’s safety and wellbeing.

Records of people’s care were not always accurate or complete.

The provider had not notified the Care Quality Commission of significant events which had occurred at the service.

People’s medicines were managed in a safe way.

The provider had procedures to safeguard people and the staff were aware of these.

There were enough staff employed to keep people safe and meet their needs.

People’s health needs were met.

People’s nutritional needs were met.

People felt the staff were kind, caring and polite.

People’s privacy and dignity were respected.

People’s care needs had been assessed and there were care plans telling the staff how to meet these needs. The providers and the staff had a good knowledge and understanding about people’s needs.

The provider had improved organised activities so there were more things for people to do. However, further improvements would make sure people’s social and emotional needs were always met.

People felt confident making a complaint and told us these were acted on and responded to.

The provider had improved systems for monitoring the quality of the service.

People felt there was an open and positive culture.

You can see what action we told the provider to take at the back of the full version of the report.

We also found that people were not always receiving the care and treatment to meet their individual needs. We also found the environment was not well maintained or clean and this put people living at the home at risk.

We spoke with 11 people living at the home, five relatives of people who lived at the home, one visiting health care professional and six members of staff. Most people told us they were happy and well cared for. Some of the things people said were, ''This is a happy home'' and ''there is a calm atmosphere''. The staff told us they felt well supported.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess how the provider was managing medicines in response to the action we were taking following a recent inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

During this inspection a pharmacist inspector looked at storage of medicines, at record keeping, observed medicines given at lunchtime to four people and spoke to two people one of whom was monitoring their own blood glucose and insulin requirements.

From our observations and inspection of supplies and records we saw that medicines were being given as prescribed. However we identified several poor practices and poor record keeping which could lead to the risk of error and harm in giving medicines safely.

The people whom we talked to said that care workers looked after them well and always brought their medicines on time. One said they were in pain and we saw that the care worker was giving regular pain relief and they were also under the care of a hospital consultant.

Another person told that they always monitored their own blood glucose and self injected their insulin. We saw that care workers monitored this person and duplicated records and brought the correct insulin for this person to take. The person told us of their concerns when their blood glucose became too high and they said they worked out the reason and took action which included speaking to the diabetic specialist nurse at their GP practice for advice.

Our inspection on 11 and 22 July found that the provider was not maintaining appropriate records and we asked them to make improvements in this area so people were protected against the risks associated with inaccurate and unsuitable records. When we visited on the 20 March 2014 we found that the provider had not made the required improvements. This meant that people continued to be at risk of receiving inappropriate and unsafe care and treatment because appropriate and accurate records were not being maintained.

The provider has introduced a system to assess and monitor the quality of the service.

We found improvements in the training and supervision of staff and records were available to evidence when training, supervision sessions and staff meetings took place. Although several staff had been registered for NVQ training in health and social care, this had not commenced and further action was needed to address this.

During this inspection we reviewed the progress the provider had made to meet essential standards in management of medicines and supporting workers. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The provider had arranged for a medication cabinet to be securely fitted and medicines' were being stored safely.

Our evidence showed that people were not being cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We also found that the provider did not have effective systems to assess and monitor the quality of service provision and maintaining records.

On this visit (12 April 2013) we found that the provider was working towards compliance. We will visit the service again before the end of July 2013 to confirm staff have completed mandatory training and arrangements have been made for the safe storage of medication.

We spoke with three people who use the service who indicated they were comfortable at the home. People said "I can follow my own interests", "I am comfortable and my family are involved" and "the staff are very pleasant". During our inspection we observed people who live in the home and staff talking in a relaxed and informal manner.

However, we identified that people were put at risk due to the lack of appropriate storage facilities for medicines held at the service, and where staff had not received up-to-date training in areas relevant to supporting people.