Beck House

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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 were supported safely, in line with their risk assessments. Safeguarding concerns had not always been reported as required, although actions had been taken. Staff were recruited, inducted and trained to support people’s individual needs. People were supported in a safe, clean environment. Regular testing of equipment took place. Staff were trained in medicine administration. Medicine audits were not identifying where recording needed improvement.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us their loved ones were safe. A relative said, “100% [Name of person] is cared for physically, emotionally and safely.” Relatives were able to raise any concerns. A relative said, “Yes, I am able to raise anything. No concerns, if we need to say, we visit once or twice a week. Communication is excellent.”

Staff knew people’s individual support needs and how to keep them safe. Staff could explain how to report and record accident and incidents. Communication systems shared information with staff and safety updates were given.

Managers understood the duty of candour and were open and honest when things had gone wrong. Accidents and incidents were reported and recorded. The reporting of unexplained bruising needed to be more robust to ensure potential safeguarding concerns were identified.

Relatives told us people were admitted safely to the service. A relative said, “Yes, definitely.” Another relative said during the admission process, “We received great care and compassion from the staff.”

The registered manager and staff told us about the admission process and how this was flexible depending on people’s individual needs. A staff member said, “An assessment is completed. People come for a visit. Families are involved.”

We received feedback that behavioural incidents were not recorded in a way that helped to understand and manage the person’s behaviour more effectively. Following meetings with external partners improvements were being made in this area.

Systems were in place to support people being admitted to the home safely. This included a pre assessment process and care plans. Hospital passports supported people if a hospital admission was required.

People were not always fully protected from abuse as safeguarding concerns had not been reported as required. Concerns about one person had been raised and were being addressed through the local authority safeguarding process. Relatives told us people were safe and well looked after. One relative said when their loved one had a chest infection, “Staff had ensured [Name of person] was checked every 15 minutes while asleep.” Another family member said told us about the actions staff had taken when their relative had fallen, “Staff stayed [at the hospital] until I got there and stayed past their duty.”

Staff had received training in safeguarding and knew how to identify and report concerns. A staff member said, “I would record and report to a senior. If I felt something was not being listened to I would go higher up.” Staff gave examples of how they worked in line with the Mental Capacity Act, by offering choices and respecting people’s decisions.

We observed people being supported safely and in their preferred way. Interactions with staff were positive.

Safeguarding concerns had been reported to the local authority but not to the Care Quality Commission (CQC) as required. Actions had been taken when safeguarding concerns were raised however, improvements were needed to ensure these were clearly recorded. Mental capacity assessment (MCA) assessments were undertaken where appropriate. There were some good examples with detailed information. However, some best interest decisions had been made without the involvement of other staff, family or professionals. The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS) when appropriate and monitored these for expiry. Nobody had any conditions attached to their DoLS authorisation.

Relatives told us risks to people were managed and independence was promoted, “As much as possible.” People enjoyed activities and holidays which had been tailored to meet their needs.

Staff told us people were supported safely and independence was encouraged. A staff member said, “Clear risks management, without taking away rights to do anything.”

We observed people being supported safely and in line with their risk assessments. For example, when mobilising around the home, resting in their room or being supported to eat and drink.

Risk assessments were in place for people in areas such as skin integrity, accessing the community and personal care. Risk assessments were updated when people’s support needs change. Mitigation of flammable risks associated with some topical creams had not been assessed. This was addressed during the assessment.

People lived in a safe, well maintained and personalised environment. A relative told us when asked if the home was in good repair, “Yes definitely. [Name of person] recently moved to a different bedroom. I asked for pictures to be put up and it was done by the next week.”

Staff told us the home was well maintained. A staff member said, “There is a maintenance book where you record things [which need repair]. Things gets fixed promptly.” A staff member said, “We have fire drills regularly.”

The home was in good repair, well maintained and free from clutter. We observed people moving safely around the home with or without support.

Regular checks were completed in areas such as fire, water and electricity. Fire drills were completed with detailed reviews of what went well or further learning. Despite this, some staff we spoke with were not always confident on emergency procedures. The registered manager said this would be revisited. Personal emergency evacuation plans (PEEPs) were not available as they were being updated. These were sent after the site visit. Servicing of people’s wheelchairs was not monitored. This was actioned during the assessment.

Relatives told us people were well supported. A relative said, “Plenty of staff there.” Another relative said, “Staff are brilliant.” Relatives told us staff were well trained and knew people’s individualised needs and preferences. A relative said, “Staff cannot care for [Name of person] if they have not had the full training on how to lift them.”

Staff told us they had enough staff to support people safely. A staff member said, “We have enough staff.” Staff spoke positively about the induction process and said they had regular training. A staff member said, “All training is completed. I requested dementia training, which was really good.” Staff were well supported and had regular one to one supervisions with a line manager. A staff member said, “I have supervision every month. We can raise any concerns and there is time for conversations.”

We observed staff were responsive and attentive to people’s needs. Staff were observed to support people in line with their risk assessments and care plans.

The service operated safe recruitment processes to ensure staff employed were suitable for the role. This included full employment history and Disclosure and Barring Service (DBS) checks. Systems were in place to implement and monitor new staff induction, ongoing training and staff supervisions.

People were protected from the risk of infection. Safe laundry procedures were followed. A relative said, “Yes cleaners are marvelous, always going round with trolleys when we are there.” Relatives all told us they had seen staff wearing personal protective equipment (PPE) when required.

Staff knew where PPE was stored. A staff member said, “The home is always clean and tidy.”

The home was clean, orderly, with no malodours. We observed domestic staff systematically cleaning rooms and communal areas. We observed staff wearing PPE as appropriate. Work was being undertaken to address malodours in one specific room.

Cleaning schedules were in place which demonstrated when different areas of the home were cleaned.

People received their medicine by trained staff. A relative said, “[Name of person] has medicines twice daily, 8am and 8pm, always done by a senior.” However, records around topical medicines and how errors were identified needed improvement to ensure people received their medicines as prescribed.

Staff told us they had completed medicines training and their competency was monitored by managers. Staff knew where information was held on as required medicines. Staff told us they knew processes to follow if a medicine had not been given. For example, by contacting 111 for advice. The registered manager acknowledged areas found in the assessment and said these would be addressed.

Medicine administration systems were operated. Temperature of storage areas were monitored. Protocols for as required medicines were in place. The quality of this information varied. When medicine stock was recorded on the medicine administration record (MAR) two staff signatures were not present. Some gaps on MARs were found which had not been identified by the daily check system in place. Therefore, appropriate actions had not been taken. Records for topical creams did not contain full prescribing information. Records showed people were not receiving topical creams at the required frequency. Medicine audits required review and development to ensure all areas of medicines management was included in checks conducted as these had not identified the shortfalls we found.