Beachview

About the service

Beachview is a residential care home registered to provide care for up to 10 young people.. It provides support to people who have a range of learning disabilities, some of whom also have a physical disability. At the time of our visit there were 9 people living at the service

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

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support.

Right Support

People’s support needs and risks associated with their care were not always appropriately managed to ensure safe care could be provided. The provider did not have effective systems in place to protect people from avoidable harm. When people expressed choices, these were not always respected due to the deployment of staff. Staffing levels prevented people from getting up when they wanted to.

Right Care

Systems and processes were not always effective in ensuring people were protected from the risk of abuse and staffing was not always provided in line with people’s needs. The service did not have enough staff to meet people’s needs and keep them safe.

People were given their medicines in a way that met their individual needs. However, record keeping was not consistent, nor were we assured that medicines were always administered as the prescriber intended. There were systems and processes in place for the safe storage of medicines. However, these processes were not always followed. We have made recommendations regarding management of medicines.

Right culture

The service did not have a registered manager. The area manager was overseeing the running of the service. Staff told us there was a lack of leadership. Staff and relatives expressed concern regarding the high turnover of managers. Staff spoke of a blame culture at the service and did not feel confident concerns raised were dealt with.

Care was not always person centred and people were not empowered to influence the care and support they received. The service was not using governance processes effectively to learn lessons or improve the service. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

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

Rating at last inspection

The last rating for this service was requires improvement (published 13 October 2022).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

We received concerns in relation to medicines, the management of people’s food, the accuracy of record keeping, staffing numbers, staff culture, leadership and oversight of practices. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

We looked at infection prevention and control measures under the safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to safe care, the management of the service and governance at this inspection. We have identified a new breach in relation to staff deployment.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beachview on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Beachview is a residential care home for 10 young people, at the time of our visit there were 9 people living at the service. It provides support to people who have a range of learning disabilities, some of whom also have a physical disability.

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

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support.

Right Support

The service did not support people to have the maximum independence or have control over their own lives. We found record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA). It was unclear if conditions related to Deprivation of Liberty Safeguards (DoLS) authorisations were being met as there was inconsistency in recording. People did not always have the support they needed to meet their needs and keep them safe. This increased the risks to people's health and wellbeing.

Right Care

People's care, treatment and support plans did not always promote their wellbeing and enjoyment of life. Care was not focused on supporting people’s aspirations. Staff were not always able to evidence people’s level of participation in activities, how often outings took place and whether all the people at the service were included. People who were distressed or expressing emotional distress did not have proactive behaviour strategies in their care records. This meant they did not provide detail on the specific actions staff should take to ensure practices were reflective of a person's best interests.

Right culture

The service did not have a registered manager. The registered manager from one of the provider’s other services was overseeing the management of the service with the support of an area manager. Staff told us there was a lack of leadership and staff did not always cooperate with each other. Relatives expressed confusion regarding the management of the service.

The area manager, acting manager and staff were not always completely open and transparent during the inspection. Although they did recognise that further improvements were needed at the service and showed a willingness to listen and improve, they felt the issues identified were due to the previous manager, disgruntled staff and ex-staff members.

Following the inspection, the provider told us a new manager has now been recruited and is due to take up the post in the next week.

Care was not always person centred and people were not empowered to influence the care and support they received. We saw that whilst some people interacted with each other and staff, other people received little or no interaction for long periods of time. The systems for reporting were not robust. For example, incident reports and records used to record people's emotional responses to situations were not consistently completed. There was no evidence the provider had taken any action to mitigate future occurrences. The lack of reporting to relevant agencies led to a lack of external oversight and promoted a closed culture. The provider's governance systems were not effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

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

Rating at last inspection

The last rating for this service was good (published 08 November 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

We received concerns in relation to the culture at the service, staffing numbers, inexperienced staff, a lack of management and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

We looked at infection prevention and control measures under the safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of the service, safe care, record keeping and governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beachview on our website at www.cqc.org.uk.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection we rated the service good. At the inspection we found that the provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The provider had failed to act in line with their legal responsibilities and had failed to notify the Commission of authorisations under the Deprivation of Liberty Safeguards (DoLS). Following the inspection we received appropriate notifications and the provider had met this regulation.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service met all relevant fundamental standards.

The service had a positive culture that was person-centred, open and inclusive. There was a strong emphasis on putting people first. People were involved in the service within their capabilities. People assisted with meal preparation with staff support. Everyone spoke highly regarding the staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

It is a requirement of the provider's registration that they have 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. The service had a manager in place who had started the process to become registered with us. The service was well led. The manager was aware of their legal responsibilities.

Staff were enthusiastic and keen to talk about their role. Staff were proud of the service and their work. They felt supported within their roles and held the manager in high regard. Recruitment practices were robust and staff received training appropriate to their role and the needs of the people living at the service. People were supported to maintain contact with their relatives.

People had comprehensive plans of care and risk assessments. Care was individualised and person centred. Medicines were managed safely and in people’s best interests.

Further information is in the detailed findings below.

Beachview is a residential care home that provides support for up to 10 people with a physical and/or learning disability and diagnosis of autism. At the time of our inspection there were six people living at the service. They had a range of complex care needs associated with autism and communication.

Beachview is a detached house that has also been adapted to cater for people with a physical disability and has wheelchair access throughout. All bedrooms are for single occupancy. All rooms have en-suite wet room facilities and, in addition, there are two communal bathrooms with bathing facilities. There is a large communal living and dining area and a separate sensory room. A lift provides easy access between floors.

The service did not have a registered manager in post at the time of our visit. 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. Beachview has not had a registered manager in post since August 2016. The area manager was managing the service day to day.

The area manager had identified the need to improve the standard and personalisation of care planning within the service. For example, whilst we found that people received appropriate care, this was not always reflected in the care plans, which contained unclear information and guidance to staff. The management team had plans to develop the care plans and to transfer the care plans to a new electronic system from January 2017 to ensure they were comprehensive and up to date.

The provider had failed to notify the Commission of Deprivation of Liberty Safeguards (DoLS) authorisations in accordance with the registration regulations.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People told us they felt safe at the home.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Accidents and incidents were accurately recorded and were assessed to identify patterns and triggers. Records were detailed and referred to actions taken following accidents and incidents. Reference was made to behaviours, observations and other issues that may have led to an accident or incident.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.

Staffing numbers were adequate to meet the needs of people living at the home. The provider used a dependency tool to determine staff allocation. This information was reviewed following incidents where new behaviours were observed which might increase or change people's dependency level.

Safe staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The staff had a good understanding of their responsibilities in relation to MCA and DoLS. Staff sought people's consent about arrangements for their care.

Staff were skilled in working with people who lived with autism. Training included autism awareness, communication and supporting challenging behaviours. Due to a lack of consistent management, we saw that some staff had only received one support and supervision in the last 12 months. However, the staff told us they felt they supported each other well and found the provider approachable and supportive.

Food was produced using fresh ingredients, to a high standard and offered good choice. People could choose to eat in the dining room or other areas of the home. Drinks were provided at regular intervals and on request.

People had access to healthcare professionals when required. This included GPs, dentists, opticians and psychiatrists.

Staff were caring, knew people well, and treated people in a dignified and respectful way. Staff acknowledged people's privacy and had developed positive working relationships with people.

People were supported to attend a range of activities based on their individual needs and wishes. Relatives told us they could visit when they wanted and that there were good communication links with the home.

Staff listened and acted on what people said and there were opportunities for people to contribute to how the service was organised. People knew how to raise any concerns.

The views of people, relatives, health and social care professionals were sought as part of the quality assurance process.

Quality assurance systems were in place to regularly review and improve the quality of the service that was provided.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

As part of this inspection we spoke with three people who use the service, the registered manager and three care staff. We also reviewed records relating to the management of the home which included five care plans, one incident report, staff rotas and records, maintaince records and audits.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place such as feedback sessions, meetings and evaluation to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there had been a recent assessment and implementation of this safeguard. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded against unlawful restriction of their activities.

Is the service responsive?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw evidence of the use of the Speech and Language Therapist (SALT) to help staff prepare specialist textured diet for a person who had difficulty in swallowing.

People's needs were taken into account as the layout of the service enabled people to move around freely and safely. There were ramps for wheelchair users. The premises had been sensitively adapted to meet the needs of people with physical impairments. We saw ceiling hoists and specialist beds to support people's mobility needs. Staff demonstrated how to use them this ensured people were moved safely.

Is the service caring?

People were treated with respect and dignity by the staff.

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person used an electronic notepad to communicate with staff. We saw staff taking time while they completed their communications.

Is the service effective?

People attended schools and clubs and completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community. People from other homes within the provider joined those at Beachview for special events and celebrations.

The service worked well with schools, clubs and health care professionals such as physiotherapists and dieticians to ensure people received their care in a joined up way. Care plans showed the involvement of other agencies, therefore care was up to date and any problems could be identified quickly.

Is the service well led?

The service had a quality assurance system. We saw records that confirmed the daily staff skill mix to ensure there were sufficient numbers of trained and skilled staff on duty. We also saw the home's maintenance audits, to show that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

We were not able to speak with some of the people who lived at the service due to their complex needs and learning disabilities. Instead we spent time observing the interactions between staff and people. We found this interaction to be positive and friendly. Staff spent time with people engaging in activities and providing reassurance and support. We found that people's care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area.

People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered.

Everyone that we spoke with told us that they could approach the staff and management if they were unhappy or had issues to discuss.

People also told us that they were happy with the environment that they lived in. However, we found that the provider had not taken sufficient steps to ensure the building was maintained to an acceptable standard.