Archived: Beech Hurst

A registered manager was 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.

Healthcare was accessible for people and appointments were made for regular check-ups as needed. However, we identified issues in relation to the systems of recording and communication between staff and other services. We saw two examples of how people’s changing healthcare needs were not due to poor communication and recording between staff and other services.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. There were visits from local churches, so that people could observe their faith. People were also encouraged to stay in touch with their families and receive visitors. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the care of people living with dementia.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager was always available to discuss suggestions and address problems or concerns.

We found one breach 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.

A registered manager was 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 and associated Regulations about how the service is run.

Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. However, risks associated with the environment and equipment had been identified, but not routinely managed.

People’s independence was not routinely promoted and their dignity was not always respected. Procedures in relation to infection control were not robust.

There were some arrangements in place to meet people’s social and recreational needs. However, activities were not routinely organised in line with people’s personal preferences.

People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly.

We saw that information had not always been updated in people’s care plans to guide staff on how to deliver care.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met their individual needs.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standard (AIS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s end of life care was discussed and planned and their wishes had been respected.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people at the end of their life. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged to express their views. They also said they felt listened to and any concerns or issues they raised were addressed. People were also encouraged to stay in touch with their families and receive visitors. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

We found three 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 undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made in most of the required areas. However, further improvements were needed in relation to the provision of meaningful activities and the mealtime experience.

We have made a recommendation about the provision of meaningful activities.

The overall rating for Beech Hurst remains as requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been made and sustained.

Beech Hurst is located in Haywards Heath, West Sussex. It is registered to support a maximum of 60 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia, some of whom had mental health issues, or a learning disability and those who had complex health needs and required end of life care. The service is divided into three separate units and set over two floors. On the day of our inspection, there were 46 people living at the service.

A registered manager was not 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 and associated Regulations about how the service is run. The registered manager had left the service approximately four months previously, and day to day management of the service was carried out by an interim manager and deputy manager.

At the last inspection on 16 and 17 June 2015 we identified areas of practice that needed improvement. This was because we found the provision of meaningful activities for people were not consistently based on their assessed need and personalised to them. This was specifically significant for people living in the Seaford Unit of the service. Some improvements had been made. The service had arrangements for people to take part in activities. However further work was required to ensure that everybody at the service had access to meaningful activities.

People were encouraged and supported to eat and drink well, and their hydration and nutritional needs were met. However, improvement was required to the mealtime experience for people in some parts of the service.

There was a varied daily choice of meals and people were complimentary about the food and drink. They were involved in making their own decisions about the food they ate. Special diets were catered for, such as pureed and fortified. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us,“I am always safe. They wheel me and my wife about in our special chairs with wheels”. Another person added, “I would tell the carer if I wasn’t safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, which included wound care, catheter training and palliative care (end of life). Staff spoke highly of the opportunities for training. One member of staff told us, “I’m up for all training if it helps with my role”. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. A relative said, “They are so caring, they really get what it means to care for the individual”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible. People were also encouraged to stay in touch with their families and to receive visitors.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person told us, “I have never had a reason to complain, but if I did, I would speak to the nurse”.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

People who lived at the service had a wide range of assessed needs including some people who had complex dementia and mental health needs and other people who required general nursing and end of life care. People consistently spoke positively about their care, one person told us “Wonderful care here I could not wish for better”.

We saw people actively seeking out staff interactions, which staff responded to positively. We saw many people displaying positive body language during our inspection which included people smiling, making eye contact with staff and affectionately touching staff. Relatives told us “It is fantastic here the improvement she has made is remarkable” and “We were so grateful that mum could stay here, she is slowly coming back to us they have worked wonders with her.”

Observation of the daily routines and discussion with people confirmed that staff accommodated people’s personal wishes with regard to meal times, going to bed, rising and bathing.

People told us that they felt respected by staff. One person told us how they were supported to improve their independence in readiness for returning home, this included regular physiotherapy support. Another person told us “That the staff encouraged me to do as much for myself as possible.”

People’s health care needs were being met. People and relatives consistently told us that the staff always sought prompt medical advice and assistance. A person described how their health had recently deteriorated and that staff liaised with their GP on their behalf and how promptly and efficiently this had been done.

People consistently told us that they felt safe living at Beech Hurst. A relative told us how they had peace of mind as they had much confidence in the staff that their relative was safe from harm and abuse. People and their relatives told us that they felt confident to raise any concerns they had with staff and felt that this would be dealt with promptly

All people we consulted with spoke positively about staff,, their comments included: “They are all delightful here “ A group of visitors told us how welcomed they had been made to feel when visiting their friend and how helpful and kind staff had been.

People, relatives and visitors all told us they felt confident to raise any concerns they had. One person told us how they had raised an issued directly to the manager and how promptly this had been addressed.

We found that care records were up to date and contained detailed information on how to meet people's needs. However, we observed that staff did not always carry out care as stated in the care plan. We observed some people were involved in activities and engaged with staff. We also saw that some people were left alone for long periods of time while staff carried out other care duties.

We looked at the procedures for managing medicines. We found that there were some errors in how medication was handled and recorded. This meant that people were at risk of receiving the wrong medication.

Most staff told us that they felt well supported and got the training they needed to carry out their roles effectively. One member of staff said they thought the team was good and worked well together. Another member of staff commented "Some practices are out of date" and described it as "Institutional".

There were robust procedures in place to monitor quality assurance. We noted that the provider was aware of the areas of non-compliance highlighted in this report and was taking steps to make sure improvements were made.