Becket House Nursing Home

Becket House Nursing Home provides nursing and residential care for older people, some of who may be living with dementia. The home can accommodate up to 23 people in one large adapted building. At the time of our visit there were 18 people using the service.

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

People were safely cared for. Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs. There were sufficient numbers of staff who had been safely recruited to meet people's needs.

Medicines were managed safely, and infection control measures were robustly followed. During the COVID-19 pandemic safe visiting processes were in place to support people to maintain relationships with friends and relatives.

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.

The service was well managed. People, relatives and staff were very positive about the leadership of the service and praised the registered manager highly. There were systems in place to monitor the quality of the service and actions were taken, and improvements were made when required. Staff felt well supported and said the registered manager was open and approachable. The service worked in partnership with outside agencies.

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 last rating for this service was Requires Improvement (report published 04 September 2019) and there was one breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities). 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

We carried out an unannounced comprehensive inspection of this service on 22 July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requirement Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Becket House Nursing Home 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.

Becket House Nursing Home provides nursing and residential care for up to 23 older people, some of who may be living with dementia. At the time of our visit there were 20 people using the service.

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

There were insufficient numbers of staff to fully meet people's needs. Improvements were needed to ensure people were supported to engage in meaningful activities and were provided with sufficient stimulation to meet their needs and wishes.

The provider had systems in place to monitor the quality of the service. Although these were completed regularly there was no evidence of the actions taken when improvements were required.

Some improvements were required to the environment. We found that many people’s rooms were very cluttered with large boxes of incontinent pads and we saw a staff members bicycle parked in a persons en-suite shower room.

People’s communication needs, although identified had not been fully met, for example, there was a lack of information in different formats to meet their communication needs.

People received safe care and were protected against avoidable harm, neglect and discrimination. However, one person raised concerns about another person wandering into their room when we asked them if they felt safe. Risks to people’s safety were assessed and strategies were put in place to reduce the risks. Staff were appropriately recruited to ensure people were suitable to work at the service.

Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People’s basic needs were assessed before they received a care package. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

People were supported to maintain good nutrition and hydration. However, people were not aware of what was on the menu until their meal was provided. One person told us “You get one choice. We only know what we are having when we get it.” Staff supported people to live healthier lives and access healthcare services when required.

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.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

Care plans supported staff to provide personalised care. There was a complaints procedure in place and systems in place to deal with complaints effectively. The service provided appropriate end of life care to people.

The service worked in partnership with outside agencies. The registered manager ensured there were systems in place to ensure compliance with duty of candour. The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.

The last rating for this service was Good: The last report was published on 20 January 2017.

Following this inspection, the service met the characteristics for a rating of Requires improvement" in four key questions when we inspected. Therefore, our overall rating for the service after this inspection was ‘Requires improvement’.

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

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Staffing. Details of the action we have asked the provider to take can be found at the end of this report. We have made a recommendation about Good Governance and The Accessible Standard.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

Becket House nursing home provides accommodation and support for people who require nursing and personal care and may have a range of social, physical and dementia care needs.

At the time of our inspection the provider confirmed they were providing support to 21 people.

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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse. Staff were comfortable in raising concerns and felt that appropriate actions would always be taken.

People had risk assessments in place to enable to make sure that they were as safe as possible. Staff were confident that the risk assessments enabled them to support people in a positive and safe manner.

Staffing levels were adequate to meet people's current needs. There were a consistent amount of staff on duty and people told us they received the support they needed promptly.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were provided with the opportunity to gain qualifications and extra skills and knowledge within care.

People told us that their medicines were administered safely and on time. We saw that medication was stored securely and appropriately, and that regular audits took place. Only trained staff took part in the administration of medicines.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. The registered manager carried out regular observations of staff to ensure good practice.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People told us that staff spoke with them and gained their consent on a regular basis.

People were able to choose the food and drink they wanted and staff supported people with this. Fresh food was cooked and served to people either in communal areas or within their rooms.

People were supported to maintain their health. Health professionals visited the service as required, and people were supported to book and attend appointments outside of the service as needed.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff interacted with people in a positive manner, and had a good knowledge of the things people liked.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.

We spoke with family members who were happy with the care that their relative had received, one relative told us that 'my father has improved since coming to Beckett House'. We found that people's representatives such as family members were involved in the planning of people's care and had been involved in decision making discussions.

The people we spoke with told us that they were quite happy with their care and that the staff treated them very well. We saw staff treating people with genuine warmth and compassion.

We found that people's care plans were regularly updated, but we also found that some care plans did not contain enough detail to inform the staff of specific care requirements such as mobility and falls.

We saw that the provider had suitable recruitment procedures in place and that staff had the right level of experience for their role. However we found that arrangements were not in place to ensure that staff received appropriate professional development, supervision and appraisal. This meant that staff had not benefitted from regular supervision meetings to support their learning and development for a long time. We found that appraisals for staff had not been practiced for a couple of years but are planned to commence later this year.