Homebeech

Updated 16 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by three inspectors, and a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Homebeech is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Homebeech is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 25 April 2022 and ended on 10 May 2022. We visited the location’s service on 25 and 28 April 2022.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from Healthwatch, which is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and 10 relatives about their experience of the care provided. We spoke with 15 members of staff including the registered manager, clinical manager, registered nurses, care workers, administrator, activity co-ordinator, laundry worker and the kitchen assistant. We spoke with two social care professionals and one healthcare professional who have regular contact with the service.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality assurance processes, training records, policies and procedures were reviewed.

Updated 16 July 2022

About the service

Homebeech is a care home providing personal and nursing care to up to 66 people. The service provides support to younger and older adults who live with physical disabilities and/or mental health needs, some people were living with dementia or learning disabilities. At the time of our inspection there were 55 people using the service.

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

People were not always protected from risks. COVID-19 infection prevention and control measures were not robust; visiting professionals were not always asked to provide proof their lateral flow device test results. People’s medicines were not always stored and disposed of safely, expiry dates of medicines were not always checked.

People were not always treated with dignity and respect. Staff did not always communicate with people before assisting them in their wheelchairs. Some confidential information about people were accessible to others who did not require to know them.

People did not always experience person-centred care. For example, people’s care records did not always contain person-centred techniques to help support people when they were anxious. Some people receiving end of life support had care plans which contained basic information which meant staff could not provide them personalised support.

The provider did not demonstrate a full understanding of regulatory requirements. Consideration had not been given to CQC’s publication ‘Right support, right care, right culture’ to support people living with a learning disability. The provider had not updated their registration with CQC to include providing a service to people living with a learning disability but subsequently did so following our inspection. Quality assurance processes had not identified areas of improvement highlighted at the inspection, such as, recruitment records not being in line with CQC regulations and care records not reflecting people’s current needs.

People were supported to maintain a healthy diet. We received mixed feedback about the food provided. One person told us, “The food was good but some of it I don’t like, some not cooked properly but you get fish and chips.” A relative told us, “They come round and get [person’s] food choices for the three meals.”

People’s associated health risks were appropriately assessed, and care planned for. People were protected from risk of abuse; staff and management demonstrated a good understanding of preventing and reporting concerns. People had access to healthcare services and staff supported them to attend appointments. Professional guidance had been recorded in people’s care documentation and followed by staff.

People, their relatives and staff gave positive feedback about the leadership and management at the service. Comments included, “They are very approachable and always been there for me in personal and work situations.” And, “The management are fine. I love my room, it's beautiful, I asked to move to the ground floor, when a room became available, I got the room.”

People and their relatives were complimentary of the staff. Comments included, “I can’t rate the staff highly enough.” And, “I can’t say a bad word about any of them.” Staff were mostly observed to be kind and considerate to people. Staff spoke in fond terms with the people the supported. One staff member told us, “The best thing is the residents, always, they come out with funny little things, they just make your day.”

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 last rating for this service was requires improvement (published 28 August 2020). There were no breaches of regulation, the inspection looked at safe and well-led only and had met the breach of regulation 17 at that time.

The rating for the previous inspection was requires improvement (published 26 April 2019) and there were multiple breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. We looked at all of these breaches at this inspection. This service has been rated requires improvement for the last six consecutive inspections.

At this inspection some improvements had been made and the provider was no longer in breach of regulation 14 (Meeting nutritional and hydration needs) and regulation 18 (Staffing). Not enough improvement had been made and the provider remained in breach of regulation 9 (Person-centred care). We found new breaches of regulation 10 (Dignity and respect), regulation 12 (Safe care and treatment) and regulation 17 (Good governance).

Why we inspected

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.

The inspection was prompted in part due to concerns received about medicines and pressure area care. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on actions we told the provider to take at the inspection (published 26 April 2019).

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

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

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 breaches in relation to infection prevent and control, medicines management, dignity and respect, person centred care and good governance.

We have made a recommendation for the provider to research and make improvements to create a dementia friendly environment.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.