As part of this inspection we followed up on a number of areas of non-compliance from our last inspection in February 2014. These concerns related to the care and welfare of people using the service, management of medicines, supporting workers, quality assurance and records. As part of our last inspection we fined the provider for continued mismanagement of medicines, and issued two warning notices regarding assessing and monitoring the quality of service provision and records. We noted that at this inspection the provider had taken significant action. On the day of our visit 13 people were using the service. They were supported by a combination of three care workers, a chef and a nurse. We spoke with three people who used the service and three relatives. We also spoke with a nurse, three care workers, a chef and the provider. Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions;
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
Although improvements had been made the service was not completely safe. Following our last inspection we fined the provider because people's medicines were not being managed safely. At this inspection we saw that the service had taken action, however there was still need for improvement. We noted that people's medicines were stored securely but were not always administered as prescribed.
People were protected from the risk of malnutrition and dehydration. Care staff completed food and fluid charts where they had concerns over people's well-being. Care plans had also been updated to reduce the risk of people receiving inappropriate care and treatment.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit we noted that no one had a DoLS application and we did not see that anyone was having their liberty deprived. The nurse showed awareness of the DoLS and was aware of current legislation in this area.
Is the service effective?
Although improvements had been made the service was not completely effective. People told us they enjoyed being at the home and felt well cared for. People we spoke with told us they felt respected. One person said, 'Everyone is kind, friendly and talks to me in a nice way.'
People's views and experiences were taken into account in the way the service was provided and delivered. For example, one person told us, 'they asked us about the meals and if we would like anything different on the menu. We made some suggestions and the menu changed.' This meant that people were encouraged and enabled to be involved in how the service was run.
Care workers had not been appropriately trained to carry out their roles. All care workers undertook a period of induction training before starting work. Whilst care workers felt supported they had not received appropriate training. We saw that senior staff had identified the training that was needed, however no plan had been implemented to address this.
Is the service caring?
We found the service was caring. People we spoke with were complementary about the home. One person said, "I've never been so well cared for. The girls do a brilliant job.' Another said, 'I am so well looked after, everyone is so good and kind.' A relative told us "It's marvellous. The staff are gentle and reassuring. We have a good laugh, they pull mums leg in a gentle and nice way. I've said stick my name down I'm coming here.'
Care workers recognised and understood people's social and cultural needs. We heard care workers talking to people about their families and the occupations they had before retiring. One care worker told us, 'I sat with a lady and her daughter and did their life history. It's so interesting, I love it. We can then talk to people about the things they have told us.'
We observed that people were involved in a range of activities for example using a bat and balloon for physical exercise or completing jigsaw puzzles with care workers. Throughout our inspection the atmosphere was pleasant and we observed many positive interactions between care workers and people that were relaxed and friendly.
Is the service responsive?
We found that the service was responsive. For example, we saw that where people's needs had changed staff took appropriate action. We noted that the service had sought the advice of tissue viability nurses to help manage or prevent pressure damage, and speech and language therapists (SALT) when they had concerns about people's swallowing.
The care workers we spoke with were able to describe how people should be supported following guidance from SALT. We observed people being assisted with fluids in accordance with instructions in their care plan.
We noticed that incident and accident records noted that the service took appropriate action to manage the risks associated with incidents and accidents and ensure the health and welfare of people living in Beech Court Nursing Home. This included making referrals to occupational therapists for specific equipment.
Is the service well led?
We issued a warning to the provider that we would take enforcement action following our last inspection. This was because the service did not have appropriate arrangements for assessing and monitoring the quality of service provision, to help ensure people's safety. The service was taking appropriate steps to improve the service and lead its development. However it is too soon to be able to see if these changes were embedded and sustainable. The provider had designated responsibility to a nurse to conduct management tasks. The service had implemented audits regarding medicines and care plans following concerns raised at previous inspections. The service monitored all incidents and ensured people's welfare. However, but the provider may wish to note that they did not have an audit in place to identify trends or concerns.
Staff told us that they all felt supported. All staff had access to supervisions and felt they had appropriate direction from senior nursing staff.
The provider had implemented action plans following our last inspection and had identified their own concerns with the service. We noted that these concerns were acknowledged and appropriate action taken.