Archived: Beaufort Care Home

We found the following examples of good practice:

• Staff were using and disposing of personal protective equipment (PPE) safely and in line with the relevant national guidance.

• The home had a testing programme in place to frequently test staff and people living at the home.

• Staff and people living at the home were supported to self-isolate when necessary.

• The home was clean and hygienic. There were cleaning schedules in place to ensure frequent cleaning was carried out throughout the day, particularly frequently touched surfaces.

• Relatives had been supported to safely visit their loved ones in exceptional circumstances in line with the national guidance.

Further information is in the detailed findings below.

Beaufort Care Home is a care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 32 people in one adapted building.

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

People told us they received their medicines as prescribed however, on the first day of the inspection we found robust practices for the administration and recording of medicines were not always adhered to. On the second day of the inspection we saw improvements had been made around systems to ensure safe management of people’s medicines however, the provider needed to ensure the improvements were sustained.

Good record keeping in relation to people’s changing needs was not always maintained and this placed them at risk of avoidable harm because staff might not be aware of their actual needs to support them safely. Staff told us they were confident when supporting people and received effective handovers before they commenced duty.

The system for oversight of Deprivation of Liberty Safeguards (DoLS) authorisations was not always followed because one person’s DoLS authorisation had expired three months before the inspection. The provider acted immediately and applied for an extension to the authorisation. No changes were noted to the restrictions needed to support the individual. In the main 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.

There was a process in place to ensure good governance however, the registered manager did not ensure the system was consistently followed and therefore the above failings were found. The registered manager acknowledged their shortfalls and on day two of the inspection demonstrated commitment to ensure improvements were made.

Sufficient numbers of staff were deployed and recruitment processes were robust. Staff received sufficient training to undertake their role and responsibilities. Staff told us they were supported. People had access to a wide range of health and social care professionals and staff made referrals to specialist services when needed. People told us they were provided with nutritious and appetising meals.

Staff had built trusting relationships with people they supported. We observed positive interactions between staff and people at the service. People told us they felt involved and had their opinions listened to. There was large communal space and we observed people interact and engage in social activities.

People’s care plans were not consistently person-centred because they were not always up to date. However, we observed people received individualised care and people told us there wishes and preferences were respected. People had access to the complaints procedure and told us they felt confident to raise any concerns.

The registered manager encouraged staff, people and relatives to be involved in the running of the service. Regular meetings were held with all stakeholders. There was a strong emphasis towards equality throughout the staff team and this showed during our observations of the support people received.

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 18 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of people’s medicines and record keeping at this inspection. Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beaufort Care Home is on a main road position in Burscough. Accommodation is provided for 32 adults requiring personal or nursing care. At the time of our inspection there were 26 people living at the home. The majority of rooms are of single occupancy, with en-suite facilities. The environment is spacious, well maintained and tastefully decorated with good quality furnishings. All amenities are easily accessible within the nearby village of Burscough and public transport links are close by.

There was no registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. There was a manager at the home who had been in post for approximately four months at the time of our inspection. The manager had begun the process of registering with the CQC at the time of our inspection.

People told us they felt safe living at the home and that staff were kind and compassionate to their needs. Appropriate safeguarding practices were in place and staff knew how to recognise and report potential safeguarding issues.

We looked at the way the service supported people with their medicines. During the inspection we observed people being sensitively and safely supported with their medicines. We found medicines were being stored safely and securely. Room and fridge temperatures were monitored in order to maintain the appropriate storage conditions. Processes were in place to manage the appropriate disposal of medicines, including returns to the pharmacists. Controlled drugs were administered and stored appropriately.

We found some examples of ‘as needed’ medicines protocols which included pre-printed ‘generic’ instructions, they were lacking in person centred detail to ensure the medicine was administered safely and effectively in response to the person’s specific needs. We have made a recommendation about this.

During the course of our inspection we found there were sufficient numbers of staff to meet people’s assessed needs. We asked people and relatives about staffing levels and we received mainly positive responses.

We found the home to be clean, free from clutter and devoid of any malodours. There was an efficient cleaning and infection control regime within the home.

Staff received the appropriate training to undertake their specific role effectively. We reviewed the homes training matrix, discussed training with staff and spoke with the external training advisor for the home. People we spoke with had no concerns regarding the ability or competence of staff.

The home was working within the principles of the Mental Capacity Act and any conditions or authorisations to deprive a person of their liberty were being met.

The home supported people with their nutritional needs including catering for people with specific needs such as those needing a diabetic or soft diet. Feedback regarding the quality of food was positive and the dining experience was seen to be a positive one.

We spoke with staff about the needs of the people who lived at the home. It was evident that staff knew people well and were able to describe people’s preferred routines, likes and dislikes. There was evidence within people’s care plans to show that this was documented.

The service had policies and procedures for dealing with any complaints or concerns. People told us they felt comfortable raising issues and that they felt any concerns would be dealt with appropriately.

Care plans evidenced that people were able to make choices across a number of areas including; food, clothing, activities undertaken and if they preferred a male or female carer to assist them. People we spoke with expressed no concerns in being able to make their preferences known.

We spoke with people who lived at Beaufort Care Home about the management and culture within the home. The responses we received were positive.

The organisation had introduced a ‘service hub’ which assisted managers and regional managers to oversee the performance of each home within the group. The hub contained information from audits undertaken as well as staffing, resident, financial and estates information for each home.

A range of meetings took place within the home so people, relatives and staff could raise issues in a formal setting.

During our inspection we looked around the home. We spoke with two relatives and one person who lived at the home. They all told us they were happy with the care and had no concerns. None of them had ever had to complain but they all told us they would be comfortable to approach the manager or staff and felt confident they would be listened to.

We looked at three care plans (two in detail) and were concerned that there were sections that were blank or incomplete. We were also concerned that there were insufficient processes in place to ensure that records such as policies, accident files, medication records, were reviewed regularly. There were few systems in place to monitor the quality of care provided such as satisfaction surveys or residents/relatives meetings.

we were also concerned that staff records showed us that systems were not robust in relation to recruitment and could not be confident that people would be kept safe.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We undertook a tour of the premises at the beginning of our inspection and viewed a number of people's private rooms, toilets, both sluice rooms as well as all communal areas of the home. The environment was very clean and hygienic and there were no unpleasant odours. We undertook another tour of the home with a member of the domestic team later in the day who showed us were cleaning equipment was stored. They also talked us through the daily cleaning schedules that the home had in place.

Records showed care assessments had been carried out and we saw that care plans were written in a person centred way. However we did find examples of missing information and contradictory information within some of the care plans we looked at. One example being that one person we spoke to told us that they felt they had lost weight over the past few months. We checked their care plan and saw that during a six month period they had lost a substantial amount of weight. However monthly weight checks had not been carried out regularly and we could not find any record of weight checks being carried out for the previous two month period.

Is the service effective?

We spoke to the activities co-ordinator who visited the home once per week as well as several other homes within the Dovehaven group. They told us, "The recent change in management has meant there is a more proactive approach to activities. I've spoken to Sue (Acting Manager) and we have worked out who would benefit from 1-1 time and I spend time with people who are unable to leave their room if they want to see me".

Is the service caring?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, Incontinence service and GP's.

We spoke with four members of staff as well as the acting and deputy manager. All the staff we spoke with were clear what to do in the event of an emergency at the home such as fire or if a person living at the home had fallen.

Is the service responsive?

The homes complaints procedure was on display within the reception area and the people living at the home and visiting relative we spoke with all told us that they would feel comfortable raising issues or complaints of they felt they needed to. Staff we spoke with knew how to assist people if they had any concerns or wanted to make a formal complaint.

Is the service well-led?

We saw that a number of audits took place such as medication, hand hygiene and care plans. We saw that issues had been identified and actions put in place as a result. However some of the issues highlighted within the care plan audits were still apparent during our inspection, e.g. weight charts not completed or relevant risk assessments completed.

We found recruitment practices to be robust and those living at Beaufort Care looked comfortable in the presence of staff. We also spoke with some relatives who were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

"The staff are wonderful."

"The girls are exceptionally nice. They are very friendly and extremely helpful."

"It is beautiful here. We couldn't wish for any more."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.