Beenstock Home

We found the following examples of good practice.

Robust processes were in place for any essential visitors to the home. This included completion of a risk assessment, temperature check and lateral flow device (LFD) test.

Contact with relatives had been maintained throughout the pandemic. The home had ensured any changes to visiting guidance was communicated, with a code of conduct provided for relatives to follow. Screened indoor visiting had been facilitated via an appointment system in line with local and government guidance. Alongside these, the home had supported contact through video and telephone calls, window and balcony visits.

The home was ready to support the reintroduction of internal visits for one named individual per person. Staff training in LFD testing had been completed, with a file set up in which to document each nominated visitor, along with their pre-visit LFD test results. A separate testing and meeting room had been created, which could be accessed via an external door. The meeting room had ensuite facilities, to ensure visitors did not have to access any other part of the home.

The home had robust cleaning procedures in place, which had been increased in response to the pandemic. Frequent touch points had been cleaned up to four hourly, more often during any religious festivals, when people tended to move around the home more often. Infection control audits had been completed monthly, alongside regular spot checks, to ensure best practice was maintained.

The home had a plentiful supply of PPE, which was worn correctly and consistently by staff. Staff travelled to work in their own clothes, changing into their uniform on arrival and putting on PPE. Staff had completed both internal and local authority training in infection control and the safe use of PPE.

People’s ability to safely practice their faith had been supported through the building of a Shul, which was adjoined to the current premises. This meant people did not have to leave the grounds to attend their local Synagogue, thereby reducing the risk of infection. The home’s activity programme had been amended, with a focus on exercise, due to people not being able to access the community. This included a weekly therapy bike competition.

Where possible, changes had been made within the home to promote social distancing, including spacing chairs in communal areas, such as the lounges and dining room and introducing ‘bubbles’ at mealtimes. Isolation, cohorting and zoning had been used effectively, to manage any cases of COVID-19. Staff continued to be allocated to specific areas of the home to minimise risk and cross contamination.

Beenstock Home is a residential and nursing home which provides nursing and personal care for up to 26 people. The home also provides a domiciliary care service to people who reside in flats located predominantly on the ground floor of the home. The home offers a culturally specific service for the Orthodox Jewish community. At the time of inspection 23 people were in receipt of a regulated activity and therefore included in the inspection; 15 were receiving nursing or personal care and eight receiving domiciliary care.

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

Meeting people’s spiritual and recreational needs was at the forefront of the home’s ethos. People and relatives were highly complimentary of the activities available and the support they received to be integrated and involved in the local community, including attending the local synagogue or being supported to practice their faith within the home.

The home actively involved and welcomed the local community, people's family and friends into the home, to ensure people felt engaged and involved in what was going on around them. People told us they benefited greatly from this involvement, which enabled them to live as full and as normal a life as possible.

The home had developed excellent links with a number of community groups and organisations. These provided positive benefits to both people living at the home and the wider community. The home had taken part in a number of schemes and initiatives, which evidenced their standing with local and professional organisations.

The home was well-led, with people, relatives and staff are speaking positively about the running of the home, the support provided by the management team and how they had created a ‘home from home’.

People spoke positively about the care provided and the caring nature of the staff. People were treated with dignity and respect and supported to maintain their independence and engage in activities both socially and spiritually of importance to them.

People were encouraged to provide their views and opinions about the home and care provided through both meetings and questionnaires, to help drive continuous improvements. The home completed a range of audits and quality monitoring processes to help support this process.

People told us they felt safe living at the home. Staff had all received training in safeguarding and knew how to report concerns. The home followed local authority reporting procedures, to notify them of any incidents or potential abuse. Accidents, incidents and falls had been consistently documented with analysis completed to look for trends and minimise future risks.

Staff spoke positively about the training provided, with completion monitored to ensure their knowledge and skills remained up to date. People and relatives confirmed staff were competent and good at their jobs. One told us, “The staff are exceptional, really caring. [Relative] can be challenging, but the staff are so patient.”

People received personalised care which met their needs and wishes. People and/or their relatives had been involved in discussing their care. Care plans clearly explained how people wanted to be supported and had been reviewed regularly to reflect people’s changing needs.

People spoke positively about the food and drinks provided, confirming they were offered choice and received enough throughout the day. We found meal times to be a positive experience, with people receiving support and encouragement in a dignified way and in line with their care plan.

People said they had enough to do each day to keep them stimulated and engaged. The home had a full weekly activities programme, facilitated by a coordinator. Relatives and the local community were welcome to engage in a range of activities, to encourage social interaction.

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 the service was good (report published June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Beenstock Home is registered to provide nursing and personal care for up to 26 people. The care home offers residential care on the third floor, nursing care on the second floor and sheltered housing facilities to the ground and third floor. All bedrooms are single occupancy with en-suite facilities. The home offers a culturally specific service for the Orthodox Jewish community.

There was a registered manager at the service at time of inspection. 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.

At the last comprehensive inspection on the 20 October 2015 the service was found to be in breach of regulation 17 with regards to Good Governance. We then carried out a focused inspection on 15 February 2016 where we found the service had worked towards rectifying their position. We concluded the service was then meeting all the regulations applicable at that time.

During this inspection, we found the service continued to meet current regulations.

We received positive feedback from people using the service, their families and staff members. Everybody we spoke with told us with confidence that the management and staff team were caring, respectful and understood their needs and requirements well. Relatives voiced their confidence in the service and its ability to support their relatives safely and effectively.

The provider had processes in place to maintain a suitable environment for people living at the service and their visitors. Risk assessments were established to identify any environmental risks associated with areas both internal and external areas such as the use of lifts, stairs and substances hazardous to health (COSHH). The service also employed a full time maintenance person to carry out any repairs to the building.

Suitable training was offered to staff to ensure they were competent in recognising the signs of abuse and could appropriately and confidently respond to any safeguarding concerns. Staff were aware of how to notify the relevant authorities when required.

The service had satisfactory staffing levels to support the operation of the service and provide people with safe and personalised care. Comments from people using the service, their relatives and staff supported this. Staff were expected to access a variety of mandatory and additional training which ensured they were skilled and experienced in safely and effectively supporting all people using the service. The registered manager was very supporting of staff development and additional training.

Recruitment procedures were in place to ensure appropriate steps were taken to verify new employee's character and fitness to work. New employee induction processes were robust and staff were required to complete an additional shadowing programme with an experienced member of staff prior to working alone. This process ensured the correct amount of detail was provided to them to ensure they were equipped with the knowledge to carry out their support role effectively. People spoken with and their relatives felt that staff knew their needs well. Staff demonstrated a good understanding of their role and how to support people based on individual need and in a person centred way.

The provider had appropriate processes in place for the safe administration of medicines; this was in line with best practice guidance from the National Institute for Health and Care Excellence. Staff were adequately trained in the administration of medicines and all medicines were stored securely and safely.

Each person had a care file containing documents such as care plans, risk assessments and a personal profile. These records gave clear information about people's needs, wishes, feelings and health conditions. Changes to people’s needs and requirements were communicated well which meant staff were kept up to date with any changes. These were also reviewed monthly by staff and annually by the person and their family member when appropriate.

Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provided legal safeguards for people who may be unable to make their own decisions. The management team also demonstrated their knowledge about what process they needed to follow should it be necessary to place any restrictions on a person who used the service in their best interests.

People, their relatives and staff spoke positively about the management team referring to them as “Extremely caring” and “Very approachable.” People informed us they were happy to approach the management team with any concerns or questions.

We found the ethos of the service was very much about providing a place where people could feel safe, develop, and access services centred on their own cultural and environmental needs and requirements. Staff and management were very much a part of enabling this to happen.

Beenstock Home is registered to provide nursing and personal care for up to 18 people. The care home is integrated into a sheltered housing complex that comprises of three floors, with sheltered flats on the ground and second floors and the nursing and residential units on the first floor. All bedrooms are single occupancy with en-suite facilities. The home offers a culturally specific service for the Orthodox Jewish community.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beenstock Home on our website at www.cqc.org.uk.

During our last inspection we found that the provider had not implemented systems to assess, monitor and improve the quality and safety of the services provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance.

During this inspection we found the service was able to demonstrate that they were meeting the requirements of regulations. We found the service undertook an extensive and comprehensive range of audits and checks to monitor the quality of services provided. These included weekly and monthly medication audits. Other audits introduced included care plans, falls, pressure ulcers, safeguarding incidents, Deprivation of Liberty Safeguards (DoLS), weekly weights monitoring, bedrail and mattress checks and infection control.

The home had introduced a training matrix to monitor the training requirements of all staff and also undertook regular Nursing and Midwifery Council checks to ensure registered nurses were suitably registered to undertake their duties.

We looked at monthly meeting reports, which detailed the home’s response to safeguarding meetings, CQC reports, monthly audits and staffing issues. An action plan was then formulated to address any issues within set time scales.

At the time of our inspection, a temporary manager had been in post for four weeks following the resignation of the previous manager. We were told the service was in the process of appointing a new manager which they hoped to be able to confirm in the near future.

During our visit we spoke to four people who used the service, four visiting relatives, three health care professionals and four members of staff.

Our inspection team was made up of an inspector who addressed our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person told us; 'I feel safe here and I'm very satisfied with service.' A visiting relative said 'We feel X is very safe, we are happy with the care here.'

Safeguarding procedures were robust and staff were able to confidently explain to us when to make a referral if they had any concerns. This demonstrated they understood how to safeguard the people they supported.

We found systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. We saw guidance available and that staff had received training.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly and people were not put at unnecessary risk.

We found there were sufficient numbers of suitably trained staff on duty to effectively meet the needs of people who used the service.

Overall recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing their care plans which reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. One relative told us; 'Staff are very welcoming, I can come anytime I want.'

Is the service caring?

People were supported by kind and attentive staff. We observed staff supporting people sensitively and with humour. People commented, ' I have been reassured from the outset, professional values and doing things that give me reassurance and confidence about the care my X is receiving.' 'Never had any cause for concern about residents, staff are very caring.' 'Very happy with care, everybody are so kind.' 'Never made to feel uncomfortable, everything is fine.'

Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities within the home. An organised programme of events was displayed and people were gently encouraged to be involved.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One visiting professional told us; 'It is a very caring home.'

The service had quality assurance system in place, records viewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly being improved.

Staff told us they were clear about their roles and responsibilities and were respectful of the religious and cultural values of the people who used the service.

Some people who used the service had limited communication skills due to their dementia. We spoke with care staff and observed care practices. The people who used the service and their relatives spoke positively of the staff and the manager. We asked people about the care they received and they told us: "Staff are excellent, they can't do enough for you." "If you need them they are there willing to help." 'They give us choices about everything.'

Staff were seen to support people in an appropriate way, sensitively and maintained their dignity.

We saw that some of the assessment records showed that people who used the service had signed to confirm their care needs had been discussed with them and they had agreed with their planned care.

Staff spoken with told us they thought training was very good and a good standard of care was provided to people. One person told us, "I feel really well cared for here and the staff always involve me in my care'.

We asked about the meals provided and people told us: "The meals are very good." "They bring us drinks and a supper in the evening."

The provider had a system to assess and monitor the quality of service that people received.