Beech Lodge

Beech Lodge is a care home that provides accommodation and personal care for up to 28 adults some who are living with dementia. At the time of the inspection 27 people were living at the service.

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

People and their relatives told us they were happy with the care they received and people said they felt safe living there. A relative said; “We are so pleased with the care and support she has received all the way though the pandemic.” One person said; “I feel safe here and have a job to do which I enjoy.” People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

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.

People were supported by staff who completed an induction, training and were supervised. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activities with staff. Staff knew how to keep people safe from harm.

The environment was safe, with upgrades ongoing and people had access to equipment where needed.

Staff received appropriate training and support to enable them to carry out their role safely, including fire safety and mental health training.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

People were involved in menu planning and staff encouraged them to eat a well-balanced diet and make healthy eating choices. Special diets were catered for.

People were supported by a service that was well managed. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

Staff and a relative told us the registered manager of the service was ‘hands on’, approachable and listened when any concerns or ideas were raised. A relative said; “They (the registered manager) always keep in touch, lovely place.” One staff member said; “Couldn’t wish for better.” “They (the registered manager) are lovely and very approachable.”

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

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 requires improvement (published 4 May 2019) and there were multiple breaches of regulation. 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

This was a planned inspection based on the previous rating.

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.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

People’s experience of using this service:

¿ Arrangements for the management of medicines were not robust. Some people had not received their medicines as prescribed. Medicine Administration Records (MARs) were not completed in line with NICE guidelines.

¿ Staff completed an induction when starting work at the service which consisted of familiarising themselves with working practices and policies and procedures. Training was not routinely provided.

¿ The service was short staffed and agency staff were regularly used to meet people’s care needs. However, there were occasions when the number of staff on duty was lower than the levels identified as necessary to meet people’s needs. Staff told us their main concern was staffing levels and they were often rushed.

¿ Systems for checking new employees were suitable for working in the care sector were not robust.

¿ People had limited access to meaningful activities, there was no member of staff with responsibility for organising activities. Staff told us they did not have time to organise activities regularly.

¿ Restrictions were in place in order to keep people safe. Applications to authorise the restrictions had not been made in line with legislation laid down by the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. There was no evidence to demonstrate decisions made on behalf of people who lacked capacity to make their own decisions had been taken in their best interest and were proportionate and the least restrictive option.

¿ Risk assessments were in place to identify when people were at risk due to their health needs. There was a lack of guidance for staff to help them support people whose anxieties sometimes put them, and others at increased risk.

¿ The premises were clean and well maintained. Staff were aware of processes to reduce the risk of cross infection. There was some signage to support people to move around independently. There was limited storage space and equipment was kept in corridors. Access to outside areas was difficult for people with mobility problems.

¿ Care plans were comprehensive and regularly reviewed. Daily notes provided a record of the care people had received. Monitoring records were consistently and meaningfully completed.

¿ People were treated with care, consideration and respect. People’s diverse needs were known to staff and no-one was discriminated against. Staff regularly checked on people who chose to stay in their rooms.

Rating at last inspection: Good (Report published 28 June 2018)

Why we inspected: This inspection was brought forward due to information of risk or concern received by CQC. The concerns were in respect of the management of medicines, a shortage of continence aids leading to undignified practices, infection control, staff training, and a failure to follow legislation laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS).

We issued breaches of the regulations. Please see the end of the report for details of the action we have told the provider to take.

Follow up: We have asked the provider to send us an action plan detailing how they will make improvements to the service.

The service is on three floors with access to the upper floors are via stairs, stair lift or a passenger lift. Existing bedrooms on the top floor of the premises had been upgraded and additional rooms had been added in a new extension. At the time of the inspection the top floor was not in use, while these improvements were underway. These works were due to be completed a few weeks after our visit. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 25 May 2017. In May 2017 we found most people did not have a care plan or risk assessments in place. All information about people’s needs were communicated verbally between staff and this meant there was a risk that people might not receive consistent care and support. There were discrepancies in medicines records and a lack of analysis of falls. Audit processes were not effective and systems for assessing and reporting risks to senior management had not been followed.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good overall.

Care records were personalised to the individual and described how people wished to be supported. They contained detailed information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. For example, guidance for staff when using moving and handling equipment, how to support people who could become anxious or what actions to take to help people who were at risk of falls.

There were effective quality assurance systems in place and audits were routinely completed. These included audits of care plans, risk assessments and medicines. Accidents and incidents, such as falls, were analysed and where necessary changes were made to learn from events or seek specialist advice from external professionals. Systems for the registered manager to report appropriate information to senior management, about the running of the service, were robust.

Safe arrangements were in place for the storing and administration of medicines. Medicine administration records (MARs) were clear and there were no gaps. Records of medicines tallied between the stock of medicines held and what had been recorded as given.

We also found there was limited opportunity for people to take part in meaningful activities. There had been a vacancy for the post of activities co-ordinator for several months due to difficulty in recruiting to the post. This had resulted in the ceasing of most of the group activities. While external entertainers visited the service, about once a month, there were no other organised activities taking place. People told us, “I would like more to do”, “I used to enjoy the bingo and the quizzes but they have stopped” and “It can get a bit boring in the afternoon, I just go and lay down in my room.” We have made a recommendation about this.

The introduction of an electronic system provided clear records of when people’s care needs were monitored. However, some paper based care monitoring records, that had not yet been set up on the electronic system, were not consistently completed. Although, there was no evidence that this had impacted on the care provided for people.

People told us they were happy with the care they received and believed it was a safe environment. Comments included, “Everything here is good”, “My room is lovely” and “The staff are lovely.”

There were enough suitably qualified staff on duty and additional staff were allocated if peoples’ needs increased, such as when someone was unwell. Staff knew how to recognise and report the signs of abuse. There were systems to induct new staff, support staff through relevant training, one-to-one supervisions and appraisals. Staff told us they felt supported by the management commenting, “We are like a big family”, “We have lots of training”, “It’s a brilliant place to work” and “The manager is great, so approachable.”

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005.

People were supported to access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists.

People had a choice of meals and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. Comments included, “Good cook”, “The food is lovely” and “You always get choice.”

People were supported to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so.

The environment was well maintained. Extensive building and repair work to the exterior and interior of the premises were nearing completion. Any disruption to people’s lives, while the refurbishment was being completed, had been well managed. People lived in a pleasant environment which was uncluttered, clean and odour free. Appropriate safety checks were completed to help ensure the building and utilities were safe.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run. There was also a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

The service had been operating under new ownership for five months, since December 2016. In that time many improvements had been made to the environment. There was extensive building and repair work in progress to the exterior of the premises at the time of our inspection. Any disruption to people’s lives, while the refurbishment was being completed, had been well managed. People lived in a pleasant environment because the premises were uncluttered, clean and odour free.

The layout of the building had been re-structured and this had resulted in a change of use for two downstairs bedrooms. There was also extensive work being carried out to the top floor, both to make some areas safe and to extend and improve the facilities on that floor. This meant two people who had bedrooms on the ground floor and one person who had a bedroom on the top floor being moved to other rooms. While one person was happy with the move, two people were not and told us they had not been consulted about the move. Their comments included, “I wasn’t asked or given a choice. I don’t like this room as much as my other room upstairs” and “I wasn’t asked about moving room, just told that my room was needed for another use”.

While there was no evidence that people‘s needs were not being met most people did not have a care plan of their needs in place. Of the 14 people living at the service only two had a care plan and both of these were still being developed so needed more detail. Staff told us all information about people’s care needs was given to them verbally and new staff were given information, when they started, from existing staff. However, most staff had been recruited in the last three to four months so any new staff were being inducted by staff who also had not been working in the service for very long. One care worker told us, “I was told when I started that there were no care plans so I would have to ask other staff.” This meant there was a risk that staff would not know how to provide the right care for people because there was a lack of written records about people’s needs for staff to follow.

Some risk assessments had been completed to assess the level of risk in relation to areas such as nutrition and the risk of people developing pressure sores. However, where these had been completed there was a lack of guidance for staff about how to manage these risks. There were no individual risk assessments in place in any of the care files we looked at. For example, guidance for staff when using moving and handling equipment, how to support people who could become anxious or what actions to take to help people who were at risk of falls.

When incidents or accidents occurred these were recorded. However, these records were not audited to identify any patterns or trends which could be addressed, and subsequently reduce any apparent risks. For example, when people had repeated falls and where people or staff had sustained an injury.

People’s medicines were stored appropriately and mostly recorded when they were given. However, records for medicines which required stricter controls by law were not always recorded correctly. We found there were discrepancies between the stock of medicines held and what had been recorded as given. A lack of audits to check these medicines meant the service was not aware of these discrepancies.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. One person told us, “I have never seen any abuse, no shouting or swearing, staff are always patient with me.” Due to people’s health needs some people were unable to tell us verbally about their views of the care and support they received. However, we observed people were relaxed and at ease with staff, and when they needed help or support they turned to staff without hesitation.

On the day of our inspection there was a calm, relaxed and friendly atmosphere in the service. Staff were caring and attentive in their interactions with people and were kind and patient when supporting individuals. Comments from people included, “The staff are good to me, they are very kind, I can’t grumble” and “I get on with all the staff.”

People received care and support in a timely manner. There were enough suitably qualified staff on duty to meet people’s needs. One person told us, “There are enough staff and I never have to wait for help.”

Staff knew how to recognise and report the signs of abuse. Staff received appropriate training and supervision. New employees completed a thorough induction which had incorporated the care certificate, which is a care industry recognised induction programme.

People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Care records confirmed people had access to health care professionals to meet their specific needs.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People told us they were happy with the meals provided. Comments included, “I have a choice of food, it is lovely”, “We are asked the day before what food we would like the next day, they bring a menu with the choices” and “I don’t usually leave any food so it must be good.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to make certain decisions the management and staff acted in accordance with legal requirements under the MCA. Staff applied the principles of the MCA in the way they cared for people and told us they always assumed people had mental capacity.

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so.

We identified breaches of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.