Beech Hill Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People did not always receive care and treatment which was personalised to them. There was often a lack of evidence they and their relatives had contributed to the development of their care plans. Some people did not have the equipment they needed to access their lounge and dining areas. This was a breach of regulation 9 (Person-centred care) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. There was not always evidence people’s consent had been sought regarding important decisions about their care. Staff did not always have a good understanding of the Mental Capacity Act 2005 and how to apply it to protect people’s right to be included in decisions about their care. This was a breach of regulation 11 (Need for consent) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us staff knew them well and understood their needs. One person told us, “Staff know me very well; they are kind to me.” However, most people and relatives had not seen care plans. One relative said they had contributed to the development of their loved one's care plan. Relatives and people did not report regular reviews of their care, but relatives did report they were generally told if something had changed for their loved one. One relative told us, “They [staff] are very quick and they let me know straight away.” One person needed an adapted chair to leave their room. This chair had to be shared with several people, limiting their access to it, because there was only 1 in the home. The person told us they preferred to come out of their room and spend time in the lounge but could only do so for 1 ½ hours per day. For the rest of the time, they had to remain in their bed.

Staff generally knew people well; this was supported by staff usually working with the same group of people. This enabled care staff to get to know people’s needs and risks. However this knowledge was not always utilised in people’s care plans as care staff were not included in the care review process. Care staff were only given access to the care plans for the people they were supporting. Therefore in lounge areas where people being supported by multiple teams were mixing, staff did not always know the care needs and risks of the people they were with. Staff said, in these circumstances, they would offer support if they could. If they could not, they would call for a member of that person’s staff team. This meant people were at risk receiving delayed or inappropriate support. We raised this concern with the provider. They told us they would review the sharing of care plans with the care staff. An agency staff member told us they could not access people’s care plans. They had been supporting a person with various complex risks, but they could not see their risk assessment. They showed us they could only see a list of basic tasks which were not personalised. The agency staff member told us they always had experienced staff with them they could seek support from. However, we saw the agency staff member working alone with multiple people in the piano lounge on occasions during our visit. We observed good and effective care from this agency staff member and did not see anyone exposed to any risk. However, the agency staff member had not been provided with all the information they needed to ensure they could provide the specific care the person they were supporting needed. The interim manager told us agency staff should be able to access all care plans on the system. Care staff were not present for handover meetings and were not always reading handover records. The provider told us a new system was introduced to make sure care staff had this information.

Systems and processes to ensure care was personalised to people’s individual needs were not effective. Care plans were not always updated with relevant information. For example, 1 person’s guidance for how to prepare their drinks safely had changed but had not been updated on the summary page of their care plan. Care plans lacked personal details about people, such as their life history, likes and dislikes and were mainly clinical in focus. People’s care needs and risks were often detailed in basic terms, but had little information about how the person wanted to be supported to manage needs and risks. People were sharing an adapted chair, the interim manager told us several people needed it but there was only 1 chair. They said they had been advised by staff there was no point in trying to get more chairs in Birmingham due to the costs. People who wanted to leave their rooms but required an adapted chair could only come out of their rooms for a limited time each day. There was no evidence steps had been taken to assess and meet the needs of people who may require an adapted chair. We spoke to the provider, and chairs for all who needed them were ordered. At the time of our visit there were 8 shared rooms in the home. Six of these rooms were occupied by people who were not related to each other. In many cases, there was no evidence people’s individual needs had been considered when placing them in shared rooms. There was no evidence attempts had been made to consider how people’s specific needs and risks may impact upon the person with whom they were sharing a room. For example, 1 person was noted as being physically aggressive with staff at times when they were distressed. There was no evidence to show the possible impact on the other person sharing the room had been considered. Processes to ensure people living with dementia had adaptions they needed were not always effective. For example the day and date were not clearly displayed.

People told us they were happy with the standard of care they received. Relatives told us about some examples of concerns they had had about people's care. One relative said they had not felt listened to and did not feel their relative had received the care they needed in a timely way. One relative told us they were happy with the response they received to concerns raised, and the actions taken to address these and felt their loved one’s current care needs were now being addressed. People gave mixed views about the quality of the food. Some said it was very good, others felt it was a little bland or wanted more spicy options. Relatives told us they felt the standard of food was good, but some were concerned that hot meals may be going cold because staff struggled to meet everyone's needs at mealtimes.

Staff told us about people's dietary needs. A member of care staff told us there was a list in the kitchen with all the information needed about people’s dietary needs, in case any staff member was not sure. They told us they recorded what people were eating and drinking as they did so and we saw this in practice. Some staff told us people did not have the option to have fresh fruit as a snack and only biscuits were available unless people were trying to gain some weight, in which case they had cakes made for them. Some staff told us anyone could be offered alcohol with their meal. The interim manager said they had noted that people did not have proper access to snacks and was looking at putting together snack boxes for people. Staff told us they received basic training on people’s dietary needs which, aside from manual handling training, was via e-learning. Training and learning records indicated staff were not always encouraged to learn about new or innovative practices.

Systems were not always in place to monitor and assess the effectiveness of training provided. There was no analysis to show training was improving the care people received. Systems to share good practice were not embedded in the staff teams. People’s nutrition and hydration needs were met but could be improved with the provision of snacks and evidence of increased consultation with people in the development of their menus. We saw people living with dementia having food options discussed with them, rather than being shown plated options. Some people were visibly struggling to make a choice but staff did not show them the meals on offer to help them decide. We did see some people had requested meal options which were not on the menu. Staff worked hard to try to ensure people eating in their rooms received the meals they wanted quickly. Records showed people's fluids were monitored and recorded accurately. Targets for fluids were visible on the electronic care management ‘dashboard’ for each person and flagged if they had low intake that day. Evidence-based tools were used to monitor and assess various health risks and needs.

People and relatives told us they thought staff communicated well and worked together as a team. One relative told us they felt the staff team had managed the transition of their loved one’s care from hospital to Beech Hill Grange well.

Most of the staff we spoke with spoke positively about their colleagues and told us they felt they worked well together as teams. Staff told us they only had access to the care plans for the people they were assigned to support. They also told us agency staff did not all know how to use systems to view care plans and risk assessment. Care staff told us they were not included in handover meetings and 1 member of care staff told us most staff did not have time to read the handover records. The care staff could tell us a lot about people’s care needs and wishes, but they were not contributing to the development of people's care plans. Care leads told us they made sure staff had the right skills mix for each shift and agency and new staff were generally paired with experienced staff. The interim manager stated that agency staff should have access to all people's care plans and not just the tasks assigned to them.

Processes to prepare agency staff to support people safely had not always ensured that they could utilise the equipment given to them effectively. Processes were not in place to ensure care staff were fully appraised of handover information. Reviews of people's care did not utilise the knowledge and skills of the care team to enhance the guidance for all staff.

Most people and relatives we spoke with told us they, or their loved ones, had positively benefited from living at Beech Hill Grange. However, only 1 relative we spoke with had seen their loved one’s care plan and felt a part of its development. People and relatives mostly said they had not seen their care plans or been involved in reviews of their care. One relative told us their loved one's health had improved significantly since moving to Beech Hill Grange. People told us they felt they received a good standard of care.

Staff told us about ways in which they supported people to maintain and improve their health. Care staff told us about the changes they would look out for and what they would report to the nurse in charge if they had any concerns. In practice we found care to treat and mitigate future injuries was not always adequate.

Risks to people’s health, in terms of accidents and injuries, were not always fully assessed or mitigated. Processes to ensure people’s care promoted good physical and mental wellbeing had not enabled the provider to identify and mitigate the risk of isolation and the impact upon the mental health of people being cared for in bed. They had not ensured people being offered alcohol were safe to have it. Records showed people did receive support from professionals, such as their G.P, occupational therapist, speech and language assessment team, chiropodist and dentist.

People told us they were happy with their care and were happy to be living at Beech Hill Grange. One relative told us their loved one's health had improved significantly since moving to the service. One relative told us they felt their loved one's care had deteriorated because they did not have their health needs met in a timely way. One relative said changes had been needed to their loved one’s care but they were happy that this change had been made quickly once they identified the issue to staff.

Most staff told us they felt people received good quality care and the nurses’ oversight ensured people’s outcomes were positive wherever possible. One member of care staff told us they were concerned about the number of unexplained cuts and bruises people were getting and felt these were not being investigated properly. Nurses told us the local GPs, pharmacy and dentist supported people well.

Systems were not always in place to monitor people’s outcomes effectively. Although we saw some evidence of people’s needs changing and having them met by the staff appropriately, we also saw examples of changes in people’s needs not being responded to, to ensure good care provision. Although records showed people’s health conditions were monitored, it was not always clear how this monitoring was used to inform improvements in the quality of care provided. For example, the provider’s systems did not indicate reductions in the number of episodes of significant distress people experienced or in the number of unwitnessed injuries people sustained.

People told us they could make choices about how they spent their time, and how they wanted to receive their care. We saw people making choices about what they wanted to eat and drink. However, we also saw examples of staff providing support without consent. We saw a person being told they were being taken into lunch and not asked, and we saw a person having food put into their mouth without asking them if they wanted it or making any conversation with them. We also saw some people were separated at lunch time and offered food in different areas of the home. Some people who required support to eat had their lunch in the conservatory area. This decision appeared to be based on the convenience of the staff team supporting the lunch provision and not based upon the preferences of the people having lunch. We did not see people being asked if they wanted to eat their lunch in the conservatory area.

Staff told us how they sought consent from people before providing care. They told us they respected people's right to decline care and treatment and what they would do in such cases. Some of the staff we spoke with did not, however, have a good understanding of the Mental Capacity Act (MCA). They did not know who, amongst the people they supported, had a Deprivation of Liberty Safeguard (DoLS) authorisation in place, and what having a DoLS in place really meant for people. Staff told us they had received basic online training in MCA, but some could not recall when they had done this training last. Staff’s lack of understanding in relation to MCA placed people at risk of unnecessary restriction. For example, on 1 floor people had bedrooms with patio doors leading out onto the gardens. Staff told us due to the risk of some people attempting to leave via the patio doors of any room on that floor, all patio doors must be kept locked for safety. There was no evidence people’s consent had been sought or their right to have their patio doors open if they wished considered along with potential less restrictive options. We discussed this with the new home manager and provider. They told us they were not aware of this decision and would look into the matter.

Processes to ensure people’s mental capacity and ability to consent had been considered were not adequate. Some people were accommodated in shared rooms with strangers, with little evidence they had been meaningfully consulted about their wishes on these arrangements. Mental capacity assessments and best interests decision-making were either not completed or poorly documented. For example, for 1 person in a shared room, there was no record of whether the person could understand, retain and weigh up the information and communicate a decision on this matter. A best-interests’ decision was recorded but did not show whether the person’s wishes, values and beliefs had been considered. Records showed in 1 shared room, 1 person liked to rise very early and another liked to be woken late morning. Staff told us the 2 people did not always get along. A shared room policy was in place which stated people who ‘lacked mental capacity to decide on their accommodation’ would not be expected to share with anyone else unless they were an established partner. However, we found there were a number of people in shared rooms who were living with dementia and may, potentially, lack capacity to make a decision regarding sharing their room with another person. The provider had, therefore, failed to follow its own shared room policy and management could not demonstrate how people’s views and wishes had been taken into account. Systems had failed to ensure people had been consulted and consent was obtained before CCTV cameras were installed in their home. The provider took the decision to switch off the CCTV system during our assessment. They assured us the system would only be switched back on when a full consultation had been completed and the correct legal requirements were in place.