Beech Hill Grange

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At the time of our assessment there was no registered manager in post. An interim manager was in place, supporting the service whilst they awaited the newly recruited home manager. The new home manager joined the team part way through our assessment. The provider’s governance and quality assurance systems were not sufficiently effective to ensure the delivery of good quality care and support. Audits and checked were completed but had not enabled them to identify areas of concern found during our assessment. These included shortfalls in the management of environmental risks and the assessment and management of risks to people. Systems to ensure staff received and complied with effective training and received supervision in line with the policy and procedures of the service were not effective. This was a breach of regulation 17 (Good governance) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The provider addressed some concerns during our assessment as they were identified. They told us they were working through an action plan to improve and monitor governance systems.

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.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Most staff spoke highly of the management team at Beech Hill Grange. Care staff told us they could always share concerns with members of the nursing team and the care coordinators. Nurses told us about the support and supervision they received from the clinical lead. An interim manager was in place at the time of our assessment. A new home manager joined the team during the assessment. Some staff said losing the long-term registered manager, who had left at the end of April 2024, had been difficult and this had impacted upon the morale of the staff team. The management team had not identified the failings in relation to the lack of learning culture within the service. This had potentially had a detrimental impact of the quality of people’s care and safety.

There was not always clarity regarding which leaders were responsible for which aspects of various oversight tasks. For example, the provider’s incident and accident system flagged new entries to the care leads, the clinical lead and the home manager; however, there was not always evidence that anyone was reviewing these reports. There was evidence of a closed culture within the staff team which leaders had not identified and were potentially part of. For example, the local authority safeguarding team was not always notified of possible safeguarding concerns, and there was not always evidence external medical professionals had been consulted to review injuries.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Most staff we spoke with were not receiving supervision in line with the provider’s policy and procedure. One staff member told us they had never received supervision, another said they could not recall when they last had supervision. Most staff stated they had never had an appraisal. Some staff were not sure what the term supervision really meant. Some staff could not remember the last time they had received basic training in key areas and told us they had not received any training to support people with dementia or to learn more about health conditions such as diabetes or epilepsy because the nurses managed these conditions. We found a lack of evidence of efforts made to promote learning in key aspects of people’s care, such as through appointing champions or ‘leads’ in these areas. Staff told us they did feel supported by the management team in their roles. It was not always clear whose role or responsibility a particular area was within the leadership team. For example, staff did not know who the safeguarding lead was and told us there was not one. No one was tasked with oversight of falls to learn and mitigate risks. We shared all these findings with the provider and new home manager. The provider advised they were reviewing role and training to provide staff with more opportunities and were also introducing various rewards and benefits to show the staff team how much they were appreciated.

The provider’s systems and processes were not operated effectively to enable them to assess, monitor and improve the quality and safety of the service and drive improvements. Systems to monitor the safety of the environment had failed to identify and mitigate the risk of specific hazards around the home. Systems had failed to ensure staff had the right training and experience to respond quickly and appropriately in the event of a fire emergency. Processes to ensure care records were accurate and up to date with sufficient guidance and access for staff were not robust. Oversight of the means by which consent and capacity were assessed and sought had failed to ensure people’s mental capacity was always assessed when required. Decisions made on behalf of people who lacked capacity to make them were not always recorded and evidenced in line with the requirements of the Mental Capacity Act 2005. In some cases, people were restricted but there was no evidence that the least restrictive practices had been considered or implemented. For example, people were subject to CCTV recording without their consent. Systems to ensure Deprivation of Liberty (DoLS) authorisations were recorded and monitored were not always effective. For example, 2 people had conditions on their DoLS authorisations relating to their care and treatment. There was no evidence these legal conditions were being complied with. Quality assurance checks had failed to ensure staff had completed all key training , including mental capacity training, moving and handling and dementia awareness training. There were no clear systems in place to monitor the effectiveness of much of the training provided. Systems and processes to oversee staff supervision and appraisal had not ensured all staff received supervision and appraisal in line with the provider's policy and procedures. The provider told us they were putting together an action plan with the new home manager to address the concerns identified.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.