The inspection took place on 8 and 9 August 2016. The inspection was unannounced which meant the provider did not know we would be inspecting.Beechy Knoll Care Home is a residential care home based in Sheffield. The home provides care for older people and people living with dementia. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for 40 people and on the day of our inspection there were 35 people using the service.
The home had a registered manager in place and they were present on the first day of our 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.
We spoke with a range of different team members; the deputy manager, care staff, kitchen staff domestics and maintenance staff who gave us mixed reviews about the registered manager.
From looking at people’s care plans we saw they were written in plain English but not in a person centred way. The care plans did not all contain people’s personal history and information on care needs was task orientated. These were not regularly reviewed by staff or updated by the registered manager.
Individual care plans contained risk assessments. Some were individualised but others were generic. The risk assessments identified risks but did not describe the measures and interventions to be taken to mitigate risks and ensure people were protected from harm. Some of the care plans we viewed showed us that people’s health was monitored and referrals were made to other health care professionals where necessary but others indicated this was not always the case.
On the day of our inspection people who used the service were not supported by sufficient numbers of staff to meet their care needs. We could see in the staffing rotas that there had been recent staffing issues and people who used the service had not been supported by enough people on a regular basis.
When we looked at the staff training records they showed us that staff were not always supported to maintain and develop their skills through training and development opportunities. We found that some training had expired and staff needed to attend refresher training.
When we looked at supervision and appraisal records we saw that these had been carried out, however they were ineffective and did not address staff wellbeing or performance.
We also viewed staff recruitment records which showed us recruitment practice was not always robust.
We observed how the service stored and administered medicines. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication. We found that medicines were not stored safely and numerous medication errors had taken place. Audits had not identified these issues and staff did not all have the knowledge and skills to appropriately administer medicines.
During the inspection we witnessed some positive interactions between staff and people who used the service. However staff did not always respect people’s dignity when communicating and supporting people.
Activities were not always provided. We saw that some activities took place and also saw evidence that people were being supported to go out but this was not regular or consistent.
We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We saw people enjoying their meals however the daily menu was not developed with the people who used the service to incorporate their likes and preferences.
We saw the service had a complaints and compliments procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. We saw evidence that this complaints procedure was not adhered to.
We found a quality assurance survey had taken place previously and we looked at the results. Relatives told us that they had been asked to take part in the surveys. There were no actions identified that were in place to make improvements to the service as result of peoples suggestions.
The program of audits carried out by the registered manager were ineffective and not carried out regularly.
We found that the service didn’t provide an environment suitable for people living with dementia.
The service was unable to provide people with a choice of bathing or showering as there were no working showers on the premises.
During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.