Beechcroft House

Beechcroft House is a residential care home providing personal care. It provides accommodation for three people with learning disabilities or autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Safeguarding policies and procedures were in place to help protect people from harm and abuse. Staff understood how to raise safeguarding issues. People told us they felt safe living at the service. There were enough staff provided to meet people’s needs. Risks to people’s health and wellbeing were recorded and staff were aware of this information. People were protected by robust medicine management and infection control procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were met by staff who undertook induction and training to develop and maintain their skills. People’s dietary needs were assessed and monitored. Dietary concerns were reported to relevant health care professionals. People were supported to socialise, maintain family contact, undertake hobbies and go on holiday.

People’s needs were assessed, and person-centred care records were created for staff to follow. Care records detailed tasks people could undertake themselves to maintain their independence and goals people wished to achieve. Care reviews were held with people to check on progress. Staff contacted health care professionals for advice and support to maintain people’s wellbeing. People’s end of life wishes was recorded. End of life care could be provided at the service with support from relevant health care professionals.

The complaints policy was provided to people in a format that met their needs. No complaints had been received since the last inspection. People told us they were happy and had no complaints to raise.

We found an open and transparent culture at the service. People were asked for their views along with their relatives and staff. Feedback received was acted upon. The provider continued to look at how the service could be improved for people. Data was stored securely to maintain people’s confidentiality.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 February 2019).

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.

Beechcroft House is a bungalow on a residential estate and accommodates three people with learning disabilities. Beechcroft House also provides a supported living service, assisting people to live as independently as possible in their own homes. This service is run from a separate office. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider must review its registration to ensure the residential and supported living parts of the service can be counted as two separate locations. The registration section of the Care Quality Commission would not authorise a change in registration whilst the service was rated as inadequate. At this inspection, we found improvements in all areas so this change in registration can now be addressed.

People’s experience of using this service:

People were protected from the risk of harm and abuse. There were safeguarding procedures to guide staff in the action to take should they suspect abuse has occurred. The provider took appropriate action when they were informed of a safeguarding incident; this is still under investigation. Staff completed risk assessments to identify hazards and plan ways to reduce risk to people without being overly restrictive.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people to meet their health and nutritional needs. They contacted health professionals in a timely way and accompanied people to visit their GP, community nurse and dentist as required. People were supported to plan their menu, shop for ingredients and cook meals.

People were part of their community and accessed local venues of their choice for social activities, work and educational opportunities.

Staff were recruited safely and there were sufficient staff deployed to meet people’s assessed needs. People received their one to one support when this was funded by health or the local authority. People told us staff treated them well and the approach described by them, and observed by inspectors, was positive, friendly and professional.

Staff received training, supervision and support. This enabled them to feel confident and skilled when meeting people’s needs.

The provider had improved how the organisation was structured and managed to ensure more support for staff, better communication and a more systematic approach to monitoring quality. There was an open-door policy for people who used the service, staff and relatives. People were asked for their views and concerns or complaints were acted on.

Rating at last inspection:

Inadequate; last report was published on 25 July 2018. The service was placed in Special Measures, which meant we have re-inspected within six months of the publication date. At the last inspection, we rated three domains as inadequate; these were Safe, Effective and Well-led and there were multiple breaches of regulations. Whilst improvements have been made in each of these domains and the provider is now compliant with all regulations, we want to make sure these are sustained and have rated the service as Requires Improvement.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service and inspect in line with our re-inspection schedule and will return within a year from the publication date of this report or sooner if we receive information of concern.

The provider is registered to provide accommodation for people who require nursing or personal care at Beechcroft House. Beechcroft House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beechcroft House accommodates three people with learning disabilities in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider is also registered to provide personal care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a registered manager, who was also the provider. Throughout the report they are referred to as ‘registered manager/provider’. 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.

Just before the inspection, we received information of concern from the local authority safeguarding and commissioning teams. This was about how finances were managed for people who lived in Beechcroft House and about the implementation of specific care plans for people who received a supported living service. We had meetings with the local authority and they decided not to fund any new placements at Beechcroft House supported living service until further notice.

During the inspection, we found multiple breaches of regulations. These related to how the Mental Capacity Act 2005 was implemented, risk management, the safe management of medicines, staff training, one to one care provision, care planning and review, a poor quality monitoring system and poor managerial/provider oversight. Just before the inspection, the provider sought the advice and support of a consultant (referred throughout the report as ‘the consultant’) to guide them in making the required improvements.

As a result, 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Deprivation of Liberty Safeguards (DoLS) authorisations had lapsed and there was a poor understanding from staff at all levels regarding mental capacity legislation. Capacity assessments had not been completed appropriately. People who lacked capacity signed tenancy agreements they were unable to understand. There was poor recording of best interest decision-making.

The registered manager/provider lacked knowledge and specific skills required for their role. There was no structured quality monitoring in place in order to identify shortfalls and for learning to take place. Records were not always accurate and up to date and CQC had not always received notifications of incidents that affected people’s welfare.

The registered manager/provider had not completed a request for information called a ‘Provider Information Return’ when requested. This would have assisted us in planning the inspection.

Risk management required improvement. Some people had risk assessments but these required more information to help staff minimise risk. There were no environmental risk assessments completed for people who used the supported living service.

Medicines had not been managed safely and some staff, who gave medicines to people, had not received training.

Care plans did not provide enough information to guide staff in how to support people in the way they preferred, especially when they experienced anxious or distressed behaviour.

There were sufficient staff employed but the way the staff team was organised meant it was unclear if those people with periods of one to one care funded by the local authority, received the hours identified for them. Records also did not fully support the one to one care provision.

Staff had access to training courses but there were gaps in the records. There was also an over-reliance on on-line training, which limited staff’s opportunity to seek clarification or discuss issues to test their comprehension.

Despite the breaches in regulations, the people who received a service told us they were happy with the care staff and the care they received. It was clear the registered manager/provider and staff had built up good relationships with the people who used the service. Staff knew people and their needs very well.

Staff supported people to access a range of community facilities which helped to improve the quality of their lives.

Staff were recruited safely and employment checks carried out before they started work.

Staff had received training in how to safeguard people from the risk of abuse. In discussions, they could describe the different types of abuse and who they would report issues of concern to.

People’s health and nutritional needs were met. Staff supported people to access a range of community health care professionals. Staff supported people to maintain a healthy diet.

The provider had a complaints policy and procedure, although an easy-read version would enhance the ability of people to understand the process. This was mentioned to the provider to address. People who used the service told us they would complain if they were unhappy about anything.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection the service was supporting 3 people to live at Beechcroft House and providing personal care for 11 people living in their own homes under supported living arrangements.

There was a registered manager in place for 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.

People were protected from harm by staff who had received training on how to recognise and report issues of potential abuse. Staff had been safely recruited and checks had been carried out to ensure they were suitable to work with vulnerable people.

A range of training had been provided to ensure staff were able to safely carry out their roles. Staff completed an induction to the service and received on-going support and supervision to help support and develop their roles. Risks to people were assessed and management plans developed from these to ensure staff had information and knew how to support people safely. Staff knew how to administer medicines safely. Medication Administration Records (MARs) had been completed accurately.

Positive relationships existed between people who used the service and staff. Staff interacted positively with people and involved them in making decisions about their lives, to ensure they were happy with how their support was delivered. The service provided care and support to people to enable them to live fulfilled and meaningful lives. People’s support was very flexibly delivered to enable their individual needs to be met in a highly personalised way. People told us that staff treated them with kindness, dignity and respect at all times. Staff understood people’s individual needs well and supported them responsively to ensure they were able to develop their skills and achieve as much independence as was possible.

There was complaints policy to enable people’s concerns to be addressed and followed up when this was required. People were able to contribute their views and action was taken from feedback received, together with use satisfaction surveys to help the service improve and develop.

The registered manager understood their responsibilities and had extensive knowledge and experience to run the service. The registered manager demonstrated a strong value base and a desire to learn about and implement best practice throughout the service. Staff were very highly motivated and proud of the service which had an open and supportive culture. The service had developed and sustained outstandingly close links with external agencies to ensure people were able to transition smoothly between services and enable their individual needs to be met in a joined up way.

A quality monitoring system was in place to enable the quality of service delivered to be assured and enable improvements to be made. The registered manager and staff team demonstrated passion and commitment to providing the best care possible for people and celebrated their individual and personal achievements.

This inspection was carried out by one inspector over one day. We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. Due to the complex needs of some of the people who used the service, we were unable to gain some of their direct views. We therefore used a number of different methods to help us understand their experiences. This included observing how staff supported them, speaking with staff and checking people's records.

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

Is the service safe?

We saw people using the service were treated with respect and dignity by the staff who supported them. Care and support was delivered in a safe way by staff who had received appropriate training.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.

We saw robust background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people and children.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure people's human rights were protected. Relevant staff had received training on this to understand when an application should be made, and in how to submit one. This meant that people will be safeguarded as required.

Is the service effective?

We found people were encouraged to express their views and were involved in making decisions about their care and treatment. The staff we spoke with gave us examples of how people were involved in making decisions about their care and support.

People's health and care needs were assessed on a regular basis. We saw people who used the service and their relatives had been involved in the development of their plans of support and these were reviewed and updated.

Staff had received appropriate professional development. We saw they had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People told us they were supported by staff who were kind. We observed staff were sensitive to people's needs.

Care files contained information about people's needs and preferences. This included the people important in their lives and their personal aims. We saw care and support was provided in accordance with people's needs and wishes.

Satisfaction surveys and review meetings had been used to enable people to share their views on the service provided. This helped the provider to assess the quality of support people received.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs, outside agencies had been involved to make sure they received the correct care and support. For example, one person was attending regular hospital appointments for a complex health issue.

Records showed people had access to a variety of social activities. During our visit we saw people going out into the community supported by staff or participating in stimulation at the service.

The service had a complaints procedure which was available to people who used and visited the service.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and audits of the service provision. We saw action plans were in place to address identified shortfalls with these and progress was being made to address this.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

The service worked well with other agencies and services to ensure people received their care in a joined up way.

What people who used the service, and those that matter to them, said about the care and support they received:-

People who used the service told us staff were friendly. We saw care staff interacted with people positively to ensure they felt safe from harm.

Relatives told us they were, 'Very pleased' with the way support was provided and 'Quite satisfied' with the service provided. Another said their member of family was, 'Making good progress' and, 'Doing very well.'

We found a social worker had recently commented staff were, 'Polite and approachable' and that the home was 'Very warm and comfortable.' A specialist community health professional told us they had confidence in the provider and were, 'More than happy' with the service delivered.

People experienced care, treatment and support that met their needs and protected their rights. People we spoke with were positive about the care and support they received. They told us they were well cared for and were encouraged to be as independent as possible.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People living in the home confirmed they felt safe and said they liked the staff who looked after them.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People told us the staff cared for them and were respectful.

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. People we spoke with told us they were able to raise concerns with staff and felt confident that these would be acted upon.