Beaufort Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The overall rating for this key question is good; At our last inspection we identified people were not always being supported safely. At this inspection improvements had been made and safeguarding concerns were raised when needed. The service was managed by a registered manager, a clinical manager, nursing staff and there was a team of care staff, admin and housekeeping staff. Although people told us there were enough staff and we found an example where additional staff were provided to a person who was at risk of falling. We found one person who was observed on two occasions to potentially be at risk of falling. The registered manager took actions to address this during our inspection. They confirmed the person was now being supported with additional checks from staff and an alternative call bell so they could summon support. People felt supported by staff who knew them although we found some improvements were needed to people’s documentation such as to people’s risk assessments, mental capacity assessments and personal evacuation plans. People were supported to have visitors and personal protective equipment was available to staff. Health Care Professionals spoke positively about the care and support provided by staff that they felt was exceptional especially around end of life care. They described staff as helpful and polite.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt supported by staff. One person told us, “Staff are always very helpful.” Another person told us, “I can’t fault it really.” One relative told us how good the care was especially when their relative had been assessed as needing extra support from the staff due to an increase in them falling .

The registered manager confirmed they reviewed incidents and accidents and if needed they undertook reviews and further analysis of the incident so that any learning or improvements and actions could be taken. The registered manager undertook daily walk around’s within the home. These were an opportunity to review staff practice and the care people were receiving. Any learning from incidents were raised with staff through various meetings, this was so there was a culture of learning and improvement.

There was a system for staff reporting all incidents and accidents. These were uploaded onto the providers electronic system and included incidents, safeguarding’s, pressure sores, infections and falls. Any actions were taken such as any referrals, notifications, further reviews or investigations and these were reviewed by the regional director. The management was open and honest following incidents, and they recorded any outcome under the provider’s duty of candour as needed. The provider shared safety events with the registered manager when required.

People told us they were supported by staff who knew them. One person told us, “Yes, see the same staff.” One relative spoke highly of the safe care provided by staff and how the service liaised with professionals and the GP especially around changes to their medicines. People could have a weekly visit from the local GP and any changes to people’s individual needs could also be discussed at multi-professional meetings once a month.

Staff told us they felt able to raise any changes with people’s individual needs at the daily hand over meetings and with the clinical lead or registered manager if needed. One member of staff told us, “I can speak with the manager if needed and the nurses are brilliant.”

Three health care professionals provided us with feedback about the service. Comments included, “I have no concerns about the service and I’ve found staff to be helpful and polite.” Another health care professional told us that the support provided to people was of a high standard. Another professional felt the care provided was person centred.

The registered manager confirmed they worked in partnership with external agencies such as the GP, local care home liaison team, safeguarding team and the local authority team. This was to improve people’s care outcomes and ensure people were getting the care and support they needed including any referrals such as to the falls clinic or physiotherapist.

People felt happy with the support they received. One person told us, “I feel very relaxed.” Another person told us, “I am very happy here. Lovely people.” One relative told us, “There are two amazing nurses. They take amazing care of mum.” Another relative told us, “It is amazing care.”

Staff said people received safe care. All staff we spoke with felt able to raise concerns with the management of the service. Their knowledge of different types of abuse was good and they knew what to do if they had concerns.

We observed positive support provided to people from staff. People were asked if they wanted support and we observed staff interacting with people in a kind and relaxed manner. People had visitors and they could spend time in their rooms and various communal areas such as the bistro area.

The provider had effective systems, processes and practices to make sure people were protected from abuse and neglect. Staff had received training in safeguarding adults and mental capacity act training and the registered manager was aware when staff needed to undertake a refresher training. The manager completed safeguarding referrals and Deprivation of Liberty Safeguards (DoLS) when required. Notifications were sent to CQC and the local authority as needed. The registered manager kept a log of referrals made including any outcomes and actions taken. The Mental Capacity Act 2005 provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. Mental capacity assessments and best interest decisions were not always in place and up to date where people lacked capacity. For example, one person had no mental capacity assessment and best interest decisions for personal care and their diet being modified. Another person had information recorded in their mental capacity assessment that was inaccurate. We raised this with the registered manager who confirmed they would action these shortfalls.

People were supported to have their care needs met in a safe and supportive way. One person told us, “We do have a doctor who comes here, I have seen them a couple of times.” One relative told us how positive the support was when extra care was needed to support their loved one overnight. They said, “Total support was provided and the care was amazing.” Nursing staff undertook clinical observations when people’s needs needed monitoring and referrals were made to the GP or other professionals as required.

Staff felt able to discuss any changes to people’s individual needs or when they needed additional support. One member of staff told us, “We have a handover (each shift) we get an update on any falls or any problems.” Another member of staff told us, “I would ask the other carers for their support.” Another member of staff told us it was a whole home approach to supporting people. The nursing staff held clinical meetings so people’s individual needs could be reviewed, and any referrals made as required.

We observed staff supporting people in a relaxed respectful manner. People were asked if they wanted assistance or support and how they might like this. People were observed independently using walking sticks and frames to mobilise around the home and with staff support if they needed to use a wheelchair. Where people needed their diet modifying this was prepared as per their assessed need. Although we observed positive example’s of people being supported with their care we also observed one person who needed assistance from a member of staff on two separate occasions. They had not called for staff support and on both occasions, they were at risk of falling. We raised this with the registered manager who confirmed on the third day of our inspection actions they had taken to support the person.

Some people’s risk assessments needed updating following changes to their mobility and support needs. For example, one person needed their risk assessment updating following changes to the support provided by staff along with changes to their equipment. Another person needed their mental capacity assessment updating following changes to how their diet was modified. Risk assessments and care plans confirmed what support the person needed from staff. Body maps confirmed any changes to people’s individual skin and records confirmed people were being provided with their assessed support needs. Care plans contained personal evacuation plans for people such as what support they needed from staff and any individual needs they had around their mobility, and communication needs. One persons evacuation plan needed updating we raised this with the registered manager so they could review it was accurate.

People had access to call bells to summon for assistance. People told us they felt supported by staff. One person told us, “I can’t fault it really, nothing is too much trouble.” People were assessed for different equipment to support with their mobility needs when needed.

Staff told us people were reassessed for different equipment such as a hoist when they needed it. Staff had received moving and handling training.

The environment was clean and odour free. The communal areas were well presented and at lunch time, tables were nicely presented with tablecloths, fabric flowers and condiments for people to use.

The registered manager confirmed they reviewed any safety alerts within the service. Individual personal evacuation plans were in place although one person’s personal evacuation plan needed updating. These were available to staff in the office should they need to access them. Safety checks were undertaken for water, gas, electrical safety and portable appliances. People’s rooms were individually furnished and there were various lounge areas where people could spend their time listening to music, watching the television, playing the piano or relaxing in the sensory room. There were rummage boxes, various books and puzzles that people could also spend their time doing.

People and relatives told us they were happy with the support provided by staff. One person said, “They are very good on the whole.”

Staff felt there were enough staff and that if they needed additional support, they could ask nursing and other care staff from across the home. One member of staff told us, “There is always staff allocated. It’s a whole care home approach. Yes, there are enough staff.” Staff told us they had access to training, supervision and support. One member of staff told us, “I’ve had training in moving and handling, safeguarding, dementia, documentation and first aid.” They also told us staff helped each other as needed.

We observed some people who had not called for assistance needing support from staff. We also found on occasions call bells were left ringing from more than a few minutes before they were answered. The registered manager and regional director confirmed they continued to monitor the staffing levels in the service. Following observing one person needing assistance from staff the regional director confirmed the next day they had put in additional staff to support the person in this part of the service. Nursing staff and the clinical lead were also available to support people if needed.

The registered manager and regional director were responsible for reviewing if there were enough staff to support people with their individual needs. This was undertaken monthly or when required. The registered manager confirmed they were not using agency staff and they had one activities co-ordinator vacancy. Staff received training for example in Safeguarding Adults, Mental Capacity Act, Tissue Viability, Fire Safety, Data protection, Food Safety, Infection Control and Health and Safety. The service had volunteer staff. Although they felt supported by the registered manager there was no formal training or support provided. This is important as volunteers need to receive appropriate training and support to enable them to fulfil the requirements of their role and keep people safe. Staff felt supported and the registered manager undertook supervisions and appraisals which were an opportunity to support staff and discuss any areas of improvement. People were supported by staff who had suitable checks completed prior to working in the service. This included reference checks, identification checks and a disclosure and barring service check on their suitability to work with vulnerable adults. Staff were supported through staff meetings, individual supervisions and an annual appraisal.

People were supported to have vaccinations such as flu and Covid-19. The home was clean and odour free and nicely decorated.

Staff had access to personal protective equipment along with hand gel. Staff had received training in infection control.

Staff were observed wearing personal protective equipment such as gloves and an apron to support people with their lunch and hand gel was available for visitors and staff.

The registered manager sought advice from appropriate agencies when needed and staff could access personal protective equipment when needed.

People had their medicines administered by nursing staff and any changes were discussed on the GP round each week. One relative told us changes to the person’s medicines had been managed positively and the person had benefited from their medicines being reviewed. Although we observed medicines were administered safely, one medicine was not signed for after it had been administered. We raised this with the registered manager.

Nursing staff confirmed they were responsible for the safe administration of medicines to people and people had topical creams applied by care staff. Staff confirmed they had received training in the safe administration of medicines.

Medicines were stored safely, and body maps were in place where people had prescribed creams and pain patches administered. Daily meetings were an opportunity to review should people need to have any changes to their medicines or referrals made. Staff received training in the safe administration of medicines, and they had a competency check undertaken to ensure they were administering medicines safely.