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Beech Lawn Nursing and Residential Home, Liskeard.

Beech Lawn Nursing and Residential Home in Liskeard is a Nursing home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, dementia, diagnostic and screening procedures, mental health conditions, physical disabilities and treatment of disease, disorder or injury. The last inspection date here was 19th July 2019

Beech Lawn Nursing and Residential Home is managed by Beech Lawn Care Limited.

Contact Details:

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Requires Improvement
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2019-07-19
    Last Published 2017-01-07

Local Authority:

    Cornwall

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

23rd November 2016 - During a routine inspection pdf icon

The inspection took place on 23 and 24 November 2016 and was unannounced.

We last completed a comprehensive inspection of Beech Lawn Nursing and Residential Home on the 14 and 15 October 2015. Breaches of legal requirements were found and enforcement action was taken. This was because the legislative framework of the Mental Capacity Act 2005 (MCA) was not being met and the systems in place to assess and monitor the quality of service people received were not effective. Action was also required to ensure people had up to date care plans and risk assessments that reflected their needs and preferences which were reviewed regularly; and to ensure nursing competency was being assessed and there were enough staff to meet people’s needs.

We asked the provider to send us an action plan on how they were going to put these right. We returned to the service on 12 January 2016 to check whether the requirements had been met in relation to the enforcement action we had taken regarding the MCA and how the provider monitored the quality of the service. At that inspection we found improvements had been made. However, we found a breach of regulation as requirements relating to the legislative framework of the Mental Capacity Act 2005 (MCA) were still not always being followed.

At this inspection we also checked whether improvements had been made regarding the concerns identified at the previous comprehensive inspection on 14 and 15 October 2015 and we found improvements had been made.

Beech Lawn Nursing and Residential Home provides nursing and residential care for up to 44 older people who require support in their later life or are living with dementia. On the day of the inspection 29 people lived in the home.

A manager was employed to manage the service. They were in the process of registering with CQC and had been in post for two months. 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.

The manager and staff had attended training on the Mental Capacity Act 2005 (MCA) and staff’s understanding of the MCA and how it affected the way they supported individuals, had improved. During the inspection, most MCA assessments were in place. Following the inspection, the manager confirmed MCA assessments had now been completed for everyone who lacked capacity.

Since the previous inspection where improvements were found, audits had not always been carried out in line with best practice. Where audits had been completed, it was not clear whether action had been taken regarding any concerns identified. The new manager had put an annual schedule of audits in place and assured us any areas for improvement would be acted upon.

People had care plans in place which included detail about their needs but not always about their preferences. The manager told us they were reviewing people’s care plans to include information from people, those important to them and staff who knew them well. People and staff confirmed they knew and respected people’s preferences.

People had up to date risk assessments in place to help reduce any risks related to people’s care and support needs. Guidance for staff to help mitigate risks to people was recorded in people’s care plans. Staff told us they were regularly asked for their opinions regarding whether people’s support could be made safer in any way.

People and staff told us there were sufficient numbers of suitably qualified staff to meet their needs.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. The recruitment process of new staff was robust.

People

12th January 2016 - During an inspection to make sure that the improvements required had been made pdf icon

We carried out an unannounced comprehensive inspection of this service on 14 and 15 October 2015. Breaches of legal requirements were found and enforcement action was taken. This was because people’s freedom was not always supported or respected and the provider’s systems in place to monitor the quality of service people received were not effective.

After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to our enforcement action. We undertook this focused inspection on 12 January 2016 to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Beech Lawn Nursing and Residential Home on our website at www.cqc.org.uk

Beech Lawn Nursing and Residential Home provides nursing and residential care for up to 44 older people who require support in their later life or are living with dementia.

There were 35 people living at the service at the time of this inspection. The service is on two floors, with access to the upper floors via stairs, chair lift, or wheel chair lift. Some bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets, two lounges, and three dining rooms. There is an outside patio area with seating.

The registered manager for the service had recently resigned and was leaving on 14 January 2016. A new manager had been employed to replace the existing registered manager, and informed us an application for registration with the Care Quality Commission would be submitted shortly. 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’s mental capacity was being assessed in respect of some areas of their care, such as the use of bed rails and consent to care and treatment. This helped to ensure decisions were being made in line with people’s wishes. However, people’s care plans did not always provide guidance and direction for staff about how to support people when they did not have the capacity to make decisions for themselves. This meant decisions may not always be made in people’s best interests. However, training was being arranged to ensure the registered manager and staff had a better understanding of how the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. A computerised care planning system was being implemented, and would help to prompt staff to complete mental capacity assessments when necessary. People who may be deprived of their liberty had been assessed.

Monitoring systems had and were continuing to be devised, implemented and improved to help ensure the quality of the service people received was effective and meet their needs. The provider visited the service on a weekly basis and had introduced a management report which would help highlight areas of concern, in respect of staffing, the environment and documentation. The new manager had a good understanding of the importance of monitoring the service. People, their family and loved ones were being encouraged to be part of care planning reviews, and informed about how to provide feedback about the service they were receiving.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

18th November 2015 - During an inspection to make sure that the improvements required had been made pdf icon

We inspected Beech Lawn on 18 November 2014, the inspection was unannounced. We last inspected Beech Lawn Nursing and Residential Home on 18 August 2014. At that time there were no concerns in the areas we looked at.

Beech Lawn is a care home for older people who require nursing and personal care. It provides accommodation for up to 44 people. At the time of the inspection there were 37 people living at the home.

There was no registered manager at Beech Lawn. The matron, who had been in post since June 2014 and was working as a nurse on regular shifts at the home. The matron had an application in process to

had an application in process to become the registered manager. 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 and associated Regulations about how the service is run.

Staff working at the home understood the needs of people they supported. Visitors reported a good relationship with the staff and management who were approachable. However, we noted it was not recorded in care records when people and their families were involved in the planning and review of their care.

The matron had not been in post long and was keen to develop the service. However she was required to work on the floor for much of the time and was limited in how proactive she could be in identifying and dealing with issues. There were quality assurance systems in place to monitor the service but risks were not always identified or action taken to minimise risk.

The matron had not identified the concerns found at this inspection. Staff did not attend regular updates of training such as safeguarding adults and infection control. People’s care and medicine records were found available in corridors and lounge areas and were not kept securely.

The atmosphere was friendly and staff and people living at the home were relaxed in each other’s company. People told us they liked being at the home and were happy living there. People told us the staff were “very good” and “very kind,” they had no complaints.

The premises comprised of three wings. The original house had been extended in 2007 – 08 to add a new nursing care wing. People who used the home for residential care only had their bedrooms in the upper floor of the original building. There was a choice of areas for people to spend time with visitors, take part in activities, or spend time on their own. We saw many people were cared for in bed and did not leave their bedrooms. There was an enclosed outside courtyard for people to enjoy.

During our inspection we observed people looked well cared for and their needs were met quickly and appropriately. Staff addressed people politely and respectfully using their preferred name. We saw staff speak with people as they provided care and as they passed by throughout the inspection. People told us, “I am quite happy here,” and “We just sit and watch the television and chat.”

The matron and staff had developed positive contacts with other professionals who ensured effective care delivery for people whenever they needed or wanted it.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

18th August 2014 - During an inspection in response to concerns pdf icon

We gathered evidence against the outcomes we inspected to help answer one of our five key questions: Is the service safe? We gathered information from people who used the service by talking with them, their relatives and an external health professional.

This is a summary of what we found-

Before our inspection we received some anonymous information of concern about the service. The information related to concerns that the provider was not meeting people’s continence care needs, and a lack of staff was affecting the safe and effective care of people who lived at Beech Lawn.

Is the service safe?

At the time of our inspection we found the service to be safe.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

People who lived at Beech Lawn were complementary of the care and support they received, comments included, “very very good” and “good as gold, everybody…I don’t think there is anybody I could say is not”. Some people told us that there had been problems with the ordering and receiving of their allocated continence pads, people confirmed that this had at times caused them to feel uncomfortable.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People who lived at Beech Lawn told us that the staff were kind and caring. However, some comments indicated that people felt there was a lack of staff. For example we were told, “yes they are a bit short”, “if there is a shortage of staff they tell me” and “to me there is a shortage of staff”.

4th December 2013 - During a routine inspection pdf icon

We carried out the unannounced visit as part of our planned schedule of inspections. At the time of the visit Beech Lawn was providing care and treatment to thirty five people.

We spent time in the office looking at records with the manager and the majority of time we talked with seven people who used the service, two relatives and eight members of staff and the manager.

We spoke with one person and asked them about what they liked about living at the home. They said "staff are marvellous and I am very satisfied with the care I receive" another person said "we have choices in everything we do and the meals are good"

We spoke with two relatives who visited daily. They were full of praise for the service their relatives received. They made comments to us such as "staff are marvellous", "I see everything going on each day and I can't fault them".

We spoke with eight members of staff about a variety of topics including the training and support they received, how they respect people's privacy and dignity and how they kept people safe. One member of staff explained in detail how they would ensure the privacy and dignity of people they cared for and said "I would always explain what I am doing and cover people up with towels to protect their dignity", I asked another member of staff how they offered choices to people, they replied "in the morning I ask people what they want to wear".

14th January 2013 - During a routine inspection pdf icon

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We spoke to three visitors who told us that they were pleased their relative lived at Beech Lawn. We spoke to people who used the service and spent time observing people and staff over a meal period. We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

During the observations we saw staff help two people to mobilise. We also saw staff conversing with people when they were laying up tables for lunch. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interaction with people which was generally positive. People told us staff answered call bells promptly. They said the staff were “polite, good girls”. People told us the food was good and they were offered choices. One person said “I can watch TV through the night if I wake up”.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.

21st January 2012 - During a routine inspection pdf icon

People we could talk to told us that the staff were “lovely”, “nice” and “come quickly when you call the bell”.

People said “they (the staff) are lovely” and “very good”. One person had said that a piece of equipment was uncomfortable and so the staff had changed it and it was now much better.

People told us about the activities that are available and which ones they enjoyed. Some people had their own DVD players and we were told that the staff were happy to change the films in them at the person’s request.

We saw that people who use the service were happy to approach any member of staff and that they were asked if they were alright or if they wanted help with anything. Some people told us that they would be happy to talk to staff members if they had any concerns.

The four staff we spoke to said that they enjoyed working at Beech Lawn Nursing and Residential Home.

Staff told us that there are plenty of training opportunities and that they can approach the registered manager and deputy manager/clinical lead nurse with any concerns or issues they may have.

1st January 1970 - During a routine inspection pdf icon

This was an unannounced inspection on 14 and 15 October 2015. Beech Lawn Nursing and Residential Home provides nursing and residential care for up to 44 older people who require support in their later life or are living with dementia.

There were 35 people living at the service at the time of our inspection. The service is on two floors, with access to the upper floors via stairs, chair lift, or wheel chair lift. Some bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets. Communal areas include two lounges, and three dining rooms. There is an outside patio area with seating. The care home is a short walk from the main town and shops.

The service had a registered manager in post. 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.

At our last inspection in November 2014 we told the provider to take action to make improvements to how they ensured people consented to their care, how the quality of the service was monitored, and how records relating to people’s care were documented and kept confidential. Improvements were also required to ensure the management of medicines was safe, people’s human rights were protected by the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards, training and supervision of staff was undertaken, safe recruitment process were followed, and systems were in place to protect people from avoidable harm or abuse. The provider sent us an action plan confirming how improvements were going to be made and advising us that these improvements would be completed by May 2015. On 18 May 2015 the provider confirmed the action plan had been completed and requested a follow up inspection. During this inspection we looked to see if these improvements had been made. We found they had not all been completed.

People told us staff were kind and caring, and treated them with respect. Relatives told us they were happy with the care their loved ones received. People and their relatives told us there were not always enough staff. There were nursing vacancies at the service and the registered manager had been covering shifts which had impacted on the management of the service. Social activities were limited which meant some people did not have much to occupy themselves.

People were supported to eat and drink enough and maintain a balanced diet. The chef was knowledgeable about people’s individual nutritional needs. People who required assistance with their meals were supported in a kind way. People’s care plans did not always provide detail to staff about how to meet people’s individual nutritional needs. People were at risk from staff not knowing if they had lost weight, because people’s weights were not reviewed and some people were not being weighed.

People felt safe. The registered manager and staff understood their safeguarding responsibilities and had undertaken training. People did not always have a call bell in reach to alert staff if they needed assistance. People were protected by safe recruitment procedures as the registered manager ensured new employees were subject to necessary checks which determined they were suitable to work with vulnerable people.

People were not protected from risks associated with their care because staff did not have the correct guidance and direction about how to meet people’s individual care needs. Accidents and incidents were not robustly analysed to help prevent them from occurring again. People did not always have a personal evacuation plan in place, which meant people may not be effectively supported in an emergency. People’s specialist equipment, which was in place to meet their individual needs, was not always effectively monitored to ensure it was working correctly.

People’s mental capacity was not always being assessed which meant care being provided by staff may not have always been in line with people’s wishes. People who may have been deprived of their liberty had not always been assessed. The registered manager and staff did not fully understand how the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. People’s consent to care and treatment had been obtained and recorded in their care plans. Staff asked people for their consent prior to supporting them.

People did not always have care plans in place to address their individual health and social care needs. People’s care plans were not always reflective of the care being delivered. People were not involved in the creation of their care plan. People’s preferences for getting up and going to bed, were not recorded so staff were unaware of what people’s wishes were. People’s care plans to minimise the risk of pressure sores were not always followed. Care records in relation to nursing care were not always reflective of people’s care plans. People’s changing care needs were referred to relevant health services. External health professionals did not have any concerns and explained they were contacted appropriately when required.

People’s end of life wishes were documented and communicated. This meant people’s end of life wishes were known to staff. People’s medicines were managed safely.

People’s confidential and personal information was stored securely and the registered manager and staff were mindful of the importance of confidentiality when speaking about people’s care and support needs in front of others.

People living with dementia were not always appropriately supported in a person centred way. People’s care plans did not address dementia care needs and demonstrate how they would like to be supported.

People told us if they had any concerns or complaints they felt confident to speak with the staff or registered manager. People were being asked if they would like to attend residents meetings to provide their feedback about the service, and to help ensure the service was meeting their needs as well as assisting with continuous improvement.

People received care from staff that had been given training and supervision to carry out their role. However, nursing staff had not been formally supervised because the registered manager had not had time. Staff felt the registered manager was supportive. Staff felt confident about whistleblowing and told us the registered manager would take action to address any concerns

The registered manager was unable to manage the service effectively because there were not enough nursing staff. The registered manager did not receive effective support from the provider.

The registered manager did not have effective systems and processes in place to ensure people received a high quality of care and people’s needs were being met.

The Commission was notified appropriately, for example in the event of a person dying or experiencing injury. The registered manager had apologised to people when things had gone wrong. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

 

 

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