About the service: Beech Lodge is a residential care home that was providing personal and nursing care to 25 people at the time of the inspection.

People’s experience of using this service:

¿ Arrangements for the management of medicines were not robust. Some people had not received their medicines as prescribed. Medicine Administration Records (MARs) were not completed in line with NICE guidelines.

¿ Staff completed an induction when starting work at the service which consisted of familiarising themselves with working practices and policies and procedures. Training was not routinely provided.

¿ The service was short staffed and agency staff were regularly used to meet people’s care needs. However, there were occasions when the number of staff on duty was lower than the levels identified as necessary to meet people’s needs. Staff told us their main concern was staffing levels and they were often rushed.

¿ Systems for checking new employees were suitable for working in the care sector were not robust.

¿ People had limited access to meaningful activities, there was no member of staff with responsibility for organising activities. Staff told us they did not have time to organise activities regularly.

¿ Restrictions were in place in order to keep people safe. Applications to authorise the restrictions had not been made in line with legislation laid down by the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. There was no evidence to demonstrate decisions made on behalf of people who lacked capacity to make their own decisions had been taken in their best interest and were proportionate and the least restrictive option.

¿ Risk assessments were in place to identify when people were at risk due to their health needs. There was a lack of guidance for staff to help them support people whose anxieties sometimes put them, and others at increased risk.

¿ The premises were clean and well maintained. Staff were aware of processes to reduce the risk of cross infection. There was some signage to support people to move around independently. There was limited storage space and equipment was kept in corridors. Access to outside areas was difficult for people with mobility problems.

¿ Care plans were comprehensive and regularly reviewed. Daily notes provided a record of the care people had received. Monitoring records were consistently and meaningfully completed.

¿ People were treated with care, consideration and respect. People’s diverse needs were known to staff and no-one was discriminated against. Staff regularly checked on people who chose to stay in their rooms.

Rating at last inspection: Good (Report published 28 June 2018)

Why we inspected: This inspection was brought forward due to information of risk or concern received by CQC. The concerns were in respect of the management of medicines, a shortage of continence aids leading to undignified practices, infection control, staff training, and a failure to follow legislation laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS).

We issued breaches of the regulations. Please see the end of the report for details of the action we have told the provider to take.

Follow up: We have asked the provider to send us an action plan detailing how they will make improvements to the service.

We carried out an unannounced inspection of Beech Lodge on 12 June 2018. Beech Lodge is a ‘care home’ that provides care for a maximum of 26 adults. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 16 people living at the service.

The service is on three floors with access to the upper floors are via stairs, stair lift or a passenger lift. Existing bedrooms on the top floor of the premises had been upgraded and additional rooms had been added in a new extension. At the time of the inspection the top floor was not in use, while these improvements were underway. These works were due to be completed a few weeks after our visit. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 25 May 2017. In May 2017 we found most people did not have a care plan or risk assessments in place. All information about people’s needs were communicated verbally between staff and this meant there was a risk that people might not receive consistent care and support. There were discrepancies in medicines records and a lack of analysis of falls. Audit processes were not effective and systems for assessing and reporting risks to senior management had not been followed.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good overall.

Care records were personalised to the individual and described how people wished to be supported. They contained detailed information to enable staff to provide appropriate and effective care and support. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. For example, guidance for staff when using moving and handling equipment, how to support people who could become anxious or what actions to take to help people who were at risk of falls.

There were effective quality assurance systems in place and audits were routinely completed. These included audits of care plans, risk assessments and medicines. Accidents and incidents, such as falls, were analysed and where necessary changes were made to learn from events or seek specialist advice from external professionals. Systems for the registered manager to report appropriate information to senior management, about the running of the service, were robust.

Safe arrangements were in place for the storing and administration of medicines. Medicine administration records (MARs) were clear and there were no gaps. Records of medicines tallied between the stock of medicines held and what had been recorded as given.

We also found there was limited opportunity for people to take part in meaningful activities. There had been a vacancy for the post of activities co-ordinator for several months due to difficulty in recruiting to the post. This had resulted in the ceasing of most of the group activities. While external entertainers visited the service, about once a month, there were no other organised activities taking place. Pe

We carried out this unannounced inspection on 25 May 2017. This was the first inspection for the service since registering under a new provider in late December 2016. Beech Lodge is a care home which is registered to provide personal care for up to a maximum of 26 older people, some of whom had a diagnosis of dementia. On the day of the inspection there were 14 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run. There was also a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

The service had been operating under new ownership for five months, since December 2016. In that time many improvements had been made to the environment. There was extensive building and repair work in progress to the exterior of the premises at the time of our inspection. Any disruption to people’s lives, while the refurbishment was being completed, had been well managed. People lived in a pleasant environment because the premises were uncluttered, clean and odour free.

The layout of the building had been re-structured and this had resulted in a change of use for two downstairs bedrooms. There was also extensive work being carried out to the top floor, both to make some areas safe and to extend and improve the facilities on that floor. This meant two people who had bedrooms on the ground floor and one person who had a bedroom on the top floor being moved to other rooms. While one person was happy with the move, two people were not and told us they had not been consulted about the move. Their comments included, “I wasn’t asked or given a choice. I don’t like this room as much as my other room upstairs” and “I wasn’t asked about moving room, just told that my room was needed for another use”.

While there was no evidence that people‘s needs were not being met most people did not have a care plan of their needs in place. Of the 14 people living at the service only two had a care plan and both of these were still being developed so needed more detail. Staff told us all information about people’s care needs was given to them verbally and new staff were given information, when they started, from existing staff. However, most staff had been recruited in the last three to four months so any new staff were being inducted by staff who also had not been working in the service for very long. One care worker told us, “I was told when I started that there were no care plans so I would have to ask other staff.” This meant there was a risk that staff would not know how to provide the right care for people because there was a lack of written records about people’s needs for staff to follow.

Some risk assessments had been completed to assess the level of risk in relation to areas such as nutrition and the risk of people developing pressure sores. However, where these had been completed there was a lack of guidance for staff about how to manage these risks. There were no individual risk assessments in place in any of the care files we looked at. For example, guidance for staff when using moving and handling equipment, how to support people who could become anxious or what actions to take to help people who were at risk of falls.

When incidents or accidents occurred these were recorded. However, these records were not audited to identify any patterns or trends which could be addressed, and subsequently reduce any apparent risks. For example, when people had repeated falls and where people or staff had sustained an injury.

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