About the service:

Homebeech is a care home registered to provide care and accommodation for 66 people with nursing and physical care needs. There were 44 people living at the service on the day of our inspection. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Since the previous inspection, sufficient improvements in relation to quality monitoring and governance had not been made. The provider still did not have effective quality assurance systems to ensure a good level of quality and safety was maintained.

Since the previous inspection, sufficient improvements in relation to staff training had not been made. Staff had received essential training. However, some staff had not received training in topics that the provider considered mandatory, and updated training for staff had not routinely gone ahead.

Since the previous inspection, sufficient improvements in relation to people being encouraged and supported to eat and drink well had not been made. Recording of people’s food and fluid intake was not always accurate.

Since the previous inspection, sufficient improvements in relation to person centred care had not been made. Care plans described people’s preferences and needs, including their communication needs. However, staff did not routinely follow people’s agreed plans of care.

Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately. However, the provider’s audits of medicines had not routinely picked up gaps and omissions in medicines records.

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were treated with dignity and respect, and they were encouraged to be as independent as possible. However, confidential information relating to people’s care was not always stored securely.

Systems were in place for the recording of incidents and accidents. They were monitored and analysed over time to look for any emerging trends and themes.

People were cared for in a clean and hygienic environment. Appropriate procedures for infection control were in place. The provider carried out routine audits of infection control procedures.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

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

There were sufficient staff to support people. People felt well looked after and supported. We observed friendly relationships had developed between people and staff.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

Healthcare was accessible for people and appointments were made for regular check-ups as needed. People’s end of life care was discussed and planned and their wishes had been respected.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘ope

We inspected Homebeech on the 19 and 26 June 2018 and 25 September 2018.

In February 2016, we undertook a comprehensive inspection of this service and found breaches of regulations in relation to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. We undertook an unannounced comprehensive inspection of this service on 28 February and 30 March 2017. At the inspection we found that insufficient improvements had been made in relation to these three breaches of regulation. The service was rated as Requires Improvement in each domain and overall. As a result of our findings at the inspection, we took enforcement action and issued three Warning Notices on 4 April 2017, against each regulation, to the provider and to the registered manager.

Details of each breach were stated to the provider and registered manager in each Warning Notice. Regulation 12: Risks to people had not been identified or assessed adequately to ensure staff received guidance on how to support people safely. Records were not always reviewed consistently to ensure people's most up to date needs were met or communicated to staff. Premises were not always managed to keep people safe. Regulation 10: Not all staff displayed a caring attitude and several instances were observed when staff ignored people. Some people and relatives gave negative feedback about the care and support from staff. Regulation 9: Activities on offer to people had not been organised to reflect people's interests or to provide mental stimulation. Systems were not in place to ensure that records relating to people's care were accurate or contemporaneous.

We also found that the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns that the provider had not ensured that effective systems and processes were in place to assess, monitor and improve the quality and safety of the service. The provider’s audit systems were not effective in demonstrating action had been taken regarding identified shortfalls. In addition, systems were not in place to demonstrate the service operated effectively to ensure compliance with the Regulations.

We undertook a focused inspection on 30 July 2017 to check that the provider had met their legal requirements and the provider and registered manager had met the Warning Notices served under Section 29 of the Health and Social Care Act 2008. We found that improvements had been made and the requirements of the three Warning Notices were met. However, further work was needed to sustain the improvements already implemented and to drive continuous improvement.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had sustained the improvements and to confirm that the service now met legal requirements. We found the provider had not sustained improvements and were in breach of Regulations.

Homebeech is a ‘care home’. 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.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. It is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. On the day of our inspection there were 50 people living in the service, who required varying levels of support. Homebeech is arranged into three units. The main part of the home called 'Oakside', but commonly referred to as 'Homebeech,' supports people who have health care needs. Daffodil unit is f

This inspection took place on 3 July 2017 and was unannounced.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. Homebeech is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. At the time of our inspection, 48 people were living at the home. Homebeech is arranged into three units. The main part of the home called ‘Oakside’, but commonly referred to as ‘Homebeech’, supports people who have health care needs. Daffodil unit is for people under the age of 65 years who have a range of physical disabilities. Beechside unit is a secure unit that accommodates nine people living with dementia. The main part of the home comprises a large sitting room and dining room, with an adjacent conservatory. A further sitting room is available to people on the ground floor. The Beechside unit has separate facilities, including a lounge and dining area. All bedrooms have a toilet and sink ensuite. Accommodation is provided over three floors and lifts enable easy access. People have access to outdoor spaces.

In February 2016, we undertook a comprehensive inspection of this service and found breaches of regulations in relation to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. We undertook an unannounced comprehensive inspection of this service on 28 February and 30 March 2017. At the inspection we found that insufficient improvements had been made in relation to these three breaches of regulation. The service was rated as Requires Improvement in each domain and overall. As a result of our findings at the inspection, we took enforcement action and issued three Warning Notices on 4 April 2017, against each regulation, to the provider and to the registered manager.

Details of each breach were stated to the provider and registered manager in each Warning Notice. Regulation 12: Risks to people had not been identified or assessed adequately to ensure staff received guidance on how to support people safely. Records were not always reviewed consistently to ensure people’s most up to date needs were met or communicated to staff. Premises were not always managed to keep people safe. Regulation 10: Not all staff displayed a caring attitude and several instances were observed when staff ignored people. Some people and relatives gave negative feedback about the care and support from staff. Regulation 9: Activities on offer to people had not been organised to reflect people’s interests or to provide mental stimulation. Systems were not in place to ensure that records relating to people’s care were accurate or contemporaneous.

We undertook this focused inspection to check whether these three regulations had been met. This report only covers our findings in relation to the topics written about in the preceding paragraph. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Homebeech on our website at www.cqc.org.uk

A registered manager was 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.

Concerns relating to premises arising out of the last inspection had been addressed. However, at this inspection, maintenance staff working at the home had left the door to the boiler room unlocked and radiator covers were not affixed to walls, which meant that parts of the home were unsafe. Risk assessments had been improved and provid

The inspection took place on 28 February and 3 March 2017 and was unannounced.

The last inspection took place on 11 February and 9 March 2016. As a result of this inspection, we found the provider in breach of three regulations relating to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. At this inspection, we found that insufficient improvements had been made and that these three regulations were still not met. We are in the process of considering our regulatory action to respond to this and will publish the action we have taken. In addition, we found one further breach of regulations.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. Homebeech is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. At the time of our inspection, 51 people were living at the home. Homebeech is arranged into three units. The main part of the home called ‘Oakside’, but commonly referred to as ‘Homebeech,’ supports people who have health care needs. Daffodil unit is for people under the age of 65 years who have a range of physical disabilities. Beechside unit is a secure unit that accommodates nine people living with dementia. The main part of the home has a large sitting room and dining room, with an adjacent conservatory. A further sitting room is available to people on the ground floor. The Beechside unit has separate facilities, including a lounge and dining area. All bedrooms have a toilet and sink ensuite. Accommodation is provided over three floors and lifts enable easy access. People have access to outdoor spaces.

A registered manager was in post and their registration had been completed recently. Prior to their appointment, the registered manager post had been filled by the person who is now the senior 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 2008 and associated Regulations about how the service is run.

People were at risk of unsafe care or treatment because risk assessments did not provide sufficient information and guidance for staff on how to support people safely. People’s risk of malnourishment was not managed consistently nor were regular assessments carried out. Referrals were not always made to healthcare professionals in a timely manner where people had sustained falls. We observed instances of poor communication relating to moving and handling. Premises were not always managed to keep people safe.

Staff did not always treat people with dignity and respect. We observed occasions when people were either not listened to or ignored. People and their relatives had mixed views about the care and support provided by staff. Staff did not always treat people in a warm and caring way.

An activities co-ordinator arranged activities for people on a daily basis, but these did not reflect people’s interests or hobbies. Some people felt the same activities were offered every day, such as jigsaws, painting or colouring. No programme of activities was on display and a record to confirm group activities had taken place had not been completed since October 2016.

People were at risk of not receiving personalised care that was responsive to their needs. Care records were inaccurate or incomplete and documents relating to people’s individual care needs were not kept in one place. Some care plans were printed off and located in people’s rooms, some assessments were stored electronically and other records were

Homebeech is a nursing home registered to provide accommodation, personal care and nursing care for up to 62 people. They catered for a wide range of needs including care for older people, people living with dementia, and adults with physical disabilities, all of whom required nursing care. At the time of our inspection there were 57 people living at the home. Within the home there were three areas arranged by people’s needs. The main part of the home supported older people with nursing needs while Daffodil supported younger adults and Beechside provided support to people living with dementia.

The service had a 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 2008 and associated Regulations about how the service is run.

Risks to people’s health and safety were assessed prior to admission and were regularly reviewed. We found however that there was not always sufficient detail to tell staff what action should be taken when risk is identified, particularly in relation to malnutrition risk. Risk assessments stated that the aim was to reduce the risk of weight loss and dietician contact details were in place, but there was no information on when staff should take action in response to body mass index (BMI) data or weight loss. There was a risk that people may not receive appropriate support to mitigate the risk of weight loss and malnutrition.

People had mixed responses when asked about the caring manner of staff. One person told us, “There’s a percentage of staff that don’t speak”. From our observations staff did not always respond in a caring way towards people.

People told us they did not feel there were enough activities, commenting “There’s nothing to do”, and “That’s something we could do with more of”. While people’s social needs were assessed there was a lack of activities or opportunities for people to be occupied in a meaningful way and in line with their interests.

Staff were aware of their responsibilities in relation to keeping people safe. Staff felt that reported signs of suspected abuse would be taken seriously and knew who to contact externally should they feel their concerns had not been dealt with appropriately.

People told us staff responded to them when they needed help and were not left waiting. For example one person said, “I’ve never had to wait. The staff are very good. If they are busy with other jobs they say, ‘I will be five or ten minutes’.

Safe recruitment practices were in place and records showed appropriate checks had been undertaken before staff began work.

Staff had undertaken appropriate training to ensure that they had to skills and competencies to meet people’s needs. There was a formal supervision and appraisal process in place for staff and action which had been agreed was recorded and discussed at each supervision meeting.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) had been adhered to.

People’s hydration needs were met. Fluid charts were used to ensure that people received enough to drink. People received enough to eat and drink. People spoke positively of the food and the choice they were offered.

Relatives told us they felt staff made them feel welcome and made time to speak with them about any changes to their relative’s health or the care they received. A relative told us, “They always say hello and give a smile”.

People received care that was responsive to their needs and included information on their life history. People’s care plans were reviewed

Homebeech is a care home registered to provide accommodation and nursing care for up to 66 people. They include elderly people, elderly people with dementia and people with physical disabilities who require nursing care. We were informed that, at the time of our visit, 55 people were accommodated.

This inspection was carried out by an inspector who was accompanied by an expert by experience.

We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at a selection of records.

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

Is the service safe?

There were enough staff on duty, including nursing staff, to meet the needs of the people living at the service.

The provider had effective recruitment and selection processes in place to ensure staff employed at the service were appropriately screened before the worked with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were advised three DoLS applications had been made. Documentary evidence we looked at indicated applications made met the necessary criteria.

Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty.

There was a system in place to make sure that the manager and staff learned from events such as falls, accidents and incidents.

Is the service effective?

The provider demonstrated people were asked for their consent before care and treatment had been delivered and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

From our observations people were satisfied with the care that had been delivered and their needs had been met. A relative told us, "Staff are lovely and friendly. My family member is happy; they (the staff) are quite accommodating. They can change plans, like if I take my relative out to lunch on impulse.”

It was clear from the majority of our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew how to provide for them.

People's health and care needs had been assessed and reviewed. Care plans had been drawn up. They included detailed information to ensure staff delivered care consistently to meet people's needs.

Is the service caring?

Care records included information about individual needs and guidance for staff to follow to ensure they had been met.

People were supported by kind and attentive staff. We saw that the staff showed patience and gave encouragement when supporting people.

We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person.

Care was delivered in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

Relatives and friends of people using the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

A relative told us, "I see the manager about issues and they are dealt with."

Is the service well-led?

The manager held staff meetings every three months. The manager has used them to communicate issues related to the day to day running of the home.

Staff we spoke with were clear about their roles and responsibilities.

Staff also demonstrated they had a good understanding of the ethos of the home.

Staff informed us they felt well supported by the management team.

We spoke with nine people living in the home, five staff, the manager and two relatives. We also spoke with one health professional.

People told us they were happy in the home and that they had choices. One person told us "Life here is lovely". Another told us "I am very, very happy here".

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us " I am very comfortable here and I am happy with the way care is given"

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 were looked after by a well trained and supported staff.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We spoke with eight people and three relatives in the home. All of the comments made to us were positive with people telling us they were happy in the home, were well cared for and enjoyed the activities.

Due to their disabilities some of the people who had dementia were not able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. This tool allows us to spend time watching what was going on in a service and helps us to record how people spent their time, the type of support they get and whether they have positive experiences.

We spent 30 minutes observing care and support provided to six people before and during lunch in the dementia unit. We found that people generally had positive experiences and good interactions with care staff. We also spent 15 minutes observing care and activities in another sitting room for elderly people and 15 minutes in the sitting room of the physical disabilities unit. These people also had positive interactions with staff and with each other.

Three relatives told us they were very happy with the care offered to people in the home. They also told us about activities and entertainments that had been provided. One relative told us that they “were very happy with the home and that the manager was approachable.

We spoke with five members of staff. They demonstrated they knew how care was to be delivered to each person to ensure their wishes and preferences had been respected. They told us that they felt well supported by the manager.

We were in receipt of information from relatives who had some concerns about the care offered in the home. We spoke to West Sussex County Council and they did not share these concerns.

A Community Nurse and Dietician were spoken to and they stated that they were happy with the care in the home, that they are called in appropriately, that instructions are followed correctly. The Dietician further stated that equipment used in the care of people under her care is maintained and clean.

People spoken to on the day of the visit and their relatives were very happy with the care stating that staff are kind and respectful and always ready to listen. One person stated that the staff are friendly and have a laugh and a joke with people. Another person stated that long term staff are best as they know more. People spoken to stated that they are consulted on day to day life and meal choices. All people spoken to knew what was being served for lunch on the day.