CQC report explained · a residential care home
What the CQC found at Beachview
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2024
Rated Inadequate; inspectors found serious concerns about safety, staffing, medicines and leadership.
This was an unannounced focused inspection. Inspectors visited on 14 March and 25 March 2023, with a medicines visit on 20 April. They spoke with people, staff, relatives and professionals. They reviewed care records, medicines records, staffing and management systems.
The home was rated Inadequate overall. Safe and well-led were rated Inadequate, while effective was rated Requires Improvement. Inspectors found unsafe risk management, too few staff at times, gaps in medicines records, poor communication and weak oversight.
Some care was kind and people were supported with meals, medicines and health appointments. People's rooms were personalised and staff had completed training in several important areas. However, inspectors could not be assured that people's choices, safety and care needs were consistently respected.
The overall rating had fallen from Requires Improvement at the previous inspection. This inspection did not assess Caring or Responsive. Those areas were not inspected, and their previous ratings were used in calculating the overall rating.
Recruitment checks
The provider's recruitment process included references and DBS checks to help ensure suitable staff were employed.
“The provider had a recruitment system that ensured only suitable staff were employed.” from the report
Personalised rooms
People's rooms reflected their interests and belongings. The lounge was also described as spacious and pleasantly decorated.
“Peoples' rooms were personalised and individually decorated with things important to them, for example TV's, gaming equipment, pictures and photographs.” from the report
Some training completed
Records showed staff had training in areas including safeguarding, learning disabilities, person-centred care, medicines and mental capacity.
“Records showed staff had received training in topics including learning disabilities, person-centred care, safeguarding and protection of adults, medication, documentation and record keeping, MCA and DoLS.” from the report
Support with meals
People who needed help with meals were supported by staff, although inspectors found confusion about some people's food and drink needs.
“People who needed help with their meals were supported by staff.” from the report
Unsafe risk management
seriousCare plans did not consistently explain how to manage risks. Staff gave conflicting advice about moving and handling, including whether a person should use a hoist.
“Systems were either not in place or robust enough to demonstrate risk was effectively managed. This placed people at risk of harm.” from the report
Too few staff
seriousStaffing levels were not always enough to meet people's needs. One person had to wait in wet clothing because two staff were needed and were not available.
“The provider had failed to ensure there were sufficient numbers of staff deployed. This placed people at risk of harm.” from the report
Medicines records
seriousMedicine stocks did not always match the records. Storage checks and recording of medicines were also inconsistent, so inspectors could not be assured that medicines were always given as prescribed.
“However, we were not assured that medicines were always administered as documented, due to the number of medicines within the service, not always matching recorded stock balances.” from the report
Safeguarding and dignity
seriousInspectors heard concerns about verbal abuse and about people not always receiving suitable personal care. Staff did not always feel safe reporting concerns.
“At this inspection we found people were exposed to the risk of harm and abuse including verbal abuse.” from the report
Weak leadership
seriousThere was no registered manager, with frequent changes in managers. Staff described low morale and a blame culture, while audits failed to identify important gaps.
“The provider's systems and processes were ineffective and failed to identify concerns found on this inspection.” from the report
Food and drink information
needs fixingStaff were unclear about choking risks, food textures and thickened drinks. Inspectors found that important information was not always communicated consistently.
“There is confusion to what textures [Name] can have, so they're coming in tomorrow.” from the report
- 01How many staff are now on duty at different times, and how do you check that staffing is enough for people's individual needs?
- 02What has changed to make sure moving and handling instructions are accurate, current and followed by every member of staff?
- 03How do you now check medicines stocks, storage temperatures, expiry dates and changes to prescriptions?
- 04How are choking risks, food textures, thickened drinks and specialist feeding needs recorded and communicated to all staff?
- 05Who is currently managing the home, and how are staff and relatives able to raise concerns safely and receive a response?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 4 January 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2022
Beachview was rated Requires Improvement; inspectors found risks, weak records and poor management oversight.
This was an unannounced focused inspection. The inspector visited on 21 and 28 June 2022, spoke with people, staff, relatives and professionals, and checked care, medicines, staffing and management records.
The home was not always safe or effective. Risks were not consistently assessed or managed. Incidents were not always recorded or reported. Records about people's choices, activities, distress and legal safeguards were incomplete.
Management was also rated Requires Improvement. There was no registered manager at the time of the inspection. The provider's checks did not identify or correct the problems. The home was rated Good at the previous inspection in 2018, but the overall rating had fallen to Requires Improvement.
Food and drink support
People were supported with meals and drinks. Staff knew individual preferences and used equipment such as modified food, plate guards and preferred cups where needed.
“People were supported to eat and drink, they were protected from risks of choking with modified food and fluids.” from the report
Infection control
Inspectors were assured about the home's infection prevention arrangements, including visitors, protective equipment, testing and outbreak management.
“We were assured that the provider was using personal protective equipment (PPE) effectively and safely.” from the report
Suitable recruitment checks
The provider carried out employment reference checks and Disclosure and Barring Service checks as part of recruitment.
“The provider had a recruitment system that ensured only suitable staff were employed.” from the report
Personalised rooms
Most people's rooms included personal items that were important to them. Inspectors found the home clean and tidy during their visit.
“Most peoples' rooms were personalised with things important to them.” from the report
Risks and incidents
seriousThe home did not consistently assess, record or analyse incidents. This meant it could not show that risks were being reduced or that lessons were being learned.
“There was no analysis of incidents and accidents to identify triggers or trends.” from the report
Incomplete legal records
needs fixingRecords about the Mental Capacity Act and DoLS conditions needed improvement. It was unclear whether some legal conditions were being met.
“We found record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).” from the report
Activities and interaction
needs fixingRecords did not show how often outings happened or whether everyone was included. Some people had little or no interaction for long periods.
“We found staff were not able to evidence people's level of participation in activities, how often outings took place and whether all the people at the service were included.” from the report
Staffing pressures
needs fixingStaff said the home was sometimes short staffed and that activities could be missed. Inspectors also received concerns that funded one-to-one support was not always provided or recorded.
“Sometimes we are short staffed, so we have to work harder. Activities get missed.” from the report
Management gap
needs fixingThere was no registered manager when inspectors visited. Relatives were confused about changes in management and keyworkers, and staff said they did not always feel supported.
“At the time of our inspection there was not a registered manager in post.” from the report
Missing medicine
seriousStaff reported that a controlled medicine had gone missing. The provider had not considered the possibility of theft or reported the incident to CQC.
“Staff told us medicine had gone missing from the service.” from the report
- 01How will you make sure each person's risks, including risks linked to distress or self-harm, are clearly recorded and understood by all staff?
- 02How will you provide and record any funded one-to-one support, and what happens when staffing levels are lower than planned?
- 03How are DoLS conditions and Mental Capacity Act decisions checked and kept up to date?
- 04How will you make sure every person has suitable activities and outings, with their participation recorded?
- 05Who is now managing the home, and how can relatives raise a complaint and see what action has been taken?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and previous ratings for those questions were carried forward. This explanation was written from the published report of 13 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Beachview
4 rated inspections over 7 years: the service has slipped, from Good to Inadequate.
- January 2024Inadequatecurrent ratingdown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Inadequate
- October 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- November 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- December 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 31 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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28 live-in carers within about an hour of West Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,170 a week. 23 can care for a couple. 11 years' experience on average.
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