CQC report explained · a residential care home
What the CQC found at Beeches
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Staffing levels did not always match people's assessed needs, and some people did not receive the one-to-one support they required. Medicines, infection control and individual risk management had improved.
- Effective?
- Good
- People's outcomes were found to be good. Staff had relevant training, care plans were more personalised, and people were supported with food, healthcare, activities and community access.
- Caring?
- Good
- This key question was not separately rated in this focused inspection.
- Responsive?
- Good
- This key question was not separately rated in this focused inspection.
- Well-led?
- Requires improvement
- Management and leadership were inconsistent. Some governance systems had improved, but staffing pressures, communication problems and the lack of a registered manager remained concerns.
What inspectors found, April 2022
Beeches is rated Requires Improvement; inspectors found better care systems but unsafe staffing levels and weaknesses in leadership remain.
This was an unannounced focused inspection on 10 February 2022. Inspectors observed care, spoke with staff and relatives, and checked care records, staff files, medicines records and quality checks.
The home had improved since its previous Inadequate rating. It was cleaner, medicines were managed safely, care plans had improved and staff had relevant training. People had access to activities, healthcare support and community trips.
There were still important problems. Staffing levels did not always meet people's needs, so some people did not receive the one-to-one support they needed. An alleged abuse incident had not been reported properly, and some risk assessments and care plans did not match.
The overall rating changed from Inadequate to Requires Improvement. The home was still in breach of Regulation 18 about staffing, but it was no longer in Special Measures.
Cleaner environment
The home had improved its cleanliness and hygiene since the previous inspection. Extra cleaning and monitoring arrangements were in place.
“The care home premises appeared clean and hygienic.” from the report
Safer medicines
Medicines were prescribed, given, recorded and stored safely. Monitoring and communication with health professionals had improved.
“People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely.” from the report
Staff training
Staff had training relevant to learning disability and autism support, communication, positive behaviour support and restrictive interventions. Inspectors saw staff use this training in practice.
“People were supported by staff who had received relevant training in evidence-based practice.” from the report
Personalised care plans
Care plans were generally personalised and included physical and mental health needs. Staff could access clear, up-to-date records to guide support.
“People had care and support plans that were personalised, reflected their assessed needs, and included physical and mental health needs.” from the report
Activities and healthcare
People could use communal activity spaces, attend some activities in the community and receive support from a specialist multi-disciplinary team.
“People had access to various activities within the care home and also access to a vehicle for trips out to activities in the community.” from the report
Not enough staff
seriousStaffing did not always reflect people's support needs. Some people were paired together and did not receive the one-to-one support they needed, particularly when staff were also cooking or cleaning.
“Everyone living at the Beeches required one-to-one staff support for most of each day.” from the report
Staffing breach
seriousThe provider remained in breach because it had not deployed enough suitably qualified and experienced staff to meet people's needs.
“The provider failed to ensure sufficient numbers of suitably qualified, competent, skilled and experienced staff were deployed in order to meet the needs of the people receiving care.” from the report
Abuse allegation not reported
needs fixingAn alleged abuse incident had not been notified to CQC or the local safeguarding team by the previous registered manager. The acting manager reported it after inspectors raised the issue.
“The provider's safeguarding process was not always consistently applied, and an incident of alleged abuse was not notified to the CQC and local authority safeguarding team by the provider.” from the report
Care plan mismatch
needs fixingSome risk assessments and support plans did not fully agree. Inspectors said this could lead to inappropriate care and an increased risk of harm.
“People's individual risk assessments and support plans were not always aligned.” from the report
Leadership still settling
needs fixingThe home did not have a registered manager at the inspection. Communication and trust problems within the staff team had improved in parts but were not fully resolved.
“The service management and leadership was inconsistent.” from the report
- 01How many staff are on duty for each shift now, and how do you make sure every person receives their planned one-to-one support?
- 02What cover is available when staff are absent or vacancies remain, especially at weekends?
- 03Who is currently responsible for managing the home, and when will a manager be registered with CQC?
- 04How do you now make sure safeguarding incidents are reported to CQC and the local authority without delay?
- 05How are risk assessments and care plans checked to ensure they match and reflect each person's current needs?
This was a focused inspection of Safe, Effective and Well-led areas, including staffing, governance and infection control; Caring and Responsive were not separately rated. This explanation was written from the published report of 20 April 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.
What inspectors found, October 2021
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, staffing, medicines and management.
Inspectors visited the home without notice on 6 and 7 July 2021. They observed care, spoke with staff and managers, reviewed care and medicine records, and gathered views from relatives, professionals and 28 staff members.
They found people were not always protected from abuse or avoidable harm. There were problems with staffing levels, medicines, incident reporting, hygiene, risk management and the use of restraint. Staff did not always follow people's support plans, and some people's food and drink needs were not properly monitored.
The home was rated Inadequate overall. Safe and Well-led were rated Inadequate, while Effective was rated Requires Improvement. Caring and Responsive were not rated in this focused inspection.
The previous overall rating was Good, published in May 2018. The home was placed in special measures, and the provider was required to send an action plan and make significant improvements.
Safe recruitment
The provider carried out pre-employment checks and ensured staff were suitable and fit to work.
“Staff were safely recruited. The provider undertook pre-employment checks to help ensure prospective staff were suitable to care for people.” from the report
Mental capacity practice
Most people had the required authorisations for restrictions on their liberty, or the necessary referrals had been made. Staff had training in the relevant legal principles.
“The principles of the MCA were being followed.” from the report
Family communication
Relatives said they were kept regularly informed about visiting and contact arrangements during the pandemic.
“Relatives told us they had been kept regularly informed about visiting and contact arrangements during the COVID-19 pandemic.” from the report
Activities and outside links
The home had communal activity rooms and some people were supported to attend college or take part in leisure activities in the community.
“The service also had access to a vehicle to facilitate trips out to other leisure activities in the community.” from the report
Insufficient staffing
seriousStaffing levels did not always match people's assessed needs. This meant some people did not receive the support they were entitled to and activities were limited.
“People were not always supported by enough staff. Staffing levels did not always match the assessed support needs of people.” from the report
Medicines not safely managed
seriousSome prescribed medicines were not given as directed, guidance for as-needed medicines was missing, records were incomplete and one medicine continued after it should have stopped.
“People did not always receive their prescribed medicine.” from the report
Safeguarding and incident reporting
seriousA safeguarding allegation was not reported to the relevant authorities. Restraint incidents were not always recorded, and some incident reports were inaccurate or late.
“The provider's safeguarding procedures were inconsistently applied.” from the report
Restraint and staff injuries
seriousStaff did not always follow people's support plans during incidents and staff injuries were frequent. Inspectors found that incidents and injuries had become normalised.
“Managers in the service had allowed a culture to develop in which incidents, restraint, and staff injuries, had become normalised.” from the report
Poor hygiene
needs fixingSome bedrooms, mattresses and other areas were unhygienic. Staff did not always wear face masks in line with current guidance.
“Parts of the care home were not hygienic.” from the report
Weak management oversight
seriousQuality checks and audits did not identify or resolve repeated problems. Lessons from incidents were missed, including after an injury that required hospital treatment.
“The provider's quality monitoring and audit processes were not effective in identifying issues and supporting improvements to be made and the sharing of lessons learned.” from the report
- 01What changes have been made to staffing levels, including cover for weekends and staff absence, since the inspection?
- 02How are medicines now checked to ensure as-needed medicines have clear guidance and administration records are complete?
- 03How are restraint incidents, safeguarding concerns and staff injuries recorded, reported and reviewed?
- 04How do you ensure staff follow each person's positive behavioural support plan during incidents?
- 05How are bedroom cleanliness, mattress condition and other hygiene standards checked and maintained?
This was an unannounced focused inspection of Safe, Effective and Well-led, prompted by concerns about restrictive care practices and staffing; Caring and Responsive were not rated. This explanation was written from the published report of 2 October 2021 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 Beeches
5 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- April 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2021InadequateSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- January 2021Inspected but not ratedSafe: Inspected but not rated
- May 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2017Goodstayed GoodSafe: Good
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2014
Report published without a new overall rating.
- October 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- December 2011
Registered with the Care Quality Commission on 21 December 2011.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
75 live-in carers within about an hour of Nottinghamshire
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 £980 to £1,260 a week. 63 can care for a couple. 10 years' experience on average.
“Ernest is an amazing professional carer who delivers care from the heart.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.