CQC report explained · a residential care home
What the CQC found at Beechwood Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, December 2022
Rated Good and no longer in special measures; inspectors found safe, effective and well-led care, with minor medicine and record-keeping issues fixed during the visit.
This was an unannounced focused inspection over 22 and 23 November 2022. Inspectors observed care, spoke with people, relatives, staff and other professionals, toured the home, and checked care, staff, medicine and management records.
The home was rated Good for Safe, Effective and Well-led. People said they felt safe and were happy with the care. Inspectors found enough staff, improved recruitment checks, suitable training, support with health and nutrition, and stronger systems for checking quality.
There were minor problems with some medicine records, risk-monitoring records and food temperatures. The manager dealt with these during the inspection. The home had previously been rated Requires Improvement and was in special measures, but the report says it had improved and was no longer in breach of regulations or in special measures.
Staff safety and recruitment
Recruitment checks had improved and inspectors found enough staff to meet people's needs during the visit.
“We found the staff files were well organised and noted all regulatory checks had been carried out before new staff started work in the home.” from the report
Kind interactions
People described the care positively, and inspectors saw staff treating people sensitively and kindly.
“We observed sensitive and caring interactions between the staff and people living in the home throughout the inspection.” from the report
Staff training and support
New staff received an induction and staff had ongoing mandatory training, supervision and appraisals.
“New staff were supported through an induction programme and the provider's mandatory training was provided for all staff members.” from the report
Improved management checks
The management team had strengthened audits and used action plans to follow up issues and improve the service.
“The management team carried out a number of audits and checks covering all aspects of the service.” from the report
Listening to people
Residents' meetings, questionnaires and local feedback were used to understand people's views and record actions taken.
“We saw residents' meetings had been held monthly and 'You said, we did' boards on each area displayed actions taken following the meetings.” from the report
Medicine records
needs fixingInspectors found minor gaps in medicine records and in managing one person's cream treatment. The management team dealt with this during the inspection.
“We noted minor shortfalls in the record keeping and the management of one person's topical treatment, which the management team addressed during the inspection.” from the report
Risk-monitoring records
needs fixingSome records used to monitor risks were incomplete because there were not enough devices for electronic entries. Temporary paper records were put in place while new devices were awaited.
“We noted there were minor shortfalls in the records designed to monitor risk.” from the report
Food temperatures
needs fixingOn the first inspection day, the hot meal was not kept warm and pureed meals were not heated to the correct temperature. The issue was corrected by the second day.
“The hot option was not kept warm, and the pureed diets had not been heated to the correct temperature.” from the report
Dementia-friendly areas
minorThe manager agreed to look at ways to adapt the Oak and Maple areas further for people living with dementia.
“The registered manager agreed to investigate ways the Maple and Oak areas could be further adapted to support people living with dementia.” from the report
- 01How do you now check that medicine records and topical treatment instructions remain complete and accurate?
- 02Have the new devices for electronic risk records arrived, and how do you check that risk monitoring is up to date?
- 03What checks are in place to make sure hot and pureed meals are served at the correct temperature?
- 04What changes have been made, or are planned, to make the Oak and Maple areas more suitable for people living with dementia?
- 05How do you monitor that the improvements made after the previous inspection continue over time?
This was an unannounced focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward for the overall rating. This explanation was written from the published report of 9 December 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, June 2022
Rated Requires Improvement overall; inspectors found some safe and caring aspects but serious issues with management and medicines safety.
Inspectors visited Beechwood Lodge unannounced over three days in May 2022. They spoke with people living there, relatives, staff, and management, and reviewed care records and the building.
People said they felt safe and cared for, and staff knew how to protect them from harm. There were enough staff to meet needs, but recruitment checks were not thorough. Medicines were not always managed safely, with some records incomplete and timing errors.
The home was clean and infection control mostly good, but staff did not always use protective equipment properly. Risk assessments were in place but not always followed, and some environmental risks had not been considered.
The registered manager had started audits and analysed incidents but did not fully check or act on all issues. There were no recent resident meetings or satisfaction surveys. The service has been rated Requires Improvement for several years and is now in special measures due to ongoing problems with leadership and governance.
Staff understand consent
Staff had training on consent and asked people before providing care.
“Staff confirmed they asked for people's consent before providing support, explaining the reasons behind this and giving people enough time to think about their decision before taking action.” from the report
Clean and hygienic environment
The home was clean and infection control policies were up to date.
“We observed a satisfactory level of cleanliness.” from the report
Poor recruitment checks
seriousThe home did not carry out all required checks when hiring new staff, risking unsuitable people working there.
“We noted shortfalls in the required regulatory checks including a lack of exploration of gaps in staff members' employment histories and reasons for leaving previous employment.” from the report
Weak leadership and governance
seriousAudits were superficial with no clear actions, and there was no evidence of provider oversight or resident involvement.
“Most of the audits comprised of a short comment with no actions identified. There was no evidence seen of what checks had been carried out in respect of the audits.” from the report
Inconsistent use of protective equipment
needs fixingStaff did not always wear face masks properly or follow infection control guidance.
“We were somewhat assured the provider was using PPE effectively and safely This was because not all staff were wearing face masks in line with current guidance.” from the report
Risk management not always followed
needs fixingStaff did not always follow safety measures, such as securing wheelchair belts, and some environmental risks were not assessed.
“We observed one person was due to leave the home without the lap belt fastened on their wheelchair.” from the report
- 01What improvements have you made to recruitment checks since the last inspection?
- 02How do you ensure medicines are given safely and on time?
- 03What actions have you taken to improve leadership and governance?
- 04How do you support staff to use personal protective equipment correctly?
- 05How do you involve residents and families in improving the home?
This was a comprehensive inspection covering Safe, Effective, and Well-led key questions. This explanation was written from the published report of 29 June 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 Beechwood Lodge
8 rated inspections over 7 years: the service has held its Good rating throughout.
- December 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- February 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- January 2019Requires improvementstayed Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2016Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2014
Registered with the Care Quality Commission on 13 November 2014.
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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