CQC report explained · a nursing home
What the CQC found at Bushey House Beaumont
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were not always protected from avoidable harm. Inspectors found problems with choking risks, repositioning, call bells, staffing, safeguarding identification and some medicines records.
- Effective?
- Good
- This area was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This area was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This area was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- Management systems had failed to identify and respond to safety, safeguarding and staffing problems. A new manager and additional oversight had started to address the shortfalls.
What inspectors found, June 2022
Bushey House Beaumont was rated Requires Improvement; inspectors found safety, staffing and management problems, although some improvements had begun.
This was an unannounced focused inspection. Inspectors visited on 21 April 2022 and reviewed the Safe and Well-led areas. They spoke with people, relatives, staff and managers, observed care, and checked care plans and other records.
Inspectors found that people were not always kept safe. Some people did not receive the help they needed with eating, drinking or using the toilet. There were gaps in repositioning records, some unsuitable food was given to a person at risk of choking, and staffing levels did not always meet people's needs. Medicines records were also incomplete in places.
The home had a new manager and had introduced extra night staff, more management oversight, training and checks. Inspectors saw some improvements, but the problems were not fully resolved. The overall rating changed from Good at the previous inspection to Requires Improvement. The home must send an action plan, and its progress will be monitored.
Kind staff
People said staff were kind, and most people felt supported by the home.
“People told us staff were kind but busy.” from the report
Action had started
The provider had added an extra night worker, used more staff at mealtimes and introduced additional management checks after concerns were raised.
“The provider had added an extra staff member at night and the ancillary staff were supporting at mealtimes as a result of the concerns.” from the report
Mental capacity practice
Inspectors found that the home was working within the principles of the Mental Capacity Act and had appropriate authorisations where needed.
“We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.” from the report
Open about problems
Managers told people, relatives and staff about the problems found and reported incidents and safeguarding concerns to the regulator.
“The management team were open with people, relatives and staff about the issues that had arisen in the home.” from the report
People were not always kept safe
seriousInspectors found gaps in repositioning records, inaccessible call bells and inadequate support or supervision at mealtimes. A person at risk of choking was given unsuitable food.
“People who needed assistance to eat or those at risk of choking were not always supported or supervised at mealtimes.” from the report
Staffing did not always meet needs
seriousPeople sometimes waited for help with food, drinks or the toilet. Inspectors concluded that there were not always enough staff to meet people's needs safely.
“Therefore this was a breach of regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.” from the report
Medicines records were incomplete
needs fixingRecords for some as-needed medicines did not show quantities carried forward. Some instructions for as-needed or covert medicines also needed more detail and stronger documentation.
“We found that medicines carried forward from the previous month did not have their quantities recorded, for example those prescribed on an as needed basis such as paracetamol.” from the report
Management checks had failed
seriousThe home's systems did not reliably identify, record or respond to safety, safeguarding and staffing problems. Care plans also had gaps and were sometimes difficult to read.
“This meant they had a period of time when issues including safety, safeguarding and staffing were not being accurately recorded, reported or responded to.” from the report
- 01What changes have you made to ensure people at risk of choking receive the correct food and support at every meal?
- 02How do you now make sure people receive prompt help with toileting, eating, drinking and repositioning?
- 03How many staff are on duty during the day and night, and how do you check that this is enough for people's needs?
- 04How are as-needed and covert medicines now recorded, including quantities, instructions and authorisations?
- 05What actions from the inspection plan have been completed, and how do you check that the changes are working?
This was a focused inspection of Safe and Well-led only; the other key-question ratings carried over from the previous inspection. This explanation was written from the published report of 9 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.
What inspectors found, December 2019
Rated Good; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
Inspectors visited the home without notice on 21 November 2019. They spoke with people living there, relatives and staff, observed care, and reviewed care, medicines, training and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people generally felt safe, staff knew them well, medicines were managed safely and care was respectful and personalised.
The home had previously been rated Requires Improvement, with multiple breaches of regulations. The provider had made the required improvements, and inspectors found it was no longer in breach of those regulations.
Safe medicines management
Medicines were given by trained staff whose competence was checked. Records and medicine stocks matched during the inspection.
“People's medicines were administered safely by staff who were trained and had their competency checked regularly.” from the report
Kind and respectful staff
People and relatives spoke positively about staff's attitude. Inspectors saw staff treating people with dignity and involving them in choices.
“People and relatives praised staff for being kind, caring and respectful towards them.” from the report
Personalised activities
The home offered both group and individual activities, taking account of people's interests and choices.
“The service employed activities staff and volunteers who planned a varied programme of both group and individual activities taking into consideration people's individual interests.” from the report
Quality monitoring
The manager and provider carried out regular audits and used action plans to address improvements.
“Quality assurance systems were in place to ensure that staff gave good care.” from the report
Some concerns about staffing
minorPeople had mixed views about staffing. Some felt there should be more staff and said staff appeared to be rushing, although inspectors saw call bells answered quickly and found enough staff on the day.
“I would say they are short of staff, not in terrible way but they [staff] can't stop running.” from the report
Call bell system needed replacement
needs fixingThe management team had identified that the existing call bell system was not working correctly and planned to install a new one.
“They had identified the need to install a new call bel system as the current system was not operating correctly.” from the report
- 01What has happened to the call bell system since the inspection, and is the replacement now working reliably?
- 02How do you decide staffing numbers when people's needs change, and how quickly are call bells answered now?
- 03How are lessons from incidents, complaints and falls shared with all staff?
- 04What changes have been made to make care records more person-centred?
- 05How are people and relatives involved in reviewing care plans and improvement plans?
This was an unannounced inspection covering all five key questions, including both the care provided and the home premises. This explanation was written from the published report of 18 December 2019 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 Bushey House Beaumont
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- June 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- November 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- February 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 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.
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