CQC report explained · a nursing home
What the CQC found at Homebeech
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, July 2022
Rated Requires Improvement; inspectors found kind staff and some safe care, but medicines, dignity, personalised care and management systems were not reliable enough.
This was an unannounced inspection. Inspectors visited on 25 and 28 April 2022, spoke with 10 people, 10 relatives, 15 staff and health and social care professionals, and checked care, medicines, recruitment and management records.
The home had enough staff and people were protected from abuse. Staff supported people with healthcare, nutrition and communication needs. People and relatives often spoke positively about staff, and most staff were observed to be kind and considerate.
However, people were not always protected from avoidable risks. Medicines were not always stored or checked safely, infection control measures were not robust, and some people were not treated with dignity. Care records did not always describe people's current needs or personal preferences.
The overall rating and all five question ratings were Requires Improvement. Some progress had been made since earlier inspections, including improvements in nutrition, hydration and staffing. The home remained in breach of person-centred care rules and had new breaches relating to dignity, safe care and treatment, and good governance.
Enough staff
Inspectors found enough staff to meet people's needs, including planned support for people needing two staff or one-to-one care.
“There were enough staff to meet people's needs.” from the report
Safeguarding
Staff understood how to recognise and report abuse. Safeguarding concerns were investigated and referrals were made appropriately.
“People were protected from the risk of abuse.” from the report
Health and nutrition support
People's health risks were assessed, professional advice was followed, and staff supported people to eat and drink enough. The home was no longer in breach of the nutrition and hydration regulation.
“People were supported to eat and drink enough.” from the report
Activities and relationships
People were supported to keep in touch with family and friends and to take part in activities of their choice. The home had created a library and tuck shop in response to people's requests.
“People were supported and encouraged to maintain meaningful relationships with friends and family.” from the report
Consent and least restriction
Mental capacity assessments and best-interest decisions were completed where needed. Inspectors found that people were supported in the least restrictive way.
“As a result, people were supported in the least restrictive way.” from the report
Medicines and infection control
seriousSome medicines and dressings were out of date, oxygen cylinders were not always secured, and fridge temperature records were unreliable. Visitors were not always asked for proof of testing, and some frequently touched surfaces were unclean.
“There were some out of date medicines and dressings stored at the service.” from the report
Dignity and confidentiality
seriousPeople were sometimes moved or assisted without being asked or spoken to. Personal information was visible on a medicines trolley and a communal whiteboard.
“People were not treated with dignity and respect and confidentiality was not maintained.” from the report
Personalised care records
seriousSome records did not reflect people's current needs or explain how to support them when anxious. End of life plans did not always include religious needs or personal preferences.
“The provider had failed to ensure people received person centred care and treatment that was appropriate to their needs and reflected their personal preferences.” from the report
Weak quality checks
seriousAudits had not identified unsafe medicines, incomplete care plans, environmental hazards or incomplete recruitment checks. This meant managers did not have reliable oversight of quality and safety.
“The provider had failed to effectively establish and operate systems to assess, monitor and improve quality and safety of the services provided which put people at risk.” from the report
Dementia-friendly environment
needs fixingBedrooms were not clearly marked, the orientation information was out of date, dining space was limited and corridors were dimly lit. CQC recommended reviewing national guidance and making improvements.
“There had been limited consideration to the environment to support people living with dementia on the Beechside unit.” from the report
- 01What has been done to ensure medicines are checked for expiry dates, stored safely and kept at the correct temperature?
- 02How are staff now protecting people's dignity, including asking before moving or assisting them and keeping confidential information out of public view?
- 03How are care plans checked to make sure they reflect people's current needs, anxiety triggers, communication preferences and end of life wishes?
- 04What changes have been made to the dementia unit, including bedroom signs, lighting, dining space and orientation information?
- 05How are recruitment checks, nursing registration checks and quality audits now reviewed by managers?
This was an unannounced comprehensive inspection covering all five key questions, prompted partly by concerns about medicines and pressure area care and also following up earlier regulatory breaches. This explanation was written from the published report of 16 July 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, August 2020
Homebeech was rated Requires Improvement overall, although inspectors rated safe care and leadership Good and found important improvements.
This was a focused inspection on 5 and 6 August 2020. Inspectors looked at safety and leadership because concerns had been raised about risk assessments, nutrition, pressure care, medicines and quality checks. They spoke with four people, seven staff members and two relatives, observed part of lunchtime and checked care, medicine and management records.
Inspectors found people were protected from abuse and avoidable harm. Medicines were recorded and managed safely, staffing levels were sufficient, risks such as falls and pressure damage were assessed, and infection control arrangements during the Covid-19 pandemic were robust.
The home had introduced audits and an action plan covering areas such as medicines, care plans, training, infection control and health and safety. The previous breach about poor governance had been met, and there was now a registered manager. The overall rating remained Requires Improvement because this inspection did not assess all five areas, so some previous ratings were carried forward.
Safe medicines
Medicine records checked by inspectors were accurate. Staff were trained, medicines were stored securely and people received them safely.
“We saw that improvements had been made and the MAR's we looked were completed accurately and correctly.” from the report
Risk management
Staff understood individual risks, including falls, pressure damage, diabetes and specific eating needs. Care plans gave staff guidance to manage these risks.
“Staff knew people well and understood risks associated with their care.” from the report
Staffing and safeguarding
Inspectors found enough staff to meet people's needs safely. Recruitment checks and safeguarding training were also in place.
“Our own observations supported this, and we saw people being attended to in a timely manner and staff responding to people's requests and needs.” from the report
Infection control
The home had suitable Covid-19 procedures, cleaning arrangements, handwashing facilities and personal protective equipment.
“Appropriate Covid-19 (coronavirus) procedures were in place and being followed and infection control measures were robust.” from the report
Improved oversight
The provider had introduced audits and an action plan to identify shortfalls and track improvements. Inspectors judged the previous governance breach had been met.
“At this inspection, we found the provider had made improvements to how they monitored and delivered good care.” from the report
Overall rating remains Requires Improvement
minorThe overall rating did not improve because several areas were not examined during this focused visit and earlier ratings were carried forward. This means the report does not provide a new assessment of every aspect of care.
“For those key questions not looked at on this occasion, the ratings from the previous comprehensive inspection were used in calculating the overall rating at this inspection.” from the report
- 01What current evidence can you show that people's nutrition and hydration needs are being assessed and met?
- 02How do you check that pressure care plans are followed and that any pressure damage is acted on quickly?
- 03How do your audits identify problems in care records, medicines, training and supervision, and what happens when a shortfall is found?
- 04How do you decide how many staff are needed on each shift, including when agency staff are used?
- 05What has changed in the areas not assessed during this inspection, particularly caring, effective and responsive care?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous comprehensive inspection. This explanation was written from the published report of 28 August 2020 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 Homebeech
7 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- July 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2020Requires improvementstayed Requires improvementSafe: GoodWell-led: Good
- April 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2018Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2017Requires improvementstayed Requires improvementSafe: Requires improvementCaring: Requires improvementResponsive: Requires improvement
- May 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- September 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 10 January 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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