We undertook an unannounced inspection of Beacon House Nursing Home on 14 and 15 January 2019.

Beacon House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beacon House Nursing Home can provide accommodation and nursing care for up to 22 people with general nursing needs and end of life care. At the time of the inspection 16 people were receiving care at Beacon House Nursing Home.

We previously inspected Beacon House Nursing Home on 25 and 27 July 2018 and we identified breaches of regulation in relation to person-centred care (Regulation 9), dignity and respect (Regulation 10), need for consent (Regulation 11), safe care and treatment of people using the service (Regulation 12), safeguarding service users (regulation 13), good governance of the service (Regulation 17), staffing (Regulation 18) and fit and proper person employed (Regulation 19). The provider was rated inadequate in the key questions of Safe and Well-led and overall. The key questions of Effective, Caring and Responsive were rated requires improvement. As a result, the service was placed into Special Measures.

At the time of this inspection the service did not have a registered manager. The provider had recruited a manager in November 2018 and they were in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had a medicines policy and procedures in place but these were not always followed which resulted in issues with administration. Adequate checks were also not undertaken to ensure records of medicines were accurate.

The provider had not ensured that risk management plans were always developed to provide guidance for staff on how to reduce possible risks to people and others when providing care and support.

A process was in place for the recording of incidents and accidents but information was not always recorded in relation to the actions taken to reduce the risk of reoccurrence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Support was not always provided in the safest way.

The provider had not ensured some areas of the home were clean and suitable for the purpose for which they were being used for example we identified concerns with the cleanliness of bathrooms and food storage.

Some members of staff had still not completed training identified as mandatory by the provider but improvements had been made in relation to staff induction and supervision.

We saw care workers, in general, treated people in a kind and caring way but there were occasions where there was a lack of communication or focus on the needs of the person.

Care plans and other records relating to people using the service did not always provide up to date information relating to the support they needed.

The provider had a range of quality assurance processes in place but these did not always identify areas where improvement was required.

People were supported in accessing healthcare professionals but if there was a change in their support needs the information was not always transferred into the care plans so staff had all the necessary information about the support people received with their healthcare needs.

Improvements had been made in relation to recruitment, identifying and reporting safeguarding concerns and staffing levels.

People complemented the food options provided at the home and felt they had choice

We undertook an unannounced inspection of Beacon House on 25 and 27 July 2018. The inspection was prompted by the inspection of a second nursing home owned by the provider which was inspected in April 2018. The nursing home was rated as Inadequate and placed in special measures.

Beacon House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beacon House can provide accommodation and nursing care for up to 22 people with general nursing needs and end of life care. At the time of the inspection 18 people were receiving care at Beacon House.

We last inspected Beacon House on 17 October 2017 and it was given an overall rating of Good with safe being rated as requires improvement without any breaches of Regulation.

At this inspection of 25 and 27 July 2018, we have rated the service inadequate.

At the time of the inspection a manager registered with the CQC had not been in post since November 2015. The service is owned by an individual who was registered to provide one other care home. The provider told us they were considering asking the care coordinator to apply to be registered as the manager for Beacon House. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were at risk because they did not receive their medicines in a safe way.

Processes were not in place to ensure the risk of infection was reduced for people using the service. People were placed at further risk because cleaning products and other chemicals were not stored in a safe way.

Risk management plans were not in place to provide care workers with the information to enable them to mitigate these risks when providing care.

Incidents and accidents were not always recorded and investigated so appropriate actions could be taken to reduce the risk of reoccurrence.

The provider had an induction process but records were not completed to demonstrate new staff had undertaken this and had been assessed as competent.

Window restrictors were in place but not used correctly to reduce risk of falls. Some fire doors were not able to close fully which prevented them working as they should.

Personal Emergency Evacuation Plans did not provide sufficient and up to date information to enable people to be evacuated safely from the home in care of an emergency.

People told us they felt safe when they received care at the home but we saw processes for the investigation and review of safeguarding concerns had not been followed.

The recruitment process was not robust as appropriate references were not always in place before assessing applicants’ suitability for the role.

The provider did not deploy adequate number of staff to meet people's support needs.

People did not have maximum choice and control of their lives and staff practices were restrictive.

The service was not always caring as staff did not have enough time to give people they support they needed.

People’s care plans did not include the person’s wishes about how they wanted their care provided as they were focused on care tasks. Records did not provide up to date information relating to people’s care. There were no structured activities planned that met people’s areas of interest and were meaningful.

The provider had audits in place but these did not identify areas where improvement was required

People knew how to raise complaints or concerns relating to the care they received.

People told us they were happy with the food choice and how it was provided.

We found eight breaches of The Health and Social Care Act 2008

The inspection took place on 17 October 2017 and was unannounced.

The last inspection took place on 30 March and 5 April 2016 when we rated the service Requires Improvement in all key questions and overall. We had found breaches of five Regulations in relation to person centred care, dignity and respect, safe care and treatment, premises and equipment and fit and proper persons employed. At the inspection of 17 October 2017 we found that there had been improvements in all these areas and the provider was meeting the required Regulations.

Beacon House Nursing Home is a care home for up to 22 adults. A service is offered to older people and to adults who might have a physical disability, a sensory impairment or mental health needs. The provider supplies nursing and personal care for people. At the time of our inspection 20 people were living at the service. There was a wide range of ages and different needs, including some people who were cared for in bed, older people, some people living with the experience of dementia, people with mental health needs, learning disabilities and physical disabilities.

The service is owned by an individual who was registered to provide one other care home and a skin care clinic. The provider spent time at the service and was involved in the day to day management of the home. In addition, they employed three other managers who ran the service. One of these managers had applied to the Care Quality Commission to be registered.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People received their medicines as prescribed and in a safe way. However, we found that there was a risk that some medicines had not been accurately counted and recorded for people who had moved to the service shortly before the inspection. The provider told us that they would check this immediately. We also found that the refrigerator used for storing medicines needed defrosting as part of it was iced up, making the temperature unstable.

The majority of records were appropriately maintained, accurate and up to date. We found a small number of records which needed to be updated and the provider rectified these immediately after the inspection.

People living at the service were happy there. There was a diverse range of needs but this created an atmosphere which people felt was like a large extended family. We saw younger adults and older people sharing activities and choosing to spend time together. As well as a big age range people had diverse needs, with some people requiring a large amount of nursing care for physical health needs and others who were more independent but needed support and guidance. Again, this seemed to work well and we saw individuals helping each other.

The home catered for people with different cultural and religious needs and who originated from a number of different countries. A large population of the home were from an Asian background. The provider employed staff who spoke with people in their first language. Activities and food were designed to meet people's cultural needs, with an Asian menu and a traditional British choice available each day. Our visit took part during the week of Diwali. We saw that the home was decorated in the spirit of this festival and witnessed people of different cultures joining in the celebrations together.

The staff were happy and felt well supported. Many of them had worked at the service for a long time. They told us they had the training and information they needed. They felt they worked well as a team and there was good communication so that they all knew about people's needs and how to meet these.

People's needs were being met. These needs were planned for and regularly monitored

This inspection took place on 30 March 2016 and 5 April 2016. The visit on 30 March was unannounced and we told the provider we would return on 5 April to complete the inspection. We last inspected the service in September 2014 when we found it was meeting all legal requirements.

Beacon House Nursing Home provides accommodation for up to 22 people who require nursing or personal care. When we inspected, 19 people were using the service. This included people with a physical disability, older people living with dementia and people who were receiving care at the end of their life.

The service did not have a registered manager. The provider told us the previous registered manager left in July 2013. They had appointed a clinical nurse manager but this person had only recently applied to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not take action to manage fire safety risks in the service.

The provider did not carry out checks to make sure staff were suitable to work in the service before they started work.

Some staff did not record the care and support they gave to people using the service in a respectful way.

The provider had not registered a suitably qualified and experienced person to manage the regulated activities provided at the service.

People's care and treatment did not always reflect their needs and interests.

People received the medicines they needed safely and there were enough nurses and care staff to meet people’s care needs.

People’s bedrooms were bare and were not individualised and the premises were not suitable for people living with dementia.

People’s care records did not include their social care needs and there was a lack of appropriate activities.

Staff had undertaken training in areas the provider considered mandatory.

The provider obtained authorisation before they deprived people of their liberty.

People told us they liked the food provided in the service.

Staff working in the service treated people well and people were able to choose where they spent their time.

People’s health and personal care needs were recorded in their care plans with guidance for staff on the support they needed.

The provider recorded and responded to complaints from people using the service and others.

There were systems in place to monitor the quality of services provided in the service.

You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

During the inspection we spoke with three people and the relatives of three people who used the service. We spent time observing the care being provided; we spoke to four care workers, and the care co-ordinator.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Those using the service and their relatives told us they felt their loved ones were safe and staff were friendly. There were arrangements in place to ensure people who needed medicines, received these in a safe manner.

People's care needs had been assessed and care and treatment was planned and delivered in a way, which promoted people's safety and welfare. Risk assessments had been carried out where necessary; however, in one case they were not sufficiently detailed. Risk assessments were used by staff to guide the care that was provided. People's health, safety and welfare were protected. We found staff escalated health concerns to the appropriate health professional and ensured the advice from health professional was integrated into the person’s care plan.

There were systems in place to ensure medicines were dispensed and administered safely by appropriately trained staff.

Is the service effective?

Relatives of those people using the home were very complimentary of staff. We found the communication between staff was effective and there were clear roles for staff working at the home .

People’s care and support needs had been identified and staff knew how to deliver the required interventions. Care plans had been regularly reviewed and in most cases we could see people had been involved in their care planning and plans had been altered depending on the person’s condition .

Is the service caring?

We observed the care people were receiving and how staff interacted with them. We saw people using the service were spoken to respectfully and staff used a caring approach. We saw people were given the opportunity to participate in activities and staff supported people to take part in religious and cultural festivals.

Is the service responsive?

The home had a system in place for learning from incidents and complaints. We saw where care had been below the standard expected the registered manager had taken steps to ensure systems were changed to ensure this was not repeated.

People received individualised care that was responsive to their interests and preferences. A variety of activities were available for people to participate in as they chose. People's care and health was monitored closely and junior staff escalated quickly to their senior colleagues if they were concerned. Written notes about people's health and care were completed by staff.

Is the service well-led?

The home was led by an experienced senior team who understood their roles and took steps to ensure care was of a standard people would expect. The senior team undertook monitoring and checks of the quality of the service . Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

We spoke with six people who use the service and observed how they were cared for. People we spoke with told us they were happy living at the home. One person told us " I am happy here the staff are very kind, I have lived here a while". Another person said "people are kind to us, I don't get out very often and I would like to."

We looked at how people were involved in their care and found they were given the opportunity to express their wishes. People had regular reviews to discuss their care and any aspects they wanted to change. It was noted that people's relatives and advocates were involved in the reviews to ensure they also had the opportunity to raise any concerns or provide suggestions regarding the person's care.

Care plans did not always contain sufficient detail to ensure people's needs were met. We found where people had health conditions relating to their mental health or learning disability these were not always planned for effectively which meant people were at risk of receiving care which was not effective or safe. The provider told us they would improve.

The provider had a system in place to protect people from the risks of abuse. Staff working in the service had received appropriate training and staff were able to tell us the steps they would take should a person be at risk of abuse.

We looked at staff training records and found staff had received training relevant to their job role and received annual supervisions and professional development.

We inspected Beacon House Nursing Home on 14th September 2012. We made a compliance action under Outcome 1: Respecting and involving people who use services (Regulation 17 HSCA 2008 Regulated Activities Regulations 2010.) We made this compliance action because there were three double rooms. Two double rooms were occupied by two people sharing.

During this inspection we saw that building work was in progress to divide double rooms to ensure that single rooms were available in the future, for people who use the service.

A new care plan format had been developed since the last inspection and the home was in the process of updating people's care plans. The new care plans incorporated people's health, psychological and social needs.

We spoke with one person who uses the service who said he/she was able to make some choices on a daily basis.

We spoke with a relative who confirmed that his/her family member was receiving the care they needed and communication with staff was good.

At the time of the inspection 20 people were living in the home. The minimum staffing level for the home was one registered general nurse (RGN) and three health care assistant during the day and one (RGN) and one health care assistant at night. A physiotherapist was employed by the provider and visited the home twice weekly. We spoke with four people who live at the home and five members of staff during the inspection.

People we spoke with confirmed that they were satisfied with the care given at the home. People said they had a choice of menu, the cook and staff gave them a choice at the beginning of the day. Some of the comments made by people were the home was “very good” and staff “are nice”. We were told by one person they had very disturbed nights due to the person they were sharing a bedroom with. Another person said they would like to go out more but this was not possible due staff being busy.

People we spoke with were not familiar with their care plan. Although people could not recall a complaints procedure they said they would talk with the manager or the provider if they had a concern.

The provider had policies and procedues in place for the protecton of vulnerable adults. Staff we spoke with were not familiar with these procedures.

The provider has systems in place to manage people’s care, staff training and to monitor and assesses quality and safety.