About the service:

Beckfield is a residential care home that was providing personal and nursing care to 32 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Improvements to care records and medicines management had been made since our last inspection in November 2017.

Medicines were administered safely and people’s dietary and healthcare needs were met.

Care records were clear, up-to-date and reflected the care each person required. Risk assessments were in place to show what actions had been taken to minimise the risk to people. Appropriate safeguarding referrals were made and people told us they felt safe living at the service.

Most staff had worked at the service for several years. Staff were caring, compassionate and knew people and their care and support needs very well. People were encouraged to do as much as possible for themselves to build up and maintain their independence.

Activities were organised by staff to occupy people on a group and individual basis. People could access activities provided by the on-site day centre.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving regular training and updates which were relevant to their role. Staff could discuss their on-going performance and development needs at regular formal supervision and appraisals.

People and staff praised the management team and said they were supportive and approachable. The management team completed checks to ensure the service was running smoothly and people received good quality care. People’s feedback about the service was sought through quality questionnaires, meetings and reviews. A complaints procedure was available to enable people to raise complaints or concerns.

Rating at last inspection:

Requires Improvement (published February 2018). This service has been rated ‘Requires Improvement’ at the last three inspections.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Our unannounced inspection took place on 9 and 10 November 2017. At our last inspection 21 September 2016 we rated the service as ‘requires improvement’ and identified breaches of regulation related to safe care and treatment, need to consent and care planning documentation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and the timescales involved to improve the key questions regarding being ‘safe’ ‘effective’ and ‘well-led’. At this inspection we found the provider had made some improvement. However more improvements are required to ensure the service is fully ‘safe’ and ‘responsive’.

Beckfield is registered to provide accommodation and personal care to a maximum of 35 older people. Accommodation is provided on four floors and is split into four separate units. The home provides long term care, intermediate care and respite (short term) care. People living at Beckfield also have access to a day centre, which is attached. The home is on the outskirts of Bradford City Centre.

At the time of our inspection the service had a manager who was going through the registered manager’s process. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who used the service felt safe and we found staff knew how to recognise and report concerns about people’s safety and welfare. Safeguarding policies and procedures were in place and risk was well assessed. We saw guidance in place to ensure risks were minimised with as little impact as possible on people’s independence.

Staff were recruited safely as we found the necessary checks were carried out in line with the provider’s policy. Staff were on duty in sufficient numbers to provide timely care and support; including ensuring people could maintain their independence as much as possible.

Staff told us training was good and gave them the required skills to offer safe and effective support. Staff received effective support in the form of an induction programme, on-going training and appraisals.

The home was clean and the environment was well maintained. Gloves and aprons were readily available and seen to be used by staff when providing personal care.

Overall, we found medicines were safely managed. Medicines administration charts were well completed. However, the time taken for staff to respond to requests for medicines needed improving. Also the manager needs to ensure staff members remind people to take their medication when they are away from the home so that people are getting their medication when required.

People were happy with the food. People received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated. Culturally appropriate diets were supported.

People’s health care needs were supported with access to a range of professionals including GPs, district nurses and physiotherapists. Appropriate equipment was in place to meet people’s health care needs.

The service was working in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people’s rights were protected and promoted. People’s rights to choose and make decisions were supported in accordance with good practice and legislation. Staff asked people’s consent before any care or support was given.

People were treated with kindness and compassion. There was a clear emphasis on people’s individuality, dignity and independence. There was a lively and homely atmosphere and we saw people and staff knew each other well. People’s cultural and communication needs were well met.

Care plans were regularly reviewed, however some information was missing from some people

This comprehensive inspection took place on 21 September 2016 and was unannounced.

At the previous inspection, which took place on 31 July 2014, the provider met all of the regulations we assessed at that time.

Beckfield is registered to provide accommodation and personal care to a maximum of 35 people older people. Accommodation is provided on four floors and is split into four separate units. The home provides long term care, intermediate care and respite (short term) care. People living at Beckfield also have access to a day centre, which is attached. The home is on the outskirts of Bradford City Centre.

At the time of our inspection there were 32 people living at the service; 15 people lived there long term, eight people were accessing an intermediate care bed, five people were accessing respite care and four people were in short term assessment beds.

There was a registered manager in place. 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.

Risk assessments and risk management plans did not provide staff with clear guidance about how to safely manage known risks to people. Whilst the service had robust systems in place to promote the safe management of medicines we saw two people were left with their medicines, these were subsequently left unattended and meant that other people who used the service were at risk of taking them in error.

We did not see consent routinely recorded within care files and when people lacked the mental capacity to make an informed decision this had not been recorded within their care plan.

Record keeping required improvement. We saw some gaps in care records which meant we could not be assured people had received the support they required to meet their needs. Care planning documentation contained some contradictory information and required more detail to ensure staff were provided with clear direction about the care people needed. The registered manager had not always submitted timely notifications to CQC when required. Despite this oversight we found that all incidents and accidents were recorded fully and that the necessary actions were taken to protect people and make sure they received appropriate and safe care.

People told us they felt safe. The service had clear systems in place to report and investigate abuse. Staff understood the types of abuse and were confident in raising concerns with the management team. Staff were recruited safely.

New staff were provided with an effective induction programme and there was ongoing training available for staff. In addition to this regular supervision and annual appraisals meant people were supported by staff who had the skills and knowledge they required to deliver effective care.

People told us the food was of a good standard and they were happy with the range of meals available to them. The service had two kitchens, one of these was a halal kitchen and a chef was employed to ensure people’s religious and cultural needs were met.

There were strong working relationships with relevant health and social care professionals and the service was proactive in liaising with other agencies when they were concerned about people’s well-being.

People were supported to be as independent as possible. The service had assessment and rehabilitation beds and a number of people had been supported to achieve their goal of returning home.

The service had an up to date complaints policy and people told us they knew how to raise concerns. Complaints had been investigated and responded to in line with the policy.

People had access to a range of activities. Each of the four units had a communal lounge and dining area and the service had a large communal area where people accessed d

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them or their relative and responded to as part of the care planning process

Is the service caring?

Care staff were attentive and spent time talking to people and making sure their needs were being met.

A person who used the service said; “They always ask me how I am and I am never rushed with anything.”

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service, their relatives and other professionals involved with the service had completed provider satisfaction surveys. Feedback was very positive and comments included, “The management team are very professional and approachable, always supportive and helpful.”

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. This enabled the provider to focus on improvement

Before people received any care or treatment they were routinely asked for their consent. Members of staff told us they always explained all procedures and treatments. The care plans we looked at contained evidence of people’s views and experiences that were taken into account in the way the service was provided. One person told us, “I do what I want when I want.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. One person told us, “I am happy living here.” Another person told us, “I like it alright.”

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us they had no concerns with the cleanliness of the home. One person told us, “My room is clean.” People were treated by staff who were supported to deliver care safely and to an appropriate standard. Staff had a programme of training, supervision and appraisal.

There was an effective complaints system in place. Complaints people made were responded to appropriately.

During the inspection we saw people being cared for and saw staff using a kind and considerate approach. We spoke with eight people who used the service all gave positive comments about the care at Beckfield. One person told us "Nothing but the best here" and another "the staff look after me here."

We saw from a service user questionnaire conducted in January 2012 that 18 of 24 respondents said their privacy was always respected, whilst five said nearly always and one did not provide an answer. All the respondents said the staff were always polite and courteous and 20 of the 24 said they were always treated with dignity. One person who was using the service told us they chose to stay on the unit although there were activities like bingo in the main lounge downstairs and the staff respected their decision.

During the inspection we saw the two kitchens provided halal and european food. We saw people were eating good amounts and being offered second helpings. One person used specially adapted cutlery to support them to eat their meal independently. The people we spoke with told us they enjoyed the meals and one said "We always have enough to eat, the food is good."

We spoke to four people who use the service and they told us that staff are friendly and always explain what they are doing. Two people told us that they had met senior staff within the last month to discuss their hobbies and general care.

The people we spoke to told us that they had no concerns about the care they receive and would speak to the manager if they had any concerns. People told us that they were generally happy with the care being provided.