Beau House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff had training on how to recognise and report abuse and they knew how to apply it. People and those who matter to them had safeguarding information in a form they could use, and they knew how and when to raise a safeguarding concern. The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted. The numbers and skills of staff matched the needs of people using the service. Staff recruitment and induction training processes promoted safety, including those for agency staff. Staff knew how to take into account people’s individual needs, wishes and goals. Some aspects of people's medicines were not always managed in a way that supported best practice. However, we found no evidence people had been harmed, and the provider took immediate action after our feedback. In other areas of medicines management we found the service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured that people’s medicines were reviewed by prescribers in line with these principles.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service managed incidents affecting people’s safety well. Staff recognised incidents and reported them appropriately and managers investigated incidents and shared lessons learned.

Staff raised concerns and recorded incidents and near misses and this helped keep people safe. When things went wrong, staff apologised and gave people honest information and suitable support.

People were happy with the transition between services. Comments from people included, "The transition was short and immediate. The home handled it really well. They replicated [Person's] room from the previous home", “The transition was good. It was natural" and "I had no stress moving from the other place to here. It was all good."

Managers and staff fully understood the importance of ensuring people's transition between services was managed as safely and seamlessly are possible. Comments included, "We work with referring agencies to ensure all relevant information is gathered as part of the wider initial assessment. This helps to ensure we can meet the needs of the individual and other members of the household."

Health and social care professionals spoke highly of the service. Comments included, "I've worked with [Person] for many years now and their placement at Beau House has been a success. This is testament to the hard work of the manager and staff" and "I've found the service to be highly responsive and communication is good. I've every confidence in them."

Before people moved into Beau House, their needs were compressively assessed to ensure a safe transition between services. Pre-admission initial assessments were robust. Once a person was accepted to move into the service, comprehensive transition plans were in place, which included time being spent in the home getting to know staff and other supported individuals.

People told us they felt safe living at Beau House, comments included “I feel safe and looked after here.” and “I feel safe here. It’s a nice place to live.” People knew how to report any concerns they had and they told us they would speak to staff or a relative. People and relatives felt confident to raise any concerns and that their concerns would be listened to and acted upon.

Staff were aware of safeguarding processes. Staff told us they would share any concerns with the seniors and/or the manager. Staff knew how to raise concerns internally with senior leaders and to external agencies. Staff told us they received training in safeguarding vulnerable adults and were able to talk us through what this meant. Staff supported people to make decisions and understood people may lack capacity to make certain decisions. Staff told us capacity assessments were in place to assess decision making and where people lacked capacity, a referral was made to deprive the person of their liberty, in their best interests.

We observed interactions between staff and people in communal areas. Communication was natural and with the right balance of professionalism whilst 'keeping it real' for the supported individuals. It was obvious people were not afraid to 'speak up' and to share they views with staff.

The provider had a robust safeguarding processes in place. Any safeguarding concerns had been referred to the local authority safeguarding team for investigation. Processes for learning from safeguarding incidents were in place and action was taken to ensure any future risks were identified and mitigated. Complaints were acknowledged, investigated and an outcome provided. Learning from complaints was shared with the staff team. There were processes in place to assess people’s capacity and the provider applied to deprive the person of their liberty should an individual lack capacity and it be in their best interests.

People were involved in managing risks to themselves and in taking decisions about how to keep safe. People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well.

Staff could recognise signs when people experienced emotional distress and knew how to support them to minimise the need to restrict their freedom to keep them safe. Staff considered less restrictive options before limiting people’s freedom. Each person’s care and support plan included ways to avoid or minimise the need for restricting their freedom.

People’s care records helped them get the support they needed because it was easy for staff to access and keep good care records. Staff kept accurate, complete, legible and up-to-date records, and stored them securely. The service helped keep people safe through formal and informal sharing of information about risks.

The environment was homely and stimulating. The design, layout and furnishings supported people's individual needs. People personalised their rooms and were included in decisions relating to the interior decoration and design communal areas.

The registered manager and staff demonstrated they worked hard to ensure the living environment was safe and welcoming.

People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.

Environmental risk assessments were in place and safety records associated with the buildings and premises were up-to-date and in order.

We received mixed feedback from relatives about staffing levels and skill-mix of staff. Comments included, "There are enough staff, and they have got to know [Person] well" and "Plenty of staff and a high turnover. There are a lot of new staff, and I sometimes find this difficult" and, "There are a lot of staff, and it can be quite intimidating. It's a tricky one." Some of the supported individuals told us, "I get to go out whenever I ask so I think there is enough staff." Another person commented, "I like it when we're all together, staff and the lads. It can be funny."

The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.

We observed communal areas and noticed at times there could be 'pinch points' where a high concentration of staff gathered. For example, the communal dining room was used by staff to complete their notes and update records. We observed some staff getting quite animated with raised voices which could be overstimulating for some of the supported individuals which meant they could not access that area easily. We saw one person come downstairs from their bedroom, heading into the communal dining area, but they immediately turned back and went back upstairs when they saw how 'busy' the dining room was. We spoke with the leadership team about this, and swift action was taken to remind staff about not congregating in one place. We noted the main communal lounge was being refurbished at the time of this assessment and we understood this may have been a factor as to why staff chose to congregate more in the dining room.

Staff recruitment and induction training processes promoted safety, including those for agency staff. Staff knew how to take into account people’s individual needs, wishes and goals. The numbers and skills of staff matched the needs of people using the service.

The service promoted safety through the layout of the premises and staff’s hygiene practices. The service supported visits for people living in the home in line with current guidance. Staff used personal protective equipment (PPE) effectively and safely.

The service used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them. The service had good arrangements for keep premises clean and hygienic. All relevant staff had completed food hygiene training and followed correct procedures for preparing and storing food. The service’s infection prevention and control policy was up to date.

In the Provider Information Return (PIR) submitted by the service before our assessment, high-level assurances had been provided to CQC about the safety and effectives of medicines management at Beau House. However, our findings as outlined in this report demonstrated this was not entirely accurate. During the assessment process we spoke at length with the registered manager, locality operations manager, and members of the senior leadership team about the medicines management issues. Leaders were open, honest and transparent in acknowledging the shortfalls, and the corrective action that needed to be taken.

We looked at medicines for 4 of the 5 people living at Beau house and all 4 people had an adequate supply and there was no evidence that medicines had been out of stock, or any doses had been missed. However, some aspects we not always operated effectively. For example, there was no system for ensuring medicines were always in date because dates of opening were not always written on bottle boxes for medicines with limited shelf lives once opened; medication support plans were not fully completed or were not always accurate; medication risk assessments were in place but were generic documents about the risk factors in general about giving / storing ordering / refusing medicines rather than the risk of each medicine to each person; and, not all medicines which were prescribed to be given ‘when required’ had a supporting protocol, when protocols were in place, they did not always have sufficient information in them to ensure they were person centred. Whilst we found no evidence people had been harmed, we shared some of concerns with the local authority. The principal aim of this action was to ensure a supportive framework could be established which helped to ensure the right amount of support could be provided to Beau House. Following feedback, the provider took immediate remedial action and was supported by the local NHS medicines optimisation team.