Beacon House

People and relatives told inspectors they felt safe. Staff knew how to recognise abuse and how to report concerns.

“I am safe here, everything I need gets done.” from the report

Inspectors observed enough staff to meet people's needs in a timely way. Recruitment checks were in place, and staff were described as regular and familiar with people's needs.

“Safe recruitment practices were in place to ensure only staff suitable to work with vulnerable people were employed.” from the report

Staff had induction, ongoing training, supervision and appraisals. People could access healthcare professionals when needed.

“People had access to the healthcare services they required.” from the report

The home was well maintained, with communal areas, personalised rooms and an accessible garden. People gave positive feedback about the food.

“The home environment supported people's well-being. It was pleasantly decorated and well maintained.” from the report

Some people did not have the required choking risk assessment. Repositioning records had large gaps, and eight pressure mattresses were set incorrectly for people's weights.

“Pressure mattress settings did not always match people's weights. We observed 8 mattresses that were not set correctly according to people's weights.” from the report

Food and fluid charts had significant gaps. Some people regularly did not meet their fluid targets, and there was not enough guidance about what staff should do.

“Records showed people regularly did not meet their target with some people having less than half the required target.” from the report

The home did not always record the required legal decisions before using covert medicines or bedrails. This was a breach of the Mental Capacity Act requirements.

“A person had been receiving covert medicines. The covert procedure had been already implemented without a DoLS or best interests' decision prior to this being commenced.” from the report

Instructions for as-needed medicines did not explain when to give different doses. Inspectors made a recommendation to update this practice.

“Where PRN protocols were in place there was no guidance regarding variable doses.” from the report

Audits did not identify several problems with care records, pressure care, mattress settings and incident reporting. This was a breach of good governance.

“Quality checks and audits needed to be strengthened to ensure areas for improvement were identified and acted upon swiftly.” from the report