Beacon House, a 23-bed residential care home in Fleet, Hampshire, was rated Requires Improvement overall following a July 2023 inspection, with concerns in medicines management, care record-keeping, staff recruitment compliance, and governance audit effectiveness. A newly appointed manager (the third since January 2022) was actively addressing these issues through an improvement plan, though embedding of new processes remained incomplete at the time of inspection.
Concerns (8)
moderateMedication management: “Staff had administered the cream from an existing supply, which was not dated with the date of opening. Staff should only administer a medicine which has either been prescribed or authorised.”
moderateMedication management: “Two people had thickeners for their drinks which was stored in their unlocked bedrooms, this did not reflect national patient safety guidance.”
moderateRecord keeping: “People did not have a falls risk assessment as per the providers policy and national guidance... their care plans did not mention their re-positioning needs.”
moderateGovernance: “Audits completed from January to March 2023 had not identified issues overall, however, the external assessment identified a range of issues.”
moderateLeadership: “There had been 3 managers of the service since January 2022. Governance processes had not been operated effectively prior to the new manager starting.”
moderateStaff training: “The provider had commissioned an independent assessment... the report had identified a number of aspects requiring improvement, including: incident reviews, recruitment, nutrition, staff supervision, training.”
minorSupervision / appraisal: “The provider had commissioned an independent assessment... the report had identified a number of aspects requiring improvement, including: staff supervision.”
minorInfection control: “We were not assured that the provider's infection prevention and control policy was up to date.”
Strengths
· People reported feeling safe and well cared for by staff who knew them well.
· Sufficient staffing levels were maintained with shift leadership by senior carers and a duty manager.
· Processes were in place to safeguard people from abuse, with staff trained and knowledgeable about reporting.
· Incident recording and learning processes were in place, including a new lessons learnt form for falls.
· New manager acted promptly on independent assessment findings, prioritising safety issues and creating improvement trackers.
Quality-Statement breakdown (10)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood