# Pegasus Care – Beeches *Operated by Pegasus Care Homes Limited.* Pegasus Care – Beeches is a CQC-regulated home-care agency in West Bromwich. ## CQC Ratings | Key question | Rating | | --- | --- | | Overall | Requires improvement | | Safe | Requires improvement | | Effective | Good | | Caring | Good | | Responsive | Good | | Well-led | Requires improvement | Rating published: 17/04/2019 ## Practical info - Postcode: B70 6HQ - Registered manager: Watkins, Fiona - Local authority: Sandwell - Region: West Midlands - City: West Bromwich - Last CQC check: 17/Nov/2023 - 00:00 ## Inspection findings ### Other - Finding - Evidence: People and relatives reported positive experiences of care and felt comfortable communicating with staff. - Published: 2023-12-05 - Finding - Evidence: Incident and accident learning was shared with staff through meetings and memos. - Published: 2023-12-05 - Finding - Evidence: Sufficient staffing levels were maintained and safe recruitment processes were in place. - Published: 2023-12-05 - Finding - Evidence: The provider worked in partnership with advocacy and other health and social care organisations. - Published: 2023-12-05 - Finding - Evidence: The registered manager was open, transparent, and responsive to inspection feedback, taking prompt remedial action. - Published: 2023-12-05 - Finding - Evidence: People were supported to have maximum choice and control in the least restrictive way; MCA and DoLS principles were followed. - Published: 2023-12-05 - Finding - Evidence: Staff understood how to recognise and report abuse and knew how to apply training. - Published: 2023-12-05 - Finding - Evidence: Safeguarding procedures were followed and lessons learnt following concerns about unexplained bruising. - Published: 2023-12-05 - Finding - Evidence: Staff had low turnover, supporting consistent care from staff who knew people well. - Published: 2023-12-05 - **infection_control** _(minor)_ - Evidence: some areas of the care home and some supported living houses where the integrity was compromised due to wear and tear. This would impact the providers ability to prevent infections. - Published: 2023-12-05 - **record_keeping** _(moderate)_ - Evidence: Some of the daily records did not always clearly detail what de-escalation methods were used before medication and other interventions were used. - Published: 2023-12-05 - **governance** _(critical)_ - Evidence: medicines audits were ineffective as they did not identify stock count inaccuracies. Kitchen audits and cleaning schedules did not identify rust in the microwave. - Published: 2023-12-05 - **care_planning** _(moderate)_ - Evidence: some of these were not always person centred. Some people's care plans did not contain detailed information about their goals, aspirations, and development of life skills. - Published: 2023-12-05 - **care_planning** _(moderate)_ - Evidence: care plans did not always contain accurate information about people's risks...some risk assessments lacked detail about what special equipment people needed or how staff should monitor - Published: 2023-12-05 - **medication_management** _(moderate)_ - Evidence: some topical creams and liquid medicines had not been dated when they were opened. This meant there was a risk these could be used after their expiry date. - Published: 2023-12-05 - **medication_management** _(critical)_ - Evidence: when we checked the stock balance of medicines these were not always accurate with what had been administered. There were a lack of records stating what the overall stock balance should be. - Published: 2023-12-05 - Finding - Evidence: Registered manager understood notification requirements and the whistleblowing policy was known to staff - Published: 2021-01-26 - Finding - Evidence: Provider had a complaints process in place with trend monitoring - Published: 2021-01-26 - Finding - Evidence: Staff showed compassion and caring behaviour, described as 'fantastic' by a relative - Published: 2021-01-26 - Finding - Evidence: Advocates were made available to support people who could not share their views independently - Published: 2021-01-26 - Finding - Evidence: Staff were able to seek support when needed and received supervision and appraisals - Published: 2021-01-26 - Finding - Evidence: Robust recruitment process including DBS checks, references, and shadowing induction - Published: 2021-01-26 - Finding - Evidence: People were supported to access healthcare professionals and community activities - Published: 2021-01-26 - Finding - Evidence: People's independence, privacy and dignity was respected by staff - Published: 2021-01-26 - Finding - Evidence: Staff demonstrated a good understanding of people's needs, likes and dislikes - Published: 2021-01-26 - Finding - Evidence: People told us they felt safe and were happy with how staff administered their medicines - Published: 2021-01-26 - **staff_training** _(minor)_ - Evidence: It was clear that while training was available not all staff had completed the MCA training and DoLS training was in the process of being delivered. - Published: 2021-01-26 - **staffing_levels** _(minor)_ - Evidence: Over a weekend when more people were in the home due to the respite service there was no indication that staffing levels were being adjusted based upon people's needs. - Published: 2021-01-26 - **governance** _(moderate)_ - Evidence: Cleaning rotas were not being regularly monitored and checked and as a result we saw areas of the home which had not been regularly dusted and cobwebs had gathered. - Published: 2021-01-26 - **staff_competency** _(moderate)_ - Evidence: I have not had my competency checked since... Another member of the staff told us they had not had their competency checked in over 12 months. - Published: 2021-01-26 ## Source Data published by the [Care Quality Commission](https://www.cqc.org.uk/) under the Open Government Licence v3.0. Canonical page: https://homecarecompass.co.uk/agency/1-331297275 HomeCare Compass is an independent guide and is not affiliated with the CQC.