The inspection took place on 03 December 2018 and was unannounced.

Beane River View is a care home owned by Hertfordshire County Council and operated by Quantum Care Limited. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Beane River View is registered to provide care and accommodation for up to 40 people in one purpose built building across three separate units. On the day of this inspection 37 people lived at the home with a further person admitted during the day.

The home did not have a registered manager at the time of this inspection. 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.

At our previous inspection of this service undertaken in March 2016 we found the service was meeting the required standards. At this inspection we found people were not always offered opportunities for meaningful engagement and people’s care plans failed to provide detailed guidance to enable staff to provide consistent care and support.

Since the previous inspection in March 2016 there had been four changes in home manager. The current home manager was not yet registered with CQC. People who used the service told us they didn’t know who the home manager was. The manager told us of the many improvements they had introduced at Beane River View since they had been in post. These needed more time to be embedded into daily practice. Staff felt supported and liked working in the home, they were positive about their roles and the care and support people received. There were a range of checks undertaken routinely to help ensure that the service was safe. Satisfaction surveys were distributed annually to people who used the service, their friends and relatives and relevant professionals.

People felt safe living at Beane River View. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities. People's health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

The inspection took place on 07 March 2016 and was unannounced.

Bean River View provides accommodation and care to 40 older people including those who may live with dementia. There were 40 people accommodated at the home at the time of this inspection.

We last inspected the service on 09 April 2014 and found the service was meeting the required standards at that time.

The home had a registered manager. 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. The registered manager was not available on the day of this inspection, the care team manager deputised in the registered manager’s absence.

People felt safe living at Bean River View. Staff knew how to keep people safe and risks to people’s safety and well-being were identified and managed. The home was calm and people’s needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People’s medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives commended the staff team for being kind and caring. Staff were knowledgeable about individuals’ needs and preferences and people had been involved in the planning of their care where they were able. The staff team went above and beyond expectations to support people to maintain family relationships and participate in family occasions. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. A person who used the service told us, "I feel safe here." Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was always on duty in case of emergencies. Records were being kept securely and there was a system in place for their destruction.

Is the service effective?

People told us that they had been involved in discussions about their care and support needs. One person told us that care workers were “Good and helpful.” Care records were personalised and included detailed risk assessments.

Is the service caring?

People were supported by kind, caring and attentive staff. We saw that care workers were patient and gave choices and encouragement when supporting people. We observed people being assisted to do things at their own pace and not being rushed. One person told us “I can’t fault the staff here".

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us they completed a personal assessment prior to admission and were invited to review meetings to discuss what was important to them. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had been supported to maintain relationships with their friends and relatives.

Is the service well-led

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. They confirmed they had been listened to and as a result changes had been made. Staff told us they were clear about their roles and responsibilities.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us about their experiences.

People told us that they were satisfied with the care provided by staff at the home. One person said, “As a home I love it. My room, the company, it’s all just right. I live with anxiety and the staff help me with this.” We found that staff were respectful of people's right to make their own decisions and give consent to care when possible. Where people did not have capacity to make decisions, appropriate safeguards were in place.

We found that appropriate care and support was provided to people when required. One person told us, “I sometimes remind them of how I like things to be done. They always do what I ask.” There was a range of activities for people to engage in depending on their interests.

People were complimentary about the meals provided at the home and people’s dietary needs were assessed and met.

Satisfactory checks were carried out prior to staff being allowed to work at the home. This ensured that only staff suitable to work with vulnerable people were employed.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people and their relatives about the service provided.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us their experiences.

We observed staff interacting with people living with dementia and engaging them in conversation. People were alert and showed interest in their surroundings. One person told us that they enjoyed talking but that it was sometimes difficult for people to understand them as they forgot words. A visiting relative said, “The care is very good. The staff know me well, and I am always told what is going on.” However the environment of the home provided limited stimulation for people with dementia, or aids to their orientation.

We saw evidence of regular audits of procedures for maintaining health and safety in the home. The relative who we spoke with confirmed that they were able to give their views on the care their relative received. They said, “There are regular surveys to ask our views. I can also raise any concerns with the staff at any time. Everyone is very approachable.” However these checks had failed to identify that care records did not include information and guidance about some specific health needs to enable staff to support the people concerned appropriately.

During our visit to the home we found some instances of possible risk to people’s health and safety that had not been identified by the provider’s audit procedures.