We undertook an unannounced inspection of Beauchamp House Nursing Home on 17 and 18 July 2018. When the service was last inspected in May 2017, two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. This was because people were not always fully protected against the risks associated with medicines and there were a lack of sufficient numbers of suitably qualified, competent, skilled and experienced staff deployed to meet people’s needs.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Responsive and Well led to at least good.

The provider wrote to us in July 2017 and told us how they would achieve compliance with the regulations. At this inspection we found that improvements had been made in all areas and there was a commitment to on-going improvements.

Beauchamp House Nursing Home is a ‘care home’. 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.

Beauchamp House Nursing Home provides residential and nursing care for up to a maximum 54 people. At the time of our inspection, 43 people were living at the service. The service specialises in caring for older people including those with physical disabilities, people living with a mild dementia or those who require end of life care.

Within the grounds of Beauchamp House Nursing Home there are thirteen sheltered housing units where people can live independently or access personal care. At the time of our inspection, nobody living within these houses was receiving personal care from the staff at the service.

There was a manager in post who was going through the process of applying to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

People and their relatives spoke highly of the manager and the improvements that had been made since they had been in post. One person told us, “The lovely new matron [manager] has made a difference.”

Staffing levels and the deployment of staff had improved. There were systems in place to ensure suitable staff were recruited. Improvements had been made to the management of medicines; medicines were stored and administered safely.

People felt safe with the staff supporting them. People were supported by staff who knew how to recognise and report abuse. Risks to people were identified and risk management plans were in place. Measures were in place to prevent the risk of the spread of infection. There were systems in place to record and review any accidents or incidents that occurred.

People were supported to receive a diet that met their needs, and their nutritional needs were met. There were a range of choices and options on the menu and our observations of the dining experience was positive.

People received effective care from staff who had the skills and knowledge to meet their needs. Although some staff had not received supervision in line with the providers policy, staff spoken with felt supported by their managers.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People’s rights were protected because the correct procedures were followed where people lacked capacity to make specific decisions for themselves.

People were supported by staff who were kind and caring. Staff spoke positively about people; they demonstrated empathy and were able to tell us about people’s likes, dislikes and what was i

We undertook this inspection of Beauchamp House Nursing Home on 16 May 2017 and 18 May 2017. The first day of the inspection, on 16 March 2017, was unannounced. We returned on 18 March 2017 to spend time speaking with people living at the service and staff. When the service was last inspected in February 2015, no breaches of the legal requirements were identified.

Beauchamp House Nursing Home provides residential and nursing care for up to a maximum 54 people. At the time of our inspection, 51 people were living at the service. The service specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

Within the grounds of Beauchamp House Nursing Home there are thirteen sheltered housing units where people can live independently or access personal care. At the time of our inspection, nobody living within these houses was receiving personal care from the staff at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

During this inspection, we found that people were not always fully protected against the risks associated with medicines. Although people told us they received their medicines on time, people were exposed to risk of not receiving their prescribed medicines as stock balances were not always effectively maintained or monitored. This had not been identified by current governance systems.

People, their relatives and staff commented less positively about the staffing levels at the service and staff told us that people did not always receive quality, person centred care. In addition, during a review of care records, we found a small number of examples of where risk management guidance was not fully completed.

People at the service told us that activities did not meet their needs and relatives we spoke with said the same. Staff told us they felt the current activity provision was poor. We have made a recommendation in relation to activity provision. One person told us they were not told of meetings they wished to attend and relatives told us the provider was not always responsive following the meetings. People, relatives and staff gave mixed feedback on the management and leadership of the service.

People at the service told us they felt safe with the staff that supported them. Staff understood how to safeguard people and recruitment procedures were safe. Incidents and accidents were reviewed. The service was clean and the environment and equipment was maintained.

The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We saw examples of how the service had involved people and their representatives in decision making processes.

People said they received effective care. Staff had received training, supervision and appraisal from the service management. There was an induction aligned to the Care Certificate and staff told us the induction was good. People were supported when needed to eat and drink. Where required, additional healthcare professionals were consulted.

People said that staff were caring. The service had received compliments to this effect and relatives we spoke with commented highly on the staff. People’s privacy and dignity was respected and through our observations we saw people

This inspection took place on 16 February and 26 February. The visit on 16 February was unannounced. Beauchamp House Nursing Home is a care home that provides residential and nursing care for up to 54 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care.

In the grounds of the home there are twelve sheltered housing units where people can live independently or access personal care. Some move into the home as their needs change for respite or permanent care.

There were 53 people living at the home when we visited. At the last inspection on 5 December 2014, we had no concerns about the care provided to people in the home.

The registered manager had been in post for 12 years. A registered manager is a person who has registered with the Care Quality Commission 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.’

Since the last inspection in December 2014 concerns had been brought to our attention with regards to the health, safety and wellbeing of one person who used the service and the competency of one of the staff. We looked at this and found the registered manager and provider had taken action to ensure the safety of people in the home.

People we spoke with told us their care needs and support were provided safely. People said they usually had their care needs met in a timely manner because there were enough staff available.

People’s needs and the associated risks in relation to their care and support had been assessed and plans of care detailed the support required.

People were supported by staff who had been checked to confirm their suitability to work with people. Nurses were registered with the relevant professional body. Staff had undergone training and their competency had been assessed in key areas relating to the needs of people in their care.

People told us they felt safe and protected from harm and abuse. People were confident they could speak to staff if they had any concerns or were unhappy with any aspect of their care. Staff had a good understanding of what abuse was and their role in reporting concerns.

Medicines were managed safely. Procedures were in place to ensure the storage, ordering and receiving of medicines into the home. The administration of medicines was safe.

People’s assessments and plans of care had been reviewed regularly. These provided staff with guidance relating to the needs of people and told them how to care for people. Staff had a good understanding of how people wished to be supported. Up-dating sections of the care plans continued to bring them completely up to the provider’s standard of documentation.

Most people told us they enjoyed their meals which were nutritionally balanced and met their dietary needs. When people did not want the main choices at lunch time alternatives were always available. Drinks and snacks including fresh fruits were readily available.

Staff monitored people’s health and wellbeing and were referred to relevant health care professionals when there were any concerns about their health. People had access to health care support in order to meet their health needs.

Staff had undertaken training in promoting people’s dignity and rights. We observed staff treating people with care and compassion throughout our inspection visit.

The management team and staff knew how to support people to make decisions and ensure their legal rights were protected. Records showed that people made decisions whenever they were able to about their care and support needs.

People were encouraged to develop and share their experience of the service at meetings to review their care needs, ‘resident’s meetings’ and through satisfaction surveys. The provider’s complaints procedure was accessible to people who used the service, relatives and other visitors to the home.

The registered manager understood their responsibilities and demonstrated a commitment and clear leadership to continually improve the service. The registered manager was supported by the deputy manager and a team of registered nurses and senior care staff.

The manager had an ‘open door’ policy and welcomed feedback from people who used the service, relatives of people who used service, health and social care professionals and staff. The registered manager worked with other agencies such as the local authority to ensure people received care that was appropriate and safe.

Monitoring systems were in place to check the quality and safety of the service provided and action was taken to address any deficiencies found and was monitored to ensure the steps taken were effective. People lived in an environment that was comfortable and promoted their safety and wellbeing. All areas of the home including the outdoor space were safe and accessible.

The provider’s internal inspections and visits helped to ensure them people received quality care.

On entering Beauchamp House we found the atmosphere to be warm and welcoming. We spoke with people who used the service, a visiting family member and staff. We observed staffs understanding of the care and support needed. The people who used the service we spoke with said they were "well looked after" and staff were "very very nice" and a family member said staff are "very pleasant." We noted people's rooms were decorated with their personal belongings.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. Family members and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management and that they had received regular training.

We looked at the cleanliness and infection control and medicine procedures and found that the provider had adequate systems in place to ensure the safety of the people who used the service regarding the control of substances hazardous to health and the administration of medicines.

Beauchamps House Nursing Home was a large country house in landscaped gardens in a rural village. As a result of the completion of a new wing and considerable refurbishment of the existing building, at inspection we saw the home provided accommodation for 54 people. Within the grounds of the home there was a development of fourteen cottages and apartments suitable for assisted living.

Everyone who spoke to us was very positive about the care they had received at the home. We were told by many people that they were "well looked after". One person said "This is a wonderful place. I have been here two years. We don’t know how lucky we are.”

There is a thorough system of recorded assessment and monitoring of the service by the provider and the home manager. The home manager's report gave us information about the areas of the home that were reviewed and the actions that were taken to maintain good standards of care.

People told us that they make choices about the way that they spent their days in the home. We saw that people led different lives according to their preferences and needs.

Everyone who spoke to us was very positive about the care they had received at the home. We were told by many people that they were “well looked after”. One person said “I could not be better looked after than I am here.” People told us about being “warm and comfortable.”

Not all people were able to express their opinions about the care they received but they looked well presented and relaxed.

People appeared very comfortable and relaxed with the staff who supported them.

We observed that staff interacted with people in a polite and friendly manner.

We asked people who they would speak to if they had any worries. One person said “I could talk to most staff. Anyone would help."

People told us about their experiences in the home during the extensive period of rebuilding and development that the home had undergone.Most people now living in the home had moved from rooms in the old building and were now living in the completed new building. Everyone we spoke to was very positive about the comfort and decoration of the new building. People also said they would be “very glad” and relieved” when all the building works were finished.