This inspection took place on 11 and 12 June 2018 and was unannounced. The previous inspection was carried out on 02 and 03 February 2017 and there had been two breaches of legal requirements at that time. We rated the service requires improvement in two of the key questions, caring and responsive. We found at this inspection significant improvements had been made. The registered manager had submitted an action plan to the Care Quality Commission so that we could monitor the improvements made.

Beaufort House provides accommodation for up to 28 people who require personal care. At the time of our visit there were 27 people living 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 of the Health and Social Care Act 2008.

Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. People were protected from the risk of infection. Staff understood the importance of infection control and prevention.

People were provided with safe care by adequate numbers of appropriately skilled staff being made available.

Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only appropriate staff were employed to work at the service.

People received their medicines when they required them and in a safe manner. Staff received training and guidance to make sure they remained competent to handle people's medicines.

Staff received training to ensure they had the skills and knowledge required to effectively support people. Staff felt well supported by the registered manager and received regular supervision sessions and appraisals.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS.

People were monitored and encouraged with their eating and drinking where required and concerns about their health were quickly followed up with referrals to relevant professionals.

People's personal and health care needs were met and care records guided staff in how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People's privacy was respected, and their dignity and independence promoted.

People's needs were reviewed and monitored on a regular basis. Care records were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People knew about the service's complaints procedures and knew how to make a complaint.

People were supported and helped to maintain their health and to access health services when they needed them.

There was system in place for responding to and acting on complaints, comments, feedback and

suggestions.

The service was well led and the management promoted a positive culture which was open and transparent. The manager demonstrated good visible leadership and understood their responsibilities.

Quality assurance systems were in place to assess and monitor the quality of service people received and identified any areas that required improvement.

This inspection took place on 2 and 3 February 2017 and was unannounced. The previous inspection was carried out on 15, 20 and 21 May 2015 and there had been no breaches of legal requirements at that time. However we rated the home requires improvement in well led as the home had not notified us of an event that happened. We found at this inspection notifications had been appropriately reported to the CQC by the home since the last inspection.

Beaufort House provides accommodation and personal care for up to 28 people. At the time of our visit there were 25 people living at the home.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and relatives told us they felt the home was safe. Staff had received safeguarding training, demonstrated an understanding of key types of abuse and explained the action they would take if they identified any concerns.

Staff followed legislation designed to protect people's rights and ensure decisions were made in their best interests. The deputy manager understood Deprivation of Liberty Safeguards and had submitted requests for authorisation when required. Staff had a good understanding of the Mental Capacity Act 2005.

There were sufficient staff deployed to meet people's care, emotional and social support needs. Activities staff were employed to engage people in planned activities throughout each week.

All medicines were stored, administered and disposed of safely. The home had policies and procedures for dealing with medicines and these were adhered to.

People were supported by staff who had received an induction into the home and appropriate training, development, supervision and appraisal to enable them to meet people's individual needs.

People were supported to have enough to eat and drink and their specific dietary needs were met.

Staff did not always treat people with dignity and we found examples of this within the main body of the report.

People were supported to maintain their health and well-being and had access to healthcare services when they needed them.

The home was not always responsive to people's needs and care records were not always comprehensive. We found examples of this which we included within the main body of the report.

People and relatives confirmed they knew how to make a complaint and would do so if they had cause to.

The registered manager assessed and monitored the quality of care provided for people. Systems were in place to check on the standards within the home. These included regular audits of care records, medicine management, health and safety, infection control and staff training and supervision.

We were assisted by the manager who provided us with all the information we needed to carry out the inspection. This included looking at records about all aspects of people’s care and safety, staffing and the processes in place to monitor the quality of the service.

We had received information of concern from a whistle-blower informing us that the home was not clean, food was not cooked properly, and that people did not always receive safe care. We looked at these areas during our visit. We found the home to be clean and observed a midday meal where food offered to people was seen to be nutritious. We spoke with some of the staff team who demonstrated their knowledge about how people should be cared for safely. We observed staff, during the day, to be warm and respectful in their approach towards people.

People spoken with, told us “The food is nice, can’t fault it” and “The home is clean, everything is spotless”. A relative told us “The staff are all very good” and “Never heard raised voices, staff talk kindly, I’m impressed”.

The home had acted appropriately in protecting people from abuse when some staff had recently been dismissed for gross misconduct for presenting images on a social media website that were disrespectful to people living at the home.

The provider visited the home regularly to monitor all aspects of the management of the home. People's views and those of their relatives had been sought and acted on.

People looked well and were happy when we visited. People were spending time in the lounge with visitors, some were enjoying the privacy of being in their own rooms and people were walking freely around parts of the home.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received.

There was a constant interaction between staff and people in the home; everyone was relaxed and comfortable in each other's company. We were introduced to people throughout the day and they welcomed us to their home. They talked freely with staff in front of us and people were confident and assertive in their surroundings.

We spoke with and observed staff throughout our visit. They demonstrated good relationships with individuals and were knowledgeable about the care needs of those living in the home.

Some of the people who use the service have dementia and this made it harder for them to be able to make their views known. We observed how staff supported people who could not directly communicate their views to them.

We spoke to visitors about the care people received at Beaufort House. People we met told us how they felt people were well supported by the staff team at Beaufort House. We were told “They are very very caring here I don’t know how they do it”. “The staff have been marvellous”. “I do like it here”. “It’s homely here”. There was satisfaction expressed by everyone we met about the overall service people received at Beaufort House.

We saw people were well supported by staff with their range of needs. We saw that care plans mostly helped to support care practises with information to guide staff to give people the care and support they needed. However care plans did not currently include information about peoples usual sleep pattern and what time they liked to get up in the morning. This information is beneficial as it means staff will know when to assist people to get up and at times that suit them.

We saw guidance information to help staff to properly assess if it would be beneficial to peoples safety to use bed side rails on their bed. There was no risk assessment for the use of bed rails for one of the people whose care plan we read. Risk assessments need to be carried out to assess the risks of using bedrails against the benefits for the person concerned.

People were properly treated by the staff at Beaufort House. We saw effective systems were in place to help staff to know how to keep people safe in the home.

People were supported by a staff team who had done a range of training and were competent to understand how to meet peoples needs. People were cared for by staff who had a good understanding of their care needs and the impact that dementia has on people.

We saw that people were asked their views of the care and support that was provided at Beaufort House. We saw systems to learn from critical incidents and occurrences that had happened in the home involving people who used the service.

The inspection took place on 15, 20 and 21 May 2015 and was unannounced. The previous inspection was carried out on 13 September 2013 and there had been no breaches of legal requirements at that time. We had no previous concerns prior to this inspection.

Beaufort House provides accommodation for up to 28 older people. At the time of our visit there were 27 people living at the service. The service had one vacancy.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager and staff understood their role and responsibilities to protect people from harm. Risks had been assessed and appropriate assessments were in place to reduce or eliminate the risk.

People were kept safe because the registered manager and the staff team were knowledgeable about safeguarding issues and protected people from harm. They knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. All staff had received training in safeguarding adults. Medicines were administered to people safely by staff that had been trained.

Staffing numbers on each shift were calculated to ensure that each person’s care and support needs could be met. Staff were provided with regular training and were supported by their colleagues and their managers to do their jobs.

The service was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were on the whole satisfied with the quality of the food and drink provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

Staff were caring and compassionate. They understood people’s needs and developed caring professional relationships with people. They supported people to express their views and took account of what they said.

People using the service knew what the aims of the service were and they were involved in developing the service. The service was well led and organised. There were effective procedures for monitoring and assessing the quality of service.