This was an unannounced comprehensive inspection that took place on 9 March 2017.

Beaumanor Nursing Home provides care and nursing support for up to 53 people with a range of needs. These include older people and people who have a physical disability or a sensory impairment. The home is located on two floors with lift access. The home had four communal lounges, two kitchens and two dining rooms where people could spend time together. At the time of inspection there were 40 people using the service.

The service had a 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 were protected from the risk of harm at the service because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns that they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified control measures were in place.

There were enough staff to meet people’s needs. People sometimes had to wait for support. Staffing levels had been assessed and staff could usually respond to people’s requests for support in a timely manner. There were times when staff were no present in the communal areas. The provider has safe recruitment practices. This assured them that staff had been checked for their suitability before they started their employment.

People’s equipment was regularly checked. There were plans to keep people safe during significant events such as a fire. The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this.

Staff received appropriate support through a structured induction and support and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs. Nurses were supported to remain competent and maintain their qualifications.

People received sufficient nutrition and hydration. They had access to a variety of meals, snacks and drinks. Their health needs were met. This is because staff supported them to access health care professionals promptly. Staff also worked with other professionals to monitor and meet people’s needs and support them to remain well.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed. Staff told us that they sought people’s consent before delivering their support.

People were involved in day to day decisions about their support. They told us that staff treated them with respect. Staff treated people with kindness and compassion.

People received care and support that was responsive to their needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed. People were encouraged to maintain and develop their independence.

People took part in activities that they enjoyed. People were not always involved in reviewing their care plans.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place that was available for people and their relatives.

People and staff felt the service was well managed. The service was led by a registered manager who understood most of their responsibilit

This inspection took place on 15 March 2016 and was unannounced.

Beaumanor Nursing Home provides care and nursing support for up to 53 people who are aged over 65 and who may also have a physical disability or a sensory impairment. The home is located on two floors, with lift access to both floors. The home has a variety of communal rooms and areas where people can relax. At the time of the inspection 46 people were using the service.

The service had a 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 told us that they felt safe when staff supported them and that they enjoyed living at Beaumanor Nursing Home.

Risk assessments were in place which set out how to support people in a safe manner. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

People told us that they had to wait for assistance when they needed this. We saw that staffing levels had been assessed based on the needs of the people who used the service. We found a lack of presence of staff in some of the communal areas, people were left unsupervised for long periods and we saw that there were limited call bells in the communal areas.

The premises required some maintenance to make sure that it was safe. We found that radiator covers were lose or not always secured to the walls, shelves in bathrooms were loose and some wardrobes were not secured to the walls.

The provider carried out pre-employment checks before staff started to work at the service.

People received their medicines safely and at the right time from staff who were trained and deemed competent to administer medicines.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff had an understanding of the Mental Capacity Act. We saw that appropriate assessments of people's capacity to make decisions had taken place.

People were supported to maintain a balanced diet. People did not always receive support from staff with eating when they needed this. People were supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment and review of their needs.

Some people were supported to take part in group activities that they enjoyed. Where people did not enjoy the group activities they told us that they did not participate in many activities.

People’s preferences were recorded however these were not always respected.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

People were asked for their feedback on the service that they received. The provider carried out monitoring of the quality of the service.

This inspection took place on 20 October 2014 and was unannounced. At the last inspection on 28 May 2014 we asked the provider to take action to make improvements. The provider was not meeting people’s care and welfare needs, and the systems for assessing and monitoring the quality of the service required improvements. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that this action had been completed.

Beaumanor Nursing Home is located in the town of Leicestershire. The home provides accommodation and nursing care for up to 53 people who have either nursing or residential care needs. This includes health conditions, physical and sensory needs including dementia. On the day of our visit there were 47 people living at the home, this included one person in hospital. The accommodation is provided over two floors and has a passenger lift.

Beaumanor Nursing Home has a 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 and associated Regulations about how the service is run.

People who used the service including relatives we spoke with, made positive comments about the care and treatment provided.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place and appropriate action was taken if concerns were identified.

Risk plans had been completed where appropriate for people who used the service, staff, visitors and the environment.

Our observations during our visit showed us that, at times, there were periods when people were left in the communal areas without staff around. Some people were unable to request assistance and relied on staff to meet their needs.

We found some concerns with the management of medicines, the registered manager took swift action to improve the systems and process to reduce the impact on people.

The provider supported staff by an induction and ongoing support, training and development.

People’s human rights were protected because staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The home made appropriate and timely referrals to health care professionals and recommendations were followed. This included support to attend routine health checks.

People were complimentary about the attitude and approach care staff had. Whilst we observed staff were caring, compassionate and respectful, we saw some examples of care that could have been better.

People told us that they felt included in discussions and decisions about their care and treatment. People had information available to them advising about independent advocacy service and information about the providers’ complaints procedure.

The home provided personalised care and treatment, people had been asked what was important to them in how they wished to be cared for. This information was reflected in their plans of care.

People who used the service, relatives and staff were positive about the leadership and said they felt included in how the home developed.

There was evidence that the home worked well with other organisations in improving standards, and there were systems in place to monitor the quality and safety of the service.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with six people who used the service, and three relatives for their views and experiences.

The registered manager was not present on the day of our inspection. We spoke with the nurse in charge, two nurses and two care workers. We looked at some of the records held in the service, including the care files for four people who used the service. We also used observation to understand people’s experience, as some people had communication needs and were unable to tell us their views and experiences.

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. This is a summary of what we found.

Is the service safe?

People told us that they felt safe. Relatives said they had no concerns about the safety of people and that people were cared for well.

We found some concerns with the staffs practice in relation to the administration of medication. We observed nursing staff did not stay with the person to check they had taken their medicines safely. The medicines trolley was not appropriately secured at all times.

We also found concerns with how people were supported with their mobility needs. We observed some poor moving and handling practice. This meant people were not always protected from risks due to unsafe practice.

The provider had safeguarding policies and procedures in place that protected people from abuse. We found staff were knowledgeable about their role and responsibility in ensuring people were safe.

The provider had increased staffing levels since our last inspection in November 2013. The staff rota was based on the care needs of people, and informed what the numbers, qualifications, skills and experience of staff were required.

We, the Care Quality Commission (CQC) monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to nursing homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there was nobody using the service who required a DoLS authorisation. We saw staff had received training on DoLS.

Is the service effective?

People had received a pre-assessment and care plans and risk assessments were reviewed monthly. We saw documentation that showed people that used the service, and their relative or representative had been involved in discussions and decisions about the care and treatment provided.

We saw the provider made appropriate referrals to health professionals when people’s health condition or needs had changed.

The provider supported its staff by providing them with regular training, supervisions and competency assessments, to ensure staff developed their knowledge, experience and skills.

Is the service responsive?

The provider had a complaints policy and procedure that supported people to know their rights, and what action to take should they wish to complain about the service. However, the system used by the provider to record and respond to complaints was not clear. It was difficult to ascertain that complaints had been responded to in a timely manner and to a satisfactory conclusion.

The provider arranged ‘resident’ meetings to enable people who used the service an opportunity to share their views, and to be informed about the running of the service or changes that occurred.

An activity coordinator worked 25 hours a week and provided in-house activities and organised community trips.

Is the service caring?

On the whole people who used the service and relatives said staff were caring. Comments included, “You know who you can go to, the manager is good, approachable and responds quickly to any issues.” And, “The staff are caring, approachable and friendly.”

We saw examples that showed staff were caring and attentive but found some inconsistencies with staffs practice. We saw examples when staff did not always show care and compassion, for example when people refused their meal or became upset.

We found staff knowledgeable about people’s needs, preferences and routines.

Is the service well-led?

Relatives and staff spoke highly of the manager and said they felt the service was well led and organised.

Staff were aware of their roles and responsibilities, this showed good leadership and accountability.

The provider had systems and processes in place to monitor the quality and effectiveness of the service it provided. However, we found some concerns with the audit system in place that checked records were completed accurately and appropriately.

People told us they were involved in the assessment and care planning process to make sure their care needs would be met. They said staff sought permission before they were helped. One person who was nursed in bed said, “The carers are good to me.” Another person said, “The care is good, but I do think the staff are sometimes rushed off their feet.” Care plans and risk assessments were up to date and reflected people’s needs, interests and how they wished to be supported.

People were supported to take their medicines by the qualified nurses and appropriate arrangements were in place to ensure this. Records showed people’s health needs were met by the qualified nurses at the service, doctors and the community nurse, amongst others.

People lived in an environment that was clean, safe and adequately maintained. There were systems in place to maintain hygiene and reduce the risk and spread of infection. Staff were trained and regular checks were carried out on the premises to make sure it was safe for everyone.

Improvements were needed to the staffing at Beaumanor Nursing Home because there were not enough suitably qualified and experienced staff available. This had the potential of putting the health and safety of everyone using the service at risk.

People’s care records, risk assessments and monitoring reports were sufficiently detailed, kept up to date and stored securely. Staff were aware of their responsibilities to maintain confidentiality and accurate records.

People who live at Beaumanor Nursing Home told us they were well cared for. They were treated with respect and their dignity maintained. People were involved to make sure their care and support needs were provided in a manner that suited them. One person said: “So far it’s been lovely here. They staff are wonderful and nothing’s too much.”

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly.

People told us they were satisfied with the meals provided. One person said: “Food is good, there’s always a choice.” Another said: “I like to sit here and have my dinner. The main meal is at lunch time and we usually have the option of soup or sandwiches for tea.”

People were protected because there were effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work.

People were provided with suitable and safe equipment to use that ensured their health, safety and promoted their independence. All equipment was serviced and maintained in good working order.

People had opportunities to make comment about the service. People were provided with information about how to make a complaint. People told us they were confident to raise concerns with the registered manager or the staff.

People spoken with were satisfied with the care treatment and support they received. People told us that staff were helpful and respected their privacy and dignity. Staff worked in a flexible way in order to accommodate people's individual needs and preferences.