Beaumont Hall 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.

Beaumont Hall accommodates up to 60 people in one adapted building and provides accommodation over three floors. The service specialises in caring for older people including those with physical disabilities and people living with dementia.

At our previous inspection in July 2017 we rated the service as 'requires improvement'. We found improvements were needed to ensure that risks to people’s safety were assessed and managed.

People did not always receive their medicines as prescribed and care provided was not responsive or personalised. The provider was asked to complete an action plan to tell us what they would do to meet legal requirements for the breaches in safe care and treatment, and person-centred care.

You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Beaumont Hall on our website at www.cqc.org.uk.

This inspection took place on 11 June 2018 and was unannounced. We returned on 12 June 2018 announced to complete the inspection. At the time of our inspection visit 51 people were in residence.

At this inspection we found the provider had followed their action plan and made the required improvements to meet the legal requirements.

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.

The registered manager understood their legal responsibilities. They provided good leadership and supported staff and people who used the service. The registered manager and the staff team were committed to providing quality care and welcomed feedback and suggestions to enhance people’s quality of life.

People were supported to stay safe. Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly. Staff were provided with clear guidance and information to follow to meet people’s needs. A new electronic care planning system was in place.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support that ensured their ongoing health needs were met.

Systems and processes were in place to safeguarding people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Staff were recruited safely and there were sufficient numbers of staff available to support people. Staffing levels were kept under review to ensure people received sufficient staff support.

People to be involved in decisions made about all aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had developed positive trusting relationships with the staff team. People’s privacy and dignity was respected and independence was promoted. The design and homely environment ensured people’s safety and privacy. People continued to receive good care and support that was responsive to their individual needs.

Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care

At our previous inspection in May 2016 we rated the service as 'requires improvement'. We found the provider had made some improvements to how people’s medicines were managed and administered and the implementation of the provider’s governance system to monitor the quality of the service provided. Further action was needed to ensure those improvements were sustained. In addition the manager at that time was had begun the process to become the registered manager. A registered manager is a person who has registered with us to manage the service and has the legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008.

Thereafter, provider had appointed another manager but they left soon after.

This inspection took place on 7, 20 and 26 July 2017 and all visits were unannounced.

Beaumont Hall is a care home that provides residential care for up to 60 people. The service specialises in caring for older people including those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility. At the time of our inspection visit there were 49 people in residency.

This service is required to have a registered manager. A registered manager was not in post. The provider had appointed another manager. They showed us evidence to confirm that they had begun the process to become the registered manager. We will continue to monitor this.

We found people’s medicines were not always stored or administered in a safe way. Risks to people’s health and safety were not effectively assessed, monitored and reviewed to ensure that the measures put in place remained appropriate.

Staff were responsive to meet people’s needs. However, care plans were not always personalised to reflect how people wished to be supported. Care plans and risks were not kept under review or monitored effectively. Further action was needed to ensure all the information was accurate and reflective of individual preferences.

The manager had identified that staff’s training and support was not up to date. They had responded to gaps in staff’s knowledge. Some training has been provided to meet the needs of people with specific health conditions. The manager has recommenced staff supervisions. Further training and support was being planned to equip staff for their role and to meet people’s care needs effectively.

The provider’s quality governance and assurance systems had been fragmented. However, since the appointment of the manager, they had re-commenced audits and checks to monitor the service. They had identified similar issues which we found during this inspection. The provider’s representative supported the manager and monitored the progress of improvements. Further action was needed to ensure all the shortfalls identified were addressed within the timescales that had been identified and sustained.

People told us they felt safe at the service. The manager and staff understood their responsibility to protect people from the risk of abuse. Staff were recruited through safe recruitment practices. People lived in a clean and well maintained environment.

People had enough to eat and drink and their dietary needs were met. People had access to health support and referrals were made to relevant health care professionals when required.

People were supported to have choice and control of their lives and staff did support them in the least restrictive way possible. The policies and systems in the service supported this practice.

During our inspection visit we saw people take part in some activities that were of interest to them. People told us that their religious needs were met. People told us staff were kind and caring towards them. Staff were treated with respect and their privacy and dignity was maintained.

People and their relatives were confident to complain and that their concerns would be addressed. A complaints p

Beaumont Hall is a care home that provides residential care for up to 60 people. The service specialises in caring for older people including those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility.

We previously carried out an unannounced comprehensive inspection of this service on 4 and 5 May 2016. We found that the provider was not meeting the standards we expected and there were breaches of legal requirements. This was because people did not receive their medicines as prescribed and systems to assess and monitor the quality of the service continued to be ineffective. Following this inspection we served warning notices which informed the provider of the date in which they were to required to improve.

We carried out an unannounced focused inspection of Beaumont Hall on 21 September 2016. This inspection was carried out to check that the provider had made the required improvements in order to meet legal requirements. At the time of our inspection there were 52 people in residence. We found that some improvements had been made.

We inspected the service against two of the five questions we ask about services. Is the service safe and is the service well-led. This is because the service was not meeting some legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Beaumont Hall’ on our website at www.cqc.org.uk.

A registered manager was not 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.

The service has been without a registered manager since January 2016. This meant the provider’s condition of registration was not met. The regional director who facilitated this inspection told us that the service was being managed by a registered manager from another of the provider’s care services. They also told us that a new manager had been appointed at Beaumont Hall.

Some improvements had been made in relation to how the provider checked the quality and safety of service provided, however these systems were not yet established. We saw that some actions had been taken as a result of checks however further action was needed to demonstrate that people’s views influenced the development of the service and that staff received the training and support to carry out their roles. This was in order to drive improvement at the service.

Improvements had been made so that people received their medicines at the right times, as prescribed. We found there was clear guidance for staff to follow and the systems to store, manage and administer medicines safely were in place.

This inspection took place on 4 May 2016 and was unannounced. We returned on the 5 May 2016 to complete the inspection.

Beaumont Hall is a care home that provides residential care for up to 60 people. The service specialises in caring for older people, those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility. At the time of our inspection there were 57 people in residence.

At the last inspection on 17 and 18 August 2015, we asked the provider to take action to make improvements to the staffing levels, ensuring people’s privacy and dignity was maintained and the quality assurance system was used effectively. We found that service had made some improvements, however further improvements were required.

At the time of our inspection a registered manager was not in post. The service has been without a registered manager since January 2016. However, the provider had appointed a manager in March 2016 who facilitated this inspection.

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.

We found that people did not always receive their prescribed medicines at the right time. Systems to ensure adequate stocks were kept were ineffective. Although checks were carried out on the medicines administered and the records, errors were not identified therefore people’s health was put at risk.

Staff training and support provided was not always kept up to date. The planning and monitoring of staff’s skills needed to improve to ensure staff were able to meet people’s needs safely.

The provider’s quality governance and assurance systems were still not used fully or monitored to ensure people’s health, safety and wellbeing was maintained. People’s confidential information was not always maintained. There was limited opportunity for people to share their views about the service to influence changes to the care being provided.

People’s care needs were assessed including risks to their health and safety. Care plans were written to reflect people’s needs, which included the measures to help promote their safety and independence. These were regularly monitored and reviewed.

People told us they felt safe at the service and with the staff that looked after them. Staff were recruited in accordance with the provider’s recruitment procedures, which helped to ensure suitable staff, were employed to look at Beaumont Hall.

People lived in an environment that was kept clean. All the bedrooms had an ensuite facility and were personalised.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had been followed. People’s mental capacity to make decisions about their care had been assessed and their wishes were known and kept under review. The service acted in accordance with their legal responsibility to ensure that any best interest decisions made involved the relevant people and health care professionals where the person lacks capacity to make decisions or are unable to do so.

People’s views about the quality of food had been listened to and action had been taken to change the menu choices. However, the dining experiences for people varied, which meant meal times were not always pleasurable.

People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance. People’s health needs were met by health care professionals and were supported to attend routine health checks. Records showed staff sought appropriate medical advice and support when people’s health was of concern.

Although the service had a pr

We recently undertook an inspection visit to Beaumont Hall on 23 September 2014 because we had received information of concern that people did not receive the support reliably because there were not enough staff.

At the time of our inspection visit the service was managed by the acting manager. The registered manager was in the process of cancelling their registration. During our visit we spoke with seven people who used the service and observed how they were supported. We also spoke with seven staff supporting people including agency staff. We reviewed information in relation to the management and monitoring of the staffing levels at the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

People who used the service told us that they were satisfied with the care and support they received. They told us staff were available and helped them with their daily needs in a reliable manner. A few people commented that there had been times when they had to wait because staff were busy helping other people. One person said “It’s a very hard job. Most staff work very hard and are always helpful.”

Staffing levels were determined by monitoring the needs of people who used the service matched against the numbers of skilled, qualified and experienced of staff. Staff were deployed to work is specific areas and had key responsibilities. The provider monitored the staffing levels and had taken steps to assure themselves that staff respond promptly to help maintain people’s safety and wellbeing.

We carried out this inspection to ensure that improvements had been made following our previous inspection.

We found that people were satisfied with how their medicines were given to them. Staff were trained and understood people’s individual medicine requirements. Staff followed the medication administration procedures correctly and completed the medication administration records accurately.

The provider has a number of monitoring systems in place to assess and monitor the quality of service people received. People’s views were sought through reviews of their care needs and satisfaction surveys. People were made aware of how to make a complaint and were confident that any concerns raised would be addressed. One relative told us: “When we came here, we knew it was the right place for mother. There’s been a few problems at first but when we told them [staff] they were straight on it. They’re brilliant here and you can quote me.”

This inspection took place on 17 August 2015 and was unannounced. We returned on the 18 August 2015 announced.

Beaumont Hall is a care home that provides residential care for up to 60 people and specialises in caring for older people including those with physical disabilities and people living with dementia. The service is purpose built and provides accommodation over three floors. All the bedrooms have an en-suite facility. At the time of our inspection there were 58 people in residence.

A registered manager was 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.

People told us they felt safe at Beaumont Hall and we found that staff had a good understanding of safeguarding (protecting people from abuse).

People’s care needs were assessed including risks to their health and safety. Where appropriate, referrals were made to the relevant health care professionals in order to manage those risks safely. Risk management plans in place provided staff with the guidance to ensure people’s needs were met. People at risk of poor nutrition had assessments and plans of care in place for the promotion of their health. However, people’s consumption of food and drink could not be effectively monitored because the minimum intake was not known. We also found a mix of current and old care plans, which made it difficult for staff to ensure the support they provided was appropriate. We raised both issues with the registered manager and they assured us action would be taken.

Staff were recruited in accordance with the provider’s recruitment procedures, which helped to ensure suitable were employed to look after people.

People told us there were not enough staff available to support them. Relatives also had the same concerns about there being not enough staff. On the first day of our inspection we heard people calling out for help and call bells rang constantly. With the increased staffing on the second day this was not the case. The provider agreed to increase the staffing numbers temporarily whilst the allocation and deployment of staff was improved. Although the planned rota were not yet reflective of the additional staff the provider had assured us that the staffing numbers would be increased to ten staff.

The home was clean and dedicated staff were employed to maintain the hygiene and cleanliness. At times care staff were required to assist with the house-keeping and laundry duties which meant people’s needs were not always met or there was a delay. When we raised this with the provider they told us that the registered manager had the authority to use agency staff so that care staff could focus on meeting people’s care and support needs.

Medicines were stored safely and people received their medicines at the right time. Further action was needed to ensure timely recording of the fridge temperatures to ensure medicines that needed to be refrigerated were safe.

Staff received an induction when they commenced work and on-going training to support people safely. We observed the staff supporting people safely when using equipment such as a hoist. We found some staff were not aware of how to support people living with dementia. When we shared our findings with the registered manager they told us additional dementia awareness training was booked for staff. Staff were knowledgeable about people’s needs and could refer to people’s care records. Staff received information about any changes planned to the service through meetings and staff appraisals.

People told us that staff sought consent before they were helped. People were protected under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager and some staff understood their role in supporting people to maintain control and make decisions which affected their daily lives. When we shared this with the registered manager they told us additional training was booked for staff in MCA and DoLS. We found referrals, where appropriate, had been made to supervisory bodies where people did not have capacity to make decisions to were made in the individual’s best interest. Further action was needed to ensure decision specific assessments were carried out. We raised this with the registered manager and they assured us action would be taken.

There was a choice of meals that met people’s dietary needs. Drinks and snacks were readily available. People’s views about the quality of food had been listened to and action had been taken to change the menu choices. The dining experiences for people were mixed. People who needed support to eat often had to wait because staff were not available or aware that they needed encouragement and support.

People’s health needs were met by health care professionals. Records showed staff sought appropriate medical advice and support when people’s health was of concern and were supported to attend routine health checks. Health care professionals spoken with confirmed this to be the case and told us staff followed the instructions given.

People told us that they were treated with care and that staff were helpful and we also observed this to be the case. However, some people had experienced care that did not always respect their dignity, rights or their privacy, which we had also observed.

People were involved in making decisions about their care and in the development of their plans of care. Where appropriate their relatives or representatives and relevant health care professionals were also consulted.

People were confident to raise any issues, concerns or to make complaints, as were their relatives. Records showed complaints received had been documented and included the feedback to the complainant. However, not everyone spoken with felt that their concerns had been addressed properly.

The registered manager understood their responsibility about the management of the service. There was a management structure in place. We saw at times staff were needed to be directed to ensure they people’s needs were responded to and staff worked in a co-ordinated manner.

The provider’s quality governance and assurance systems were not used effectively and consistently to ensure people’s health, safety and welfare. Feedback from people who used the services, their relatives and staff were not always acted on or monitored to make the changes to the quality of care provided. Internal audits carried out were not always completed in full and actions to address any shortfalls were not monitored and sometimes not addressed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.