The inspection took place on 15 August 2018 and was unannounced.

Beaumont Lodge 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 Lodge is a nursing home which accommodates up to 43 people in one adapted building. There were 33 people living at Beaumont Lodge at the time of our inspection.

At our previous inspection on 7 December 2017 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of consistent leadership, risks to people’s safety not being effectively monitored, inconsistent staff training and support, the monitoring of accidents and incidents, people not being provided with choices regarding their care and people’s legal right’s not being respected. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection we found improvements had been made in all areas of the service and no breaches of legal requirements were identified.

There were sufficient staff deployed to meet people's needs safely. Staff had time to spend with people and worked flexibly to ensure people were given a choice regarding when they received their care.

Staff received training and supervision to ensure they had the skills required to meet people’s needs. Clinical staff ensured their knowledge and skills were regularly updated. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people's safety and well-being were assessed and control measures were in place to help minimise risks. Risks were reviewed and action taken when people’s needs changed. Staff were aware of their responsibilities in keeping people safe from abuse and any concerns were reported to the appropriate authorities. Accidents and incidents were recorded and monitored by the registered manager and compliance manager. Action was taken in a timely manner to minimise the risk of reoccurrence.

People lived in a clean environment and safe infection control procedures were followed. A contingency plan was in place to ensure people would continue to receive safe care if the building could not be used.

Safe medicines systems were in place to ensure people received their medicines in line with prescriptions. Medicines were stored securely and medicines audits were completed. Appropriate referrals to healthcare professionals were made and advice given was followed by staff. People's legal rights were protected as staff understood their responsibilities regarding the Mental Capacity Act 2005. Staff explained and sought consent from people before providing their care. People’s weight was monitored and a wide choice of nutritious food and drinks were available.

Staff knew people well and ensured their care was provided in a person-centred way. People’s individual preferences were respected and staff considered how people were feeling when providing their care. People were encouraged to maintain and develop their independence and the design of the premises and equipment available supported this. Visitors were made to feel welcome and there were no restrictions on visiting times.

Staff responded to people with kindness and understood their communication styles. Care plans were personalised and contained information regarding people’s life histories. Staff understood the care people required with regards to specific health conditions and the care they wanted at the end of their lives. However, care plans regarding these areas would benefit from more detail. We have made a recommendation regarding this. People had access to a range of activities. Entertainers visited the service and trips to places of interest

Beaumont Lodge 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. Beaumont Lodge Nursing Home is registered to provide nursing and personal care for up to 43 people. There were 34 people living at the service at the time of our inspection.

This inspection site visit took place on 7 December 2017 and was unannounced.

There was a registered manager in post however they were on leave on the day of the 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. We were supported by the senior nurse on the day of the inspection.

Staff were not recognising risks and acting upon them. There were bed rails in place for people without proper assessment around the risk of these. Staff were not always knowledgeable on the risks to people including how to support a person appropriately when they had a catheter and how to monitor food and fluid intake and output.

Medicines were not always being managed in a safe way. People did not always have access to the medicines they needed and medicines charts were not always completed accurately. People were not always protected against the risk of infection as staff did not always have appropriate guidance in relation to this. Accidents and incidents were not always monitored to ensure safety of care.

We saw that there were sufficient staff that were attentive to people’s needs. There were elements to the safety of people that were being managed correctly including mobility risk assessments, skin integrity and nutrition. Equipment was available to assist in the evacuation of people and there were personal evacuation plans in place to provide staff with guidance on how to provide support. Robust recruitment took place to ensure that only suitable staff were employed. Staff were aware of how to report abuse and people told us that they felt safe with staff.

Staff had not received effective supervisions and nurse competency had not been assessed. Clinical training had not been provided to nurses and this was reflected in the practices we identified. Staff had not ensured that people had the capacity to make decisions for themselves as appropriate assessments had not taken place.

Although people told us that they enjoyed the food there were not always choices available to people that were on restricted meals. People did not always have the option of a cooked breakfast and a cooked meal in the evenings. We have made a recommendation around this. However people did have access to health care professionals when they became unwell.

The environment did not always meet the individual needs of people living at the service particularly those living with dementia. We have made a recommendation around this.

People were not offered choices of when they wanted to get up, where they had breakfast and when they wanted a bath or a shower. There were times where people were not respected and had routines without choice. Visitors were restricted to where they could spend time with their loved ones at the service. We did see instances of staff being kind and caring towards people. Visitors were able to come to the service when they wanted. People had access to religious services that were important to them.

Care planning was not specific to the person. Care plans lacked guidance to staff on how to deliver the best care that was appropriate to their needs. People had mixed views around the activities on offer and people in their rooms were not always provided with meaningful activities. End of life care plans

This inspection took place on 27 and 28 September 2016. The inspection was undertaken by one inspector and a specialist advisor, and was unannounced. At our previous inspection on 24 October 2013 we found the provider was meeting the regulations in relation to outcomes we inspected.

Beaumont Lodge is a nursing home located in Camberley in the county of Surrey. The home is registered to provide accommodation and support for up to 43 people and specialises in providing nursing care for the elderly. At the time of our inspection 43 people were using the service.

There was a registered manager in place. 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 using the service said they felt safe and that staff treated them well. Their privacy and dignity was respected by staff. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. Staff told us they sought consent from people when offering them support. The registered manager demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

There were enough staff to meet people’s needs and appropriate recruitment checks took place before they started work. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Risks to people using the service were assessed; care plans and risk assessments provided clear information and guidance for staff on how to support people with their needs. People and their relatives [where appropriate] had been involved in planning for their care needs. People were supported to maintain a balanced diet, and had access to a range of healthcare professionals when required. People received appropriate end of life care and support.

Regular residents and relatives meetings were held so that people could talk to the registered manager and provider about the home and things that were important to them. The provider took into account the views of people using the service and their relatives and staff through surveys, and took action to make improvements to the service in response to the feedback. There was a range of appropriate activities available to people using the service to enjoy. People knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Staff said they enjoyed working at the home; they received appropriate training and good support from the registered manager. Unannounced spot checks, including weekend and night time checks, were carried out by the provider and registered manager to make sure people received good quality care at all times.

We spoke with people living at Beaumont Lodge who told us the care and support provided at the home was excellent. They said the staff were caring and professional and knew their preferences and dislikes very well. Staff we spoke with had good knowledge of people’s care and support needs.

We observed support being provided and this was person centred and respectful. We saw staff interacting with people during which they continually spoke with the person offering reassurance and explanations. This meant people were treated in ways that maintained their dignity.

People told us they felt safe at the home because the staff were always available to offer care and support. They told us they had daily contact with the manager and the lead nurses with whom they had good relationships. Staff had training in safeguarding vulnerable adults and they were clear about their responsibilities in ensuring people were protected from abuse.

People said staff consulted with them, but the decisions were always theirs. They said they signed their care plans or their relatives signed on their behalf. Two people told us they did not know if they had a care plan. One person said, “I am self caring and I get on reasonably well with the staff. I find them very accommodating”. Another person said, “I know I have a care plan. I am very capable and I am involved in my care. I am due for a review next week”. People said the staff spoke to them in a polite way.

A family member said, “I am very happy with the care my relative receive. The staff are very approachable and understanding. My relative is kept very clean and well shaved. This is so important as my relative is not a beard wearer.

Four people told us the service was generally clean and tidy. They said there were enough domestic staff employed to do the cleaning and they had their bedrooms cleaned daily.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care and were provided with suitable equipment to maintain their safety. People had their medicines at the times they needed them from staff qualified and skilled to do so. People's comments or complaints were carefully considered and responded to. Suitable precautions were in place to protect people and staff from cross infection of health care associated infections.

People who used the service told us that they or their families made the decision to use the services provided by this service. They said they were encouraged to visit the service and spent time such as having lunch or tea at the service before making a decision about the service's abilities to meet their care and social needs. Some people told us they had spent a period of respite at the service and so were aware of the care offered. They said this helped them to make the decision that the service was able to cater for their needs.

People who used the service told us they were involved in the planning of their care. They said their named nurse discussed their support options and treatments with them and their families. Matters of personal care and hygiene and of overall wellbeing had been discussed with them.

People told us their medical care was well looked after as they were registered with their own General Practitioner (GP) or with the service's GP. The GP visited the service on a regular basis and would come out to see them if they were unwell. They said they had access to private chiropody and physiotherapy care arranged by the service. They said the staff were very good and would inform their relatives of any change in their health care needs. They told us the staff accompanied them to hospital appointments.

People who used the service told us they were able to make choices in their meals. They told us they could have a cooked breakfast if they wanted and this was available over a two hour period to suit people's waking up times. They told us there were set times for meals with hot and cold drinks provided during the day. They said hot drinks were available during the night if they could not settle. People said the food was very good and the servings were just right.

People told us there were always enough staff on duty to help them and that they had their own named carer. People said staff were polite and spoke to them in a respectful way. Relatives told us they were very happy with the care their relatives received at this service.