Beckfield House Residential Home is registered to provide accommodation and personal care for up to 27 older people, including people living with dementia. At our last inspection in February 2015 we rated the home as Requires Improvement.

The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We inspected the home on 14 February 2017. The inspection was unannounced. There were 25 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for seven people living in the home and was waiting for these to be assessed by the local authority. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Any decisions that staff had made as being in people’s best interests were made in accordance with the provisions of the MCA.

On this inspection, we identified the need for further improvement in the provision of activities and other forms of stimulation available to people living in the home. We also asked the provider to ensure that people and their relatives had an opportunity to be involved in reviews of their individual care plan. In all other areas however, we found people were provided with safe, effective care that met their individual needs and preferences.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home in the future.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. Staff were provided with close supervision and regular team meetings were used effectively to facilitate good communication. The registered manager maintained a high profile within the home and provided strong, supportive leadership to her team.

There was a warm, relaxed atmosphere in the home and staff supported people in a kind and caring way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink that met their individual needs and preferences.

The inspection took place on 17 February 2015 and was unannounced.

The home is a large Victorian house with a modern extension in the village of Heighington near Lincoln. The home is registered to provide care for a maximum of 27 people who need residential care for old age or who are living with dementia. There were 26 people living at the home on the day of our inspection.

There was a registered manager at the service when we inspected. 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 had completed training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They were in the process of reviewing people’s abilities to make choices about where they lived. The registered manager was aware of the need to refer people who did not have the ability to make a choice to the relevant authority to ensure their human rights were respected.

Staff had received training in how to keep people safe from harm and knew how to report concerns both within the organisation and to external bodies.

Risks when providing care for people had been identified and assessed. However, the registered manager had not reviewed the risks to people of using fixtures on beds to keep people safe.

Medicines were managed safely and checked when coming into and out of the home. Staff took the time to ensure people knew what their medicine was for and allowed them a choice if they wanted to take it or not. Staff made sure people swallowed their medicines before recording it as being taken.

There were enough staff around to ensure people’s needs were met. The registered manager spent time on the floor monitoring if staff were able to meet people’s needs in a timely fashion and enlarged staffing levels when people’s needs increased. Staff received appropriate training and were supported to achieve nationally recognised qualifications. Staff received supervision and appraisals where they could raise concerns and identify training needs

On a daily basis staff supported people to make decisions about the care they received. This included what they wanted to eat. We saw people were supported to maintain a healthy weight and had appropriate referrals to health professionals to ensure they were able to eat safely.

Staff were kind and caring to people. When providing care they talked with people to explain what was happening and why, this enabled people to participate safely in their care. However, we saw the facilities did not always support people to maintain their privacy.

Care given was tailored to people’s individual needs and people living at the home and their relatives had been involved in designing their care. However, individual needs were not always recorded in people’s care plans. People were supported to take part in activities and maintain hobbies and interests they had before living at the home.

People told us they were happy to raise any concerns with the registered manager. People, their relatives and staff were all confident that the registered manager listened to concerns and took action to resolve the concern.

The provider completed a monthly visit to the home and there was a plan in place to refurbish areas of the home. However, audits were not in place to identify and rectify issues in the quality of care people received.

At our last inspection on 26 April 2013 we had found the hall and stair carpets were heavily worn. Ducting tape held together the carpet in the communal hall area and in two sections on the upstairs landing. We had also noted a large piece of cracked flooring outside the main door to the kitchen.

At this visit we found the stairs and landing carpets had been completely replaced with a new carpet which had been fitted professionally. The flooring outside the kitchen and in the hall area had been replaced with a non-slip floor covering.

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We looked at four care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met.

We looked at the medication records for nine of the 24 people living at Beckfield House. These records were in good order and demonstrated people were given their medicines as prescribed.

We spoke with a District Nurse who visited the home during our inspection. They told us, “We get good co-operation from the care staff here. Tissue viability is well managed and we receive prompts from the care staff if necessary.”

On the day we visited we saw some floor coverings in a poor state of repair which increased people’s risk of trips and falls.

We found there were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

We found records relevant to the management of the service were accurate and fit for purpose.

We found that people were cared for in a clean, well presented home. People’s care was based about their individual needs. The staff provided care in a pleasant and professional manner. One person living at the home said, “You won't find anywhere better than here.”

We saw staff had time to interact with people and were attentive to people's needs. Their interaction with people was friendly, respectful and professional.

We saw the cook provided a choice of hot and cold foods at each mealtime.

We looked at how the premises had been maintained. One person told us, “Overall the building is well maintained and decorated well.”

We reviewed the level of support given to staff. We found the home had a training plan in place and all mandatory training had been provided regularly.

People who live at the home and the visitors we spoke with told us they were happy with the service provided and could not think of anything they would like to change.

They said they were encouraged to be involved in planning their care. A relative we spoke with told us that as their mother could not tell staff what she wanted the family had been involved in planning how her care was delivered.

People told us there were enough staff on duty to meet their needs and they delivered care and support in a safe and competent manner. They spoke positively about the staff and how they provided attentive care and support. One person commented, “My mother is very settled here, she is always clean and well looked after”.

People said they enjoyed the activities provided at the home and could not think of anything else that was needed.

People told us they enjoyed the meals available and confirmed they were offered various choices to suit their individual preferences. One person said, “The food is good with lots of home cooking, I have no complaints”.

The people we spoke with were very complimentary about the home’s clean environment. One person told us that they felt the décor in the home was a bit out of date but it was never dirty. Another person said “it always smells nice”.