This inspection was unannounced and took place on 22 November 2016. At our last inspection visit on 26 August 2015 we asked the provider to make improvements to all aspects of the service we inspected. The provider sent us an action plan in September 2015, explaining the actions they would take to make improvements. At this inspection, we found improvements had been made. The service was registered to provide accommodation for up to 35 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 33 people were using 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to make choices, however the assessments did not always reflect the person’s level of understanding in different situations. There were sufficient staff to support people’s needs and staff had undergone a range of checks to ensure they were suitable to work in the home. The manager and provider completed a range of audits to support the improvements within the home. We saw feedback was sought from people and any areas raised had been considered and responded to.

People told us and we saw they had established positive relationships with people. Staff respected people’s choices and offered a range of choices the person was able to manage. Staff maintained people’s privacy and dignity at all times. There was a positive meal experience where people were able to choose the meals they wished to eat and alternatives were provided.

We saw that medicines were managed safely and administered in line with people’s prescriptions. Referrals had been made to health care professionals and people had access to a range of health care professionals to maintain their health needs.

The care plans covered all aspects of people’s care and their preferences. There was a clear process in place to cascade information about the service and the needs of people. People were able to choose how they spent their time and were encouraged to join activities. Any complaints had been addressed and responded to.

Staff felt supported by the manager and they were provided with suitable training for their role. We saw that the previous rating was conspicuously displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

When we inspected Beech Dene residential home we spoke with six people who used the service, two members of staff and the registered manager.

We saw that people had consented to their care and support. Where people did not have capacity to make decisions for themselves we saw that best interest meetings had been held with professional from outside the service.

The service cooperated with the wider health community to ensure people received care support appropriate to their needs.

Medicines were not always administered in a way which ensured people were kept safe.

The provider had a recruitment system which ensured only people of good character and suitably skilled were employed to provide care.

Care plans were completed in a way which enabled staff to deliver appropriate care. Risk assessments were completed and reviewed regularly. Records of staff and managerial systems were completed and reviewed.

We carried out this inspection to check on the care and welfare of people who used the service as part of our planned schedule of inspections. The inspection was unannounced which meant the provider and the staff did not know we were visiting.

We saw that people were included in making decisions and that their views on their care were respected. People we spoke with told us, "We can do as much or as little as we want to do. I like to be occupied and have many interests". Another person said, "I was spoken with about what to expect when I came here, and so far I've been happy things".

We saw the care records included all the relevant information about how people needed to be supported and how risks had been assessed. People and relatives told us they were included in discussions about care and were informed of any concerns.

Staff understood their responsibilities to recognise and protect people from the risk of potential abuse. Complaints processes were in place and people and relatives we spoke with confirmed that they knew how to make a complaint.

Staff had access to the training they needed but not all had completed relevant training at the time of our inspection. This may mean that staff didn't have the skills to meet people's needs.

The provider monitored the quality of the service to ensure that people continued to receive a good standard of care, support and treatment.

We carried out this review to check on the care and welfare of people using this service. Information we hold about Beech Dene showed us that we needed to undertake a monitoring visit, in order to update our records, and to establish that people's needs were being met. We had not received any information of concern but we had not visited the service for some time and therefore needed to ensure people were receiving appropriate care.

We concentrated on finding out how the care was provided and looked at the quality of the service, including making sure there were enough staff available to meet people’s needs.

The home was warm, comfortable and welcoming. We saw that the staff were kind, respectful and polite. They gave support in ways that respected people's dignity and privacy for example, we saw and heard the staff knocking on bedroom doors and waiting before entering. We observed the staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

People spoken with told us they felt the staff treated them well and respected them. People said they were happy and commented, “It is very nice here, clean and friendly.” One person who used the service told us they were supported with appointments as necessary. Another person told us they had help when necessary, but were able to make a number of decisions independently and were encouraged to do so.

We asked people who used the service, if they felt safe in the presence of staff. All commented that they felt safe and told us the staff treated them well.

A visitor informed us, “I think the home is perfect, the staff are very receptive and up to speed.” Relatives were able to continue to play an active role and were involved in the running of the home. Family and friends could attend social events and the staff told us that families were always involved in social outings and making decisions where appropriate.

There were some areas where improvements could be made in relation to the environment, care record information and communication. These were discussed during our visit and are recorded within this report.

We inspected Beech Dene Residential Care Home on 26 and 27 August 2015. The service is a residential care home which is registered to provide accommodation to older people who require personal care and who may have a physical illness or are living with dementia. At the time of our inspection, 35 people used the service. At the last inspection of the service on 10 September 2014, the provider was compliant against the regulations we inspected against.

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 and associated Regulations about how the service is run.

People did not always have risk assessments and management plans in place to guide staff on how care should be provided or updated when their needs changed.

People were not always protected from harm because equipment meant to support people with their moving and handling was not always used safely.

People told us that staff did not always have time to sit and interact with them. Staff did not always ensure that people’s dignity was maintained at all times.

The provider did not have effective systems in place for regularly assessing and monitoring the quality of the service provided. People’s care records did not always reflect the care they received. This meant that people were at risk of receiving inappropriate care that did not meet their needs. There were no systems in place for ensuring that required actions following audits were implemented.

There were not always enough staff on duty to meet people’s needs. The provider did not have effective systems in place for assessing and monitoring staffing levels to ensure that people’s individual needs were met safely.

The provider did not consistently follow the guidelines of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to ensure that people were not being unlawfully restricted of their liberty. Staff did not always have a good understanding of the relevant requirements MCA and DoLS. The MCA and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interest when they are unable to do this for themselves.

The design and adaptations within the home were not always suitable for people who lived with dementia.

People were not always supported to engage in activities they enjoyed. We observed people sitting for long periods without meaningful activities.

People told us they felt safe and protected from harm. Staff understood what constituted abuse and knew what actions to take if abuse was suspected.

People told us they liked the food and were supported to eat and drink adequate amounts. People were offered a choice during meals. People were supported to attend healthcare appointments and staff liaised with their GP and other healthcare professionals as required in order for people’s health and social care needs to be met.

People told us and we observed that staff were kind and respectful. People told us that the provider responded to their concerns appropriately. There were systems in place to deal with complaints and concerns.

People who used the service, their relatives and the staff were very complimentary about the registered manager. They told us the registered manager was always available and was approachable. We observed that they had a hands-on management style. People and their relatives told us they provided feedback about services on a regular basis.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we inspect against and improvements were required. You can see what action we have told the provider to take at the back of the full version of the report.