The inspection took place on 11 September 2018 and was unannounced.

The last inspection of the service was on 18 October 2016, when we rated the service good.

At this inspection on 11 September 2018 we rated the service requires improvement overall and for the questions, 'Is the service safe?' and 'Is the service well-led?' We have rated the key questions, 'Is the service effective?', 'Is the service caring?' and 'Is the service responsive?' as good.

Beech Haven Residential Care Home is a care home for up to 30 older people. 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. At the time of our inspection 29 people were living at the service.

The service is owned and managed by a partnership and a family run business. There are four members of the same family who work together to manage the service. One of the partners is also the 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.

Medicines were not always being safely managed and some of the risks to the health and wellbeing of people who lived at the service had not been mitigated.

The systems for recruiting new staff were not always effective because they did not include thorough checks on their suitability to work with vulnerable people.

Whilst the provider had systems for monitoring the quality of the service, these had failed to identify the risks relating to medicines and health and safety.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, fit and proper persons employed and good governance.

You can see what action we have told the provider to take at the back of this report.

Following our feedback at the end of the inspection visit, the provider made improvements in all areas where we had identified concerns. They sent us information about these improvements.

People living at the service and their relatives were happy there. They felt their needs were being met and they found the staff kind, caring and compassionate. We observed that interactions between staff and people living at the service were caring and demonstrated affection.

The staff felt well supported and had the training they needed to carry out their roles and responsibilities. The staff enjoyed working at the service and appeared confident and knowledgeable about the people who they were caring for.

The atmosphere and culture at the service were reflective of a family run business. The owners and their family were involved in the day to day running of the service and were well known, liked and respected by people who lived there, staff and visitors. People felt reassured that the owners were available whenever they needed. They felt that their concerns were addressed and were happy to raise these with one of the owners.

There had been improvements to some areas of the building, with refurbishment of communal rooms and bedrooms. Further improvements were planned. The home was accessible for people with mobility needs and people were able to access communal rooms, the garden and their bedrooms without restrictions. The home was generally clean, although some areas needed deep cleaning or redecoration. The provider had a plan to address these areas.

People had enough to eat and drink, and most people liked the food.

People's needs were assessed, planned for and being met. These needs were recorded in care plans, which they had been involved in creating. The staff monitored their wellbeing and responded appropriately to changes in thei

The inspection took place on 18 October 2016 and was unannounced.

The last inspection took place on 10 and 16 November 2015 when we found breaches of three Regulations relating to safe care and treatment, notifications of significant events and injuries, record keeping and quality monitoring. At the inspection of 18 October 2016 we found these breaches had been met.

Beech Haven Residential Care Home is a care home for up to 30 older people. There were 21 people living at the home at the time of our inspection. The majority of people funded their own care. The service is a family-run business with the owners also overseeing the day-to-day management of the home. One of the owners is the registered manager. 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 and associated Regulations about how the service is run.

People told us they liked living at the service. One person said, “The place is clean and tidy. People are pleasant. The staff are pretty decent and obliging.” Another person told us, “If I wasn’t happy here I would have gone before.” One relative commented, “I am happy with my [relative's] care. It took him a while to settle in. He’s not forced to join in anything. He’s made a couple of friends here.” Another relative told us, “There’s no perfect place but I cannot fault it here. There is nothing I would change.

People found the staff kind and caring. They felt their needs were being met. They looked well cared for and records showed that people had regular showers or baths and were able to see the doctor or other healthcare professionals when needed. People liked the food. Their weight was monitored. There was a variety of activities provided, although people did not always have opportunities to pursue their individual interests or hobbies.

There had been improvements to the cleanliness and safety of the environment. The provider was planning further improvements to the building. Some repairs and refurbishment were needed, and the provider had not completed the requirements of the fire safety officer at the time of our inspection, although they were in the process of completing these. In addition some areas of the building had an unpleasant odour which could not be removed by cleaning and the provider felt that replacement of carpets in these areas was needed.

The staff told us they felt supported. They worked well together and were polite and caring towards the people who they cared for. They told us they were happy working at the home. The family who owned the service worked alongside the staff, supporting people each day and they were available on call at any time. People who lived at the service, their visitors and the staff told us they liked this and felt they could ask for help whenever they needed.

The provider had improved the records used at the service and we found these were accurate and up to date. People received their medicines in a safe way. People told us they felt safe and accidents at the service were rare. The provider had some systems for monitoring the quality of the service, but only minimal recorded audits because they were at the service each day. The provider had worked hard to improve different aspects of the service over the last two years.

The inspection took place on 10 and 16 November 2015 and was unannounced.

The last inspection took place on 28 April 2015 when we rated the service requires improvement and made seven breaches of Regulation.

At this inspection we found there had been improvements to the service and the provider was able to demonstrate plans for further improvements. However, the improvements at the time of the inspection were not sufficient and the provider was in still in breach of some of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Beech Haven Residential Care Home is a care home for up to 30 older people. There were 30 people living at the home at the time of our inspection. The majority of people funded their own care. The service is a family-run business with the owners also overseeing the day-to-day management of the home. One of the owners is the registered manager. 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 and associated Regulations about how the service is run.

The provider had not always assessed and mitigated the risks of unsafe premise and equipment. Areas of the environment were not clean and the provider had not taken steps to control the spread of infections.

Some people had been asked to consent to their care and treatment. However, relatives and other representatives made decisions about care and treatment on behalf of other people. Although these decisions may have been made in the person’s best interest, the provider had not assessed people’s capacity to make sure they were unable to consent themselves.

The staff felt supported to do their jobs. They received training but some of this required updating.

The provider had not always identified the risks to people’s safety and wellbeing.

Records of people’s care were not always accurate or complete.

The provider had not notified the Care Quality Commission of significant events which had occurred at the service.

People’s medicines were managed in a safe way.

The provider had procedures to safeguard people and the staff were aware of these.

There were enough staff employed to keep people safe and meet their needs.

People’s health needs were met.

People’s nutritional needs were met.

People felt the staff were kind, caring and polite.

People’s privacy and dignity were respected.

People’s care needs had been assessed and there were care plans telling the staff how to meet these needs. The providers and the staff had a good knowledge and understanding about people’s needs.

The provider had improved organised activities so there were more things for people to do. However, further improvements would make sure people’s social and emotional needs were always met.

People felt confident making a complaint and told us these were acted on and responded to.

The provider had improved systems for monitoring the quality of the service.

People felt there was an open and positive culture.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 28 April 2015 and was unannounced. The last inspection of the service was on 9 December 2014, where we found breaches in seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches related to safeguarding people who used the service from abuse, supporting staff, consent to care and treatment, meeting nutritional needs, respecting and involving people who used the service, care and welfare of people who used the service and assessing and monitoring the quality of service provision. We rated the service Inadequate. The provider wrote to us on 27 March 2015 with an action plan stating how they would make the required improvements. They said they would have made all the necessary improvements by 1 May 2015.

Beech Haven Residential Care Home is a care home for up to 30 older people. There were 26 people living at the home at the time of our inspection. The majority of people funded their own care. The service is a family-run business with the owners also overseeing the day-to-day management of the home. One of the owners is the registered manager. 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 and associated Regulations about how the service is run.

There had been improvements to the service and the provider was able to demonstrate plans for further improvements. However, the improvements at the time of the inspection were not sufficient and the provider was in breach of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection we identified the staff did not always have the skills, knowledge and training to make sure people were protected from abuse. Since then the provider had made improvements but not all staff had the information they needed and therefore may not have recognised when someone was being abused.

People’s medicines were not always managed in a safe way. Some of the records relating to medicines were inaccurate and we could not tell whether people had received their medicines as prescribed. The staff administering medicines had not had sufficient training or competency assessments to ensure they could do this safely.

At our last inspection we identified the staff did not always have the skills and knowledge they needed to support people. At this inspection we found the provider had made improvements including better staff training. However, they had not implemented a system of formal supervision and appraisal.

At the last inspection we found the provider had not always acted in accordance with their legal responsibilities under the Mental Capacity Act 2005. At this inspection we found improvements had been made but not everyone had consented to their care and support. People’s capacity to consent had not been properly assessed. The CQC monitors the implementation of Deprivation of Liberty Safeguards (DoLS). These safeguards ensure restrictions to people’s liberty are lawful. The provider had recognised the deprivation of one person’s liberty but had not made the necessary applications for this to be lawful at the time of our inspection.

At our last inspection we found people did not always receive personalised care which met their individual needs. This was still the case. There was not enough information about people’s individual preferences and social needs. The provider had introduced some new organised activities but these did not provide enough stimulation or variety and they did not consider people’s individual needs and choices.

At our last inspection we found the provider did not operate an effective system to monitor the quality of the service. At this inspection we found improvements had been made and the provider had created a system to audit and monitor quality, however this was not fully operational and the provider had not always sought the views of people who lived at the home.

The provider had not displayed the rating from the last CQC inspection report and this information was not made available to people who lived at the home and their representatives.

Areas of the environment were not accessible for people with mobility needs.

The risks to people’s wellbeing had been assessed and there was clear information for staff on how to support people to reduce risks. The premises and equipment were managed to keep people safe.

There were enough staff employed to keep people safe and to meet their needs.

People’s nutritional needs had been assessed and they were given support to meet these. However, information about these needs had not always been clearly recorded. The provider had made improvements to the variety and quality of food at the home and people were able to make choices about their meals. However, there was limited forward planning of menus and people were not involved in planning or informed of the choices in advance of mealtimes.

People’s healthcare needs were assessed and they were supported to meet these.

The service was caring. People had good relationships with the staff and they felt their privacy and dignity were respected.

People told us the staff were kind and caring and were available whenever they needed them.

There was an appropriate complaints procedure and people knew how to make a complaint.

People living at the home and staff felt there was a positive culture and one staff member told us there had been significant improvements at the service in the last few months.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 9 December 2014 and was unannounced.

Prior to this inspection we inspected this service three times between March and August 2014.

On 20 March 2014 we inspected the service and found the provider was not keeping accurate and up to date records. We issued a warning notice telling the provider that they must make the necessary improvements by 15 May 2014.

We carried out an inspection over two days on 28 July 2014 and 4 August 2014 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches were in respecting and involving people who use the service, care and treatment of people who use the service, cleanliness and infection control, safety and suitability of the premises and assessing and monitoring the quality of the service.

On 20 August 2014 a pharmacy inspector undertook an inspection and we found one breach of the Health and Social Care Act 2008 (regulated Activities) Regulations in the management of medicines.

The provider sent us an action plan which stated they would make the necessary improvements by 30 November 2014.

At the inspection of 9 December 2014 we reviewed whether the provider had made improvements to the service. We found that they had made improvements in all areas. However, we identified eight areas where the provider had breached the Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. Safeguarding people, supporting workers, consent to care and treatment, meeting nutritional needs, respecting and involving people who use the service, care and welfare of people who use the service and assessing and monitoring the quality of the service.

At this inspection we found the provider had taken action to address the Breaches we identified at the last inspections. Some of these Breaches had not been fully met.

Beech Haven Residential Care Home can accommodate up to 30 older people. There were 28 people living at the service at the time of our inspection. The majority of people were privately funded. The service is owned and managed by a partnership and is a family run business. The providers oversaw the day to day management of the home, and one of the partners was the 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 living at the home were not always protected against the risks of abuse because the staff were not trained and were not able to identify abuse or tell us what action they would take if someone was being abused.

People could not be confident the staff had the knowledge and skills to carry out their roles and responsibilities because training was not up to date. There was no plan for on going training and staff development and there were no systems for appraising and formally supervising staff.

The Mental Capacity Act 2005 requires providers to ensure safeguards are in place when someone does not have the capacity to make an informed decision about their care and treatment. People’s capacity to consent had not been assessed. The provider had not taken appropriate action in line with legislation and guidance to ensure people’s rights were protected.

People’s nutritional needs were not being met and they did not always have a varied and balanced diet.

People were not always given information about the service so they could make informed choices, for example about social activities or menus. Although some needs had been assessed, other areas of need had not been identified or assessed and people did not always receive personalised care which met their individual needs and preferences.

The provider had started to improve systems for monitoring the quality of the service; however, these did not always identify areas of concern, take account of the views of people living at the home and their representatives or include planning for the future based on an analysis of significant events and incidents.

People liked living at the home. They felt well cared for and their relatives also liked the care at the home. Some of the things people told us were, ‘’This home is better than we expected, we have no grumbles’’, ‘‘[the providers] are brilliant and the quality of all the staff is good’’, ‘’the staff are quick to inform us if something is wrong with [our relative’s] health’’ and ‘’they treat [our relative] like we would.’’ Although we received positive feedback during this inspection we discovered some significant concerns.

People had access to healthcare services and their health needs were monitored and met. The staff were kind and caring and people’s privacy and dignity were respected.

The provider had made improvements to the service since the last inspection. There had been improvements to the environment including ensuring health and safety hazards were identified and removed. The way in which people’s medicines were managed had improved and we were assured that they would receive the medicines they needed. There had been improvements to record keeping.

Staff were employed in sufficient numbers and the providers were involved in the day to day running of the home. They were available for staff and people living at the home to speak with and people felt able to raise concerns. The staff felt supported and told us they could speak with their managers if they had any concerns.

We identified eight areas where the provider had breached the Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. Safeguarding people, supporting workers, consent to care and treatment, meeting nutritional needs, respecting and involving people who use the service, care and welfare of people who use the service and assessing and monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess how the provider was managing medicines in response to the action we were taking following a recent inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

During this inspection a pharmacist inspector looked at storage of medicines, at record keeping, observed medicines given at lunchtime to four people and spoke to two people one of whom was monitoring their own blood glucose and insulin requirements.

From our observations and inspection of supplies and records we saw that medicines were being given as prescribed. However we identified several poor practices and poor record keeping which could lead to the risk of error and harm in giving medicines safely.

The people whom we talked to said that care workers looked after them well and always brought their medicines on time. One said they were in pain and we saw that the care worker was giving regular pain relief and they were also under the care of a hospital consultant.

Another person told that they always monitored their own blood glucose and self injected their insulin. We saw that care workers monitored this person and duplicated records and brought the correct insulin for this person to take. The person told us of their concerns when their blood glucose became too high and they said they worked out the reason and took action which included speaking to the diabetic specialist nurse at their GP practice for advice.

We spoke with five people who use the service. All were satisfied with the care and support they received. Their comments included, “all of the staff are very patient and caring” and “I haven’t been here very long but it’s excellent, they have listened to what I want and always try to help.” Another person said, “I am settling in, they look after me very well.” A relative told us, “my [relative] has been here since July and I’ve absolutely no complaints. We visit regularly and he has put on weight and always looks well.”

Our inspection on 11 and 22 July found that the provider was not maintaining appropriate records and we asked them to make improvements in this area so people were protected against the risks associated with inaccurate and unsuitable records. When we visited on the 20 March 2014 we found that the provider had not made the required improvements. This meant that people continued to be at risk of receiving inappropriate and unsafe care and treatment because appropriate and accurate records were not being maintained.

The provider has introduced a system to assess and monitor the quality of the service.

At this inspection we spoke with one of the owners, a member of staff who managed the training for the staff and three care staff.

We found improvements in the training and supervision of staff and records were available to evidence when training, supervision sessions and staff meetings took place. Although several staff had been registered for NVQ training in health and social care, this had not commenced and further action was needed to address this.

We inspected Beech Haven Residential Care Home on the 12 December 2012. During the inspection we found the registered provider was not compliant with two outcomes. Outcome 9: Management of Medicines and Outcome 14: supporting workers. We found that medicines were not kept safely at the service, due unsecured storage facilities. We also found that staff did not receive appropriate support and training to meet the needs of people who use the service.

On this visit (12 April 2013) we found that the provider was working towards compliance. We will visit the service again before the end of July 2013 to confirm staff have completed mandatory training and arrangements have been made for the safe storage of medication.

We spoke with three people who use the service who indicated they were comfortable at the home. People said "I can follow my own interests", "I am comfortable and my family are involved" and "the staff are very pleasant". During our inspection we observed people who live in the home and staff talking in a relaxed and informal manner.

We spoke with five people who use the service and four staff. People told us that they liked living at the home. One person who had recently moved to the service said “I feel just like I am at home”. They told us the staff were kind and they liked the food. We observed the staff being polite towards people and speaking to them in a calm and respectful way, where the staff responded to requests for assistance promptly and to the satisfaction of the person.

However, we identified that people were put at risk due to the lack of appropriate storage facilities for medicines held at the service, and where staff had not received up-to-date training in areas relevant to supporting people.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We spoke with five people who use the service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

All the people we spoke with said their choices were respected although two people said the service did not provide many activities with one person saying that they “did (sic) not do much”. They all said their privacy and dignity was maintained by the service and the staff. One person said “staff give you privacy”.

All the people we spoke with said they enjoyed the food. However, two people said they did not get to choose what they ate.

All the people we spoke with felt they were well cared for and did not have any concerns with how they were treated. They also said they knew how to raise any concerns.

All the people we spoke with were happy with the staff and said they were always available if they needed them during the day. All the people we spoke with found the staff helpful.

Very few of the people we spoke with were aware of their care plan although some people were living with the experience of dementia and were not always able to remember whether they had seen their care plan or not.

Whilst using SOFI, we observed good staff interaction with people including supporting them to eat and ensuring they were comfortable. However, the staff did not interact with some of the people during mealtimes for long periods. This included a person who was in pain. This meant people’s needs were not always being met.

We spoke to the relatives of one person who used the service. They said the home always tried to accommodate any requests. One example they gave was that the home had allowed the person to try the home for a few days before the person and relatives had to decide whether they would admit them into the home permanently.

People told us they were happy living at the home, were being treated well and had no concerns. People told us they liked the food and are offered a choice, plus they are asked about changes they would like to the menu from time to time. People said that they receive the care and support they need and that staff respond to call bells in a timely way. People can get up and go to bed when they wish, and can spend time in their rooms or in the communal areas, depending on what they want to do. People said that they would feel confident to raise any complaints if they needed to. People told us that there is a variety of activities, both organised and informal, such as large print books and board games being available. People said that they enjoy sitting out in the garden.

We carried out this inspection because when we visited the service on 20 March 2014 we found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained. We issued a warning notice telling the provider they must make improvements by the 15 May 2014. We returned on 28 July 2014 and 4 August 2014 and found the provider had made some improvements to record keeping but these were not sufficient and some care records were inaccurate. Therefore people living at the home were at risk of inappropriate care and treatment.

We also found that people were not always receiving the care and treatment to meet their individual needs. We also found the environment was not well maintained or clean and this put people living at the home at risk.

We spoke with 11 people living at the home, five relatives of people who lived at the home, one visiting health care professional and six members of staff. Most people told us they were happy and well cared for. Some of the things people said were, ''This is a happy home'' and ''there is a calm atmosphere''. The staff told us they felt well supported.