This comprehensive inspection took place on 23 and 25 October 2018; the first day of inspection was unannounced.

The service had previously been inspected in February 2016 and was rated ‘Good’.

Beech House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation and personal and nursing care for up to 32 older people, some of whom are living with dementia. The service has a range of communal areas and a garden. There were 27 people using the service at the time of our inspection.

Beech House Care Home took a thorough and carefully planned approach to ensure people received a personalised and responsive service. Staff enjoyed going the extra mile to ensure people enjoyed how they spent their time and understood how this benefitted their well-being. Links between people and the local community were valued and actively promoted and supported, again with staff understanding the value this had on people's well-being.

Activities were carefully planned to be relevant to people, were meaningful to people and matched to people’s levels of ability, if for example they were living with dementia or were restricted in how they could participate.

People were supported to maintain their relationships with their relatives who were welcomed to become as involved with the home as they liked, including becoming volunteers if they so wished.

The provider had a clear vision for providing care that was inclusive and centred on people’s individual needs. The provider and the registered manager's leadership style was inclusive and inspired and valued their staff team. As such, the staff team were highly motivated, dedicated and passionate about the quality of care they provided to people.

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. Robust systems were in place to check standards of care met with people’s expectations and identify where improvements could be made.

People felt safe living at the service and people were supported by staff whose suitability for the role had been checked.

Risks to people were identified and actions taken to manage and reduce known risks. This included risks associated with people’s health conditions as well as risk in the environment and risk from foreseeable emergencies, such as fire.

Medicines were administered as prescribed and well managed. Medicines were stored and disposed of safely.

The premises were clean and hygienic and staff followed infection prevention and control guidelines.

There were sufficient numbers of staff deployed to meet people's needs.

Staff working at the service had been subject to pre-employment checks. Pre-employment checks help the provider decide whether staff are suitable to work at the service.

Systems were in place to identify and review when things went wrong so as to be able to make improvements.

People's needs were assessed, regularly reviewed and robustly monitored; this helped staff provide care to meet their needs and proactively promote good health outcomes for people. This was reinforced as staff had received training in areas relevant to people's needs; for new staff this included a robust period of introductory training and assessment to ensure their competence. Staff had the skills and knowledge to help ensure people were treated equally, were free from discrimination and were supported with any needs relating to their faith.

The provider ensured people received sufficient nutrition and hydration. Peo

We carried out an unannounced inspection of the service on 11 February 2016. Beech House Care Home is registered to accommodate up to thirty two people who require nursing or personal care. At the time of the inspection there were twenty five people using the service.

On the day of our inspection there were two registered managers in place. One of the registered managers was newly registered and would soon be taking over full management of the home.

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 risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Accidents and incidents were investigated, analysed and used to reduce the risk to people’s safety. Regular assessments of the risks to people’s safety, the environment in which they lived and the equipment used to support them were carried out. People had personal emergency evacuation plans (PEEPs) in place although these required more detail.

Processes were in place to support people to lead as free a life as possible with the minimum of restrictions.

People felt there were enough staff to support them safely. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. People’s medicines were stored and administered safely.

People were supported by staff who completed an induction prior to commencing their role and had the skills and training needed to support them effectively. However, there were a small number of areas where some staff required refresher training.

The registered manager ensured they had recorded how the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. The appropriate processes had been followed when applications for Deprivation of Liberty Safeguards had been made. Some of the records for people who had ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) orders in place were not appropriately completed or reviewed. This is being reviewed by the registered manager.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by staff and external health and social care professionals. Referrals to relevant health services were made where needed. External professionals spoke highly of the quality of the service people received.

Staff supported people in a kind, caring and respectful way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed and communicated well with people living with dementia. Staff ensured they treated people with dignity when providing personal care and respected their wish for privacy.

People were able to contribute to decisions about their care. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

People were involved with planning the care they wanted to receive from staff. People’s care records were written in a person centred way and staff knew people’s likes and dislikes and what interested them. Innovative and thoughtful activities were in place that encouraged all people to do the things that were important to them. People were provided with the information they needed if they wished to make a complaint.

The registered managers and the provider led the service well, understood their responsibilities and were well liked and respected by peop

Prior to our inspection we reviewed all the information we had received from the provider. As part of our inspection we spoke with four people who used the service. We also spoke with a cook, two care workers, the assistant manager, the business co-ordinator, the owner and the registered manager. We also spoke with a district nurse who was visiting the home.

We spoke with two relatives about their views. We observed the support staff gave to people who used the service. We also looked at records, including care files of four people and carried out a tour of the building.

We found people gave consent to their care and where people lacked capacity to do so the provider had acted in accordance with legal requirements.

We asked people who used the service what they thought of the food that was provided for them. One person told us, "There is always a good choice.”

We found the service to be well led and there were sufficient skilled and experienced staff to support people who used the service. One care worker told us, “It’s like one big family of people, everybody looks after each other, it’s just like being at home. It’s worth more to me than anything when families thank you.”

The building was clean, safe and effectively maintained. A person told us, "It’s lovely my room. You’d have to go a long way to get a better one.”

We spoke with seven people who lived at the home, two relatives who were visiting the home, three staff members, the manager and the home owner. We observed how people were supported with their care and looked at people's care plans and information about how the service operated.

One person told us, "Staff here treat us kindly. It’s lovely."

We saw that people’s bedrooms were well furnished and made personal with family photographs and ornaments. People told us they could use their rooms at any time and they were proud of them. Staff had gathered information about people's preferences and needs regarding their care, so that they could treat people individually There was evidence that relatives had assisted with gleaning the information where needed.

Two regular visitors to the home told us they were very satisfied with the way the staff cared for people. One of them told us, "I'm happy, because I know she is well looked after and I don't have any worries about her care here."

People and we spoke to told us that they felt safe at the home. Regular visitors to the home told us that they felt it was safe and said they had confidence in the owner and manager to make sure everyone was kept safe.

We found that the staff were well supported by the staffing arrangements that were in place and received regular training and supervision from the manager.

A relative told us, "If I had any ideas I would speak to the owners, they always listen to people."