The inspection took place on 29 November 2017 and was unannounced.

Beech House is a care home providing personal care and accommodation for up to 27 older people in one adapted building. On the day of the inspection the home was full, having 27 people using the service. 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.

Beech House is a traditional Victorian style building, which has been converted and extended to provide all single bedrooms, one of which has en-suite facilities. The home is situated approximately one mile from Heywood town centre and is on bus routes to and from Rochdale, Middleton and Bury.

There was a registered manager at the service. 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.

Care files included a dependency tool, which outlined the level of assistance each person who used the service required. There were sufficient staff to meet the needs of the people who used the service.

The service had a robust recruitment procedure and disciplinary procedures were followed appropriately. There was an appropriate safeguarding policy, staff had regular training and demonstrated good knowledge of procedures and confidence to report any issues.

Health and safety policies and procedures were followed appropriately. Infection control procedures were in place and staff had undertaken relevant training. Medicines systems for ordering, storage, administering and disposal were appropriate and safe.

There was relevant information within the care plans, relating to health and support needs. We saw evidence of appropriate referrals to other agencies and partnership working.

The induction programme was thorough and included all mandatory training, introduction to the service and reading of all policies and procedures. Training was on-going and mandatory courses were refreshed on a regular basis. Staff were given opportunities for extra courses and National Vocational Training (NVQ).

Nutritional and hydration needs were documented and there were complete and up to date food and fluid charts for people who required extra support.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service told us staff were kind and caring. We observed care throughout the home during the day and saw interactions were friendly and respectful.

Staff promoted people’s choices and encouraged as much independence as possible, whilst offering support to everyone. We saw examples throughout the day where staff members ensured people’s dignity was preserved.

The service had an up to date policy and procedure around equality and diversity. It was clear from observations that people were treated as individuals and their diversity respected.

There were regular residents’ meetings. There was evidence within care plans of involvement of people who used the service and their relatives in care planning and reviews.

There was a service user guide and a statement of purpose with relevant information included.

Care files we looked at included personal information and were person-centred. Appropriate equipment and technology, such as sensor mats, were used to help keep people safe.

There was a monthly magazine for people who used the service and all the information was in easy read format, with pictorial representations, to make it as accessible as possible to all.

There was a dedicated activities coordinator and there were a number of activities on offer at the home. Care pl

Beech House is a care home providing personal care and accommodation for up to 27 older people. Beech House is a traditional Victorian style building, which has been converted and extended to provide all single bedrooms, one of which has en-suite facilities. The home is situated approximately one mile from Heywood town centre and is on bus routes to and from Rochdale, Middleton and Bury.

The service was last inspected in September 2013. Areas reviewed during that inspection were assessed as meeting the regulations in force at that time.

This inspection was carried out on the 10 August 2015. At the time of our inspection there were 26 people living at Beech House.

The manager is registered with the Care Quality Commission. 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 provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. Although monitoring records in relation to people at risk of weight loss were not accurately maintained ensuring information clearly showed people received adequate nutrition and hydration to meet their needs.

People who used the service told us they felt safe living at Beech House. People’s visitors said they were happy with the care their relative received and had no concerns about their safety. We saw that interactions between people and staff were polite and friendly. What staff told us clearly demonstrated they understood the individual needs of people they cared for.

People’s care records contained enough information to guide staff on the care and support they required and the risks people might experience. We saw that people and their relatives were involved and consulted about the development of care plans.

We saw there were sufficient numbers of suitably trained and experienced staff available to support people in meeting their emotional, social and physical needs so their health and well-being was maintained.

Records showed people who had applied to work at the service had been properly recruited so only those applicants suitable for employment were offered work at the home.

We found the management of people’s medication was safe. People were supported to access health care support so their current and changing health needs were met.

The registered manager and senior staff were able to demonstrate their understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Staff were also able to tell us what they would do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We saw systems were in place to monitor, review and assess the quality of service provided so that people were protected from the risks of unsafe or inappropriate care.

Complaints records showed that the registered manager reported and responded to any issues or concerns brought to their attention. People felt confident any issues raised with staff would be taken seriously and dealt with.

Suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken to help keep people safe from harm or injury.

We saw improvements were being made to enhance the standard of accommodation provided for people. All areas of the home were clean, well maintained and accessible; making it a safe environment for people to live and work in.

We found a breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements had been made to care records. Information provided staff with enough information about the current and changing needs of people and how they were to be met.

Systems to monitor that records were kept up to date had been developed to help make sure people's health and well-being was maintained.

As part of our inspection we looked at what progress had been made following our last visit to the home on the 17 August 2012.

During our inspection we spent some time observing the care provided for people. We also spoke with people and their visitors. Comments received were positive. People told us; “It would be hard to find something wrong”, “We’re quite happy” and “I would feel able to raise anything if I needed too”.

From our observations we saw that staff were gentle in their approach and offered people reassurance and encouragement with activities, such as using the hoist.

Some of the care records directing staff in the safe delivery of care were not as accurate as they should have been. This potentially left people at risk of not receiving the care and support they needed.

Suitable arrangements were in place with regards to meeting the nutritional needs of people.

Ongoing refurbishment was taking place within the home to enhance the standard of accommodation provided for people.

Suitable arrangements were in place for the safe recruitment of staff and their on-going training and development.

Systems to monitor and review the quality of service provided had been developed. Where improvements had been identified, action was planned for.

We visited Beech House on the 17 August 2012 at 5.50am. The reason for this visit was to follow up on concerns, which had been raised with us about people being ‘got up’ early.

As our visit was early in the morning, most people were not awake to speak with us.

During this visit we spoke with the two night staff on duty. It was acknowledged that earlier in the year this had been the practice followed by staff however this had now ceased. One staff member said “we don’t feel under pressure to do this now”. Staff did tell us that four people were woken so that their medication could be administered at a specific time and prior to eating.

Looking round the home we saw that two people were up and sat in the lounge. We were told that one person liked to sleep in the chair and that this was detailed in their care records. The second person was able to wash and dress themselves. This person told us that they had wanted to get up. They appeared to have a good rapport with the night staff and told us that they, "like those two girls, they look after me” and “they are the best two”.

During our discussions with staff it was clear that they had a good understanding of people’s individual needs and how they liked to be cared for.

People spoken with were relaxed and appeared content. One person told us that they “would not have been able to manage without the staff”.

We received positive comments about the staff and the care provided. Some of the comments were: “I have been here a long time and they look after us well” and “Yes it’s good”. Staff were described as “friendly” and one person told us also told “The food is good”.

People were aware that work was being completed in the home to improve the environment. One person told us, “the place is looking a lot brighter”.

We also spent some time observing staff practice. Staff were seen to support someone using the hoist. This was carried out in a gentle manner and slowly so as not to distress the person. Staff were patient and supportive throughout.

We did not talk to people about their medicines during this visit.

We saw that a number of people living in the home had some degree of forgetfulness or a dementia type illness. Therefore during our visit we did not ask people specific questions about their care and support, however spent time observing the care and support they received from staff.

From our observations it was clear that some people required more help from staff in all aspects of the care and support. Those able to manage independently had a more relaxed routine and were able to rise, have breakfast or choose where to spend their times as they wished.

One person spoken with told us they didn’t like to get up too early and that staff were aware of this.

Whilst looking at the environment we saw that people had personalised their rooms with items from home.

One person told us they preferred to spend their time in their room although did occasionally spend time in the communal lounge with other people or when having meals. Another person who was resting in bed told us “I’m very comfortable”.

We saw people were able to access all areas of the home, spending time in either the communal areas or in the privacy of their own rooms.

During our visit we found that people were able to access all areas of the home, spending time in either the communal areas or in the privacy of their own rooms. People appeared to enjoy a good rapport with staff. The atmosphere within the home was relaxed. Staff were respectful and polite.

People spoken with told us, “I’m happy”, “I enjoy the bingo”, “They are very good” and “We have a laugh”. Other comments received from people included, “It’s not like home but they do their best”, “The staff are very helpful” and “There’s a good atmosphere”.

Comments were received from visitors about their opinion of the care and support provided at the home. They said, “It’s a relaxed environment, runs really smooth” and “The care is very good”. They also told us; “Consistent care was provided even when the manager was leave”, “Any issues I have raised have been addressed by the manager”, “I’ve never come across anything concerning about the service or care” and The manager is very supportive”.

Staff spoken with said, “We work well as a team”, “It’s a relaxed environment but we get the job done”, “I definitely feel I have enough support”, “I can go to the manager with any ideas or issues and they get followed up” and “I feel I am listened to”.