The inspection took place on 15 and 16 January 2018 and it was unannounced.

Beech House is a care home which is registered to provide care (without nursing) for up to six people with a learning disability. People who use the service have their own bedrooms and use of communal areas that include an enclosed private garden. The people living in the service needed care and support from staff at all times and had a range of care needs.

CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection six people were living at the service. The service had a registered manager in place. 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 supported us during the inspection.

At the last inspection the service was rated Good overall. However, the Safe domain was rated Requires Improvement but there were no breaches of the regulations. At this inspection we found improvements had been made in the Safe domain and the service remained Good in all other domains.

Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The service assessed personal and environmental risks to the safety of people, staff and visitors and took actions to minimise those risks. Appropriate records were in place and stored correctly.

The provider had employed skilled staff. They were knowledgeable and caring, making sure people received appropriate care and support. People received support that was individualised to their personal preferences and needs. Their needs were monitored and their care plans were reviewed regularly or as changes occurred.

People received care and support that was personalised to meet their individual needs. People were able to continue their usual daily activities and access the local community to enhance social activities. Staff understood the needs of the people and we saw care was provided with kindness and consideration.

The recruitment and selection process helped to ensure people were supported by suitable staff of good character. There were sufficient numbers of staff on each shift. The service ensured there were enough qualified and knowledgeable staff to meet people's needs at all times.

People received their prescribed medicine safely and on time. Storage, handling and records of medicine were accurate. People's rights to confidentiality, dignity and privacy were respected. Staff supported and encouraged people to develop and maintain their independence wherever possible. Relatives were complimentary of the service and the way their family members were supported.

People were given a nutritious and balanced diet and hot and cold drinks and snacks were available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. The registered manager and staff team knew how to access specialist professional help when needed. People were supported in the least restrictive way possible to have maximum choice and control of their lives. The policies and systems in the service supported this practice.

We observed a calm and relaxed atmosphere during our inspection. People were treated kindly and with respect. Staff were happy in their jobs and there was a good team spirit. The registered manager had quality assurance systems in place to monitor the quality of care being delivered and the running of the service. They promoted positive culture in the service and ensured people were at the centre of staff team’s attention.

Further information is in the detailed findings in the full report.

This inspection took place on the 22 December 2015 and was unannounced.

Beech House is a care home which is registered to provide care (without nursing) for up to six people with a learning disability. The home is a large detached building within Reading close to local shops and other amenities. People had their own bedrooms and use of communal areas that included an enclosed private garden. The people living in the home needed care and support from staff at all times and have a range of care needs.

There is a full-time manager who has commenced the process to become 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 2008 and associated Regulations about how the service is run.

People who use the service had a range of communication abilities. These ranged from non-verbal to limited verbal communication. Other methods of communication were used by people such as the use of pictures and symbols to indicate their needs and wishes. These were understood by staff. The manager and staff were building on and improving communication methods that were specific to people’s assessed needs. This was in order to promote and respect the choices they made.

People’s medicine was not always managed safely. However, processes were in place to monitor and improve the safety of giving people their medicine.

The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient number of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a staff team who had received support through supervision, staff meetings and training. Their care plans detailed how they wanted their needs to be met. Risk assessments identified risks associated with personal and specific behavioural and or health related issues. They helped to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

People were encouraged to live a fulfilled life with activities of their choosing. People’s families told us that they were very happy with the care their relatives received.

The manager had been employed three weeks at the time of our visit and had made a positive impact. This had been achieved from her evaluation of the services provided and implementation of change in consultation with people, their relatives and staff. These included improvement to the environment and improved individualised care and support for the people who lived in the home.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people and their care.

Staff received the training and development they needed to care for and support people’s individual needs. People received good quality care. The provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not able to tell us their experiences. We spent time observing what people did during the day. We also used observations of the interactions between people who use the service and the staff to inform the judgements reached within this report.

We found staff always asked people for their consent to support them prior to starting. Where consent was required for complex health matters, the location and staff acted in accordance with the legal requirements of the Mental Capacity Act 2005.

We found people were supported to be able to eat and drink sufficient amounts to meet their needs. We saw people who use the service were relatively independent and could eat and drink with little staff support.

We found the premises were satisfactorily maintained. The house was observed to be clean, tidy and potential risks to people posed by the building were adequately controlled.

We found appropriate checks were undertaken before staff began work. We looked at three staff personnel files and saw checks were conducted in accordance with the required regulation.

We found people were given support by the provider to make a comment or complaint where they needed assistance. Staff we spoke with knew how to support people to raise concerns and a system was available to enable people to send their complaints to the provider for investigation.

None of the five people living at Beech House at the time of our inspection were able to communicate verbally, although most were able to respond with occasional words, sounds or basic sign language in order to communicate their needs. Evidence suggested that they were consulted and involved in how they wished to live their lives.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

We found that there were systems in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that adequate numbers of competent staff were available to support people living at Beech House and that they received appropriate training and support to be able to meet peoples needs.

We found the quality of the service was being monitored and evidence indicated that concerns were promptly acted upon. Systems were in place to meet peoples health, welfare and safety needs.

The majority of the people living at Beech House are not able to communicate verbally. So that we could gain an understanding of their views and experiences of living at the home, we spent time observing what people were doing during the day. We also used observations of the interactions between people living at the home and the staff to inform the judgements reached within this report.

During our visit, all interactions we observed between the staff and the people living at the home were open, respectful and courteous.

We saw numerous occasions where the people living at the home communicated that they wanted assistance. We saw the staff providing whatever was wanted in a way that demonstrated a good knowledge of each individual person. Where appropriate, we saw staff providing support and encouragement to the people to do things as independently as possible.

We observed people being spoken with and supported in a sensitive, respectful and professional manner. We saw that staff included people living at the home in the day to day running of the home and that, whenever possible, it was the people living at the home that made decisions on what happened through the day and when. We saw that people's needs were met in a calm and unhurried way, with enough staff available to meet any needs as they arose.