We carried out this inspection on 11 December 2018. The inspection was unannounced, which meant the people living at Beech Tree Hall and the staff working there didn't know we were visiting. Beech Tree Hall is a 'care home'. 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 Tree hall accommodates up to 17 people in one adapted building that is divided into four flats. The service supports younger people with a learning disability. At the time of our inspection 15 people were using the service. At the last inspection in March 18, the service was rated requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for 'Beech Tree Hall' on our website at www.cqc.org.uk

The care service was working towards the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen.

At the time of our inspection 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.

At the last inspection in March 2018, we asked the provider to take action to make improvements to person centred care, dignity and respect, consent, safe care and treatment, staffing and governance. Action had been taken and we found improvement had been made, however further improvement still need to be made to governance.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse; however safeguarding concerns had not always been reported to the local authority or to CQC, so training in this area had been ineffective.

We found there were enough staff to meet people's needs and the deployment of staff was appropriate to meet people's needs their social and recreational needs.

Risks had been identified and regularly reviewed and evaluated.

Systems were in place for safe management of medicines. Staff received appropriate training and competency assessments. However, we identified some minor issues around storage and medicine returns.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not well maintained.

People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people's individual needs.

We found the service met the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had a satisfactory understanding or knowledge of this. People had been assessed to determine if a DoLS application was required. We found people's mental capacity and best interest decisions were considered.

People were offered choices around their meals and maintained a well-balanced diet. People received access to health care services when required. Various professionals were in involved in providing healthcare to people.

We found staff to be kind and caring. Staff respected people’s privacy and dignity.

Care plans identified people's needs and contained sufficient detail for staff to be able to meet their needs.

Relatives we spoke with told us they were listened to by the management team and were confident any concerns would be dealt with by them.

People were involved in meaningful activities, stimulation and community access.

There were opportunities for people who used the ser

We carried out this inspection on 23 and 26 March 2018. The inspection was unannounced, which meant the people living at Beech Tree Hall and the staff working there didn’t know we were visiting.

Beech Tree Hall is a ‘care home’. 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 Tree hall accommodates up to 17 people in one adapted building that is divided into four flats. The service supports younger people with a learning disability. At the time of our inspection 15 people were using the service.

At the last inspection in November 2015, the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Beech Tree Hall’ on our website at www.cqc.org.uk

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen.

The manager at the service was registered at another location owned by the same registered provider. They were in the process of adding this location to their registration. The registration of the manager at this location was completed on 6 April 2018. 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 told us they would eventually only be registered at this location when a new manager had completed the registration process at the other location. Since our last inspection the service has deteriorated, the registered manager acknowledged that the service was not good and there were improvements to be made. They had commenced an action plan to encompass the require improvements and ensure changes were implemented.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. We identified issues at the time of our inspection which when reported to the registered manager they took appropriate action.

Staff told us there were enough staff to meet people’s needs. However, it was not clear if the deployment of staff was appropriate to meet people’s needs in particular their social and recreational needs.

Risks had been identified. However, these lacked detail and were not reviewed or evaluated.

Systems were in place for safe management of medicines. Staff received appropriate training and competency assessments. However, some minor issues were identified.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not clean.

We found procedures were followed for the recruitment of staff. Staff supervision did not always take place and staff did not always receive an annual appraisal of their work. Staff received training. However we identified this was not always effective.

We found the service did not always meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Not all staff had a satisfactory understanding or knowledge of this. People had been assessed to determine if a DoLS application was required. However, we found people’s mental capacity and best interest decisions were not always considered and there was not a consistent approach to ensure all decisions were made in people’s best interests.

People were offered a well-balanced diet. Howev

The inspection took place on 3 and 4 November 2015 and was unannounced on the first day. Our last inspection of this service took place in January 2014 when no breaches of legal requirements were identified.

Beech Tree Hall is a care home for up to 17 adults with learning disabilities. Accommodation is provided in four flats; Oak House, Holly House and Birch House are located on the ground floor. Elm House is located on the first floor. The home is owned and by run by Mr Donald Smith, who also has a small number of other homes for people with learning disabilities, in the Yorkshire area. At the time of the inspection there were 15 people using the service.

The service has 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 said they felt safe and the staff we spoke with had a clear understanding of safeguarding people from abuse, and of what action they would take if they suspected abuse.

Care and support was planned and delivered in a way that ensured people were safe. The individual plans we looked at included risk assessments which identified any risk associated with people’s care. We saw risk assessments had been devised to help minimise and monitor the risk, while encouraging people to be independent.

People’s medicines were well managed generally, although the temperature that the medicines were stored at was not monitored and recorded consistently in all of the flats.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. There had been a period where there had been shortages of staff, and this had led to the use of agency staff, while new staff were recruited. However, this had improved, as new staff had been recruited and when the management team used agency staff, they tried to use the same workers to help maintain consistency for people.

We saw the staff training record for the service. This showed that staff were provided with appropriate training to help them meet people’s needs. An improved system was also being introduced to make it easier for the registered manager to keep track of when staff needed training and updates. However, there was a need to ensure that all staff, including the registered manager, received regular formal, documented supervision with their line managers.

We found the service to be meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and the staff we spoke with were aware of the Act. However, there was a need to further develop some of the assessments, records, and the practice in some areas, and the registered manager was taking action to address this.

People were supported to maintain a balanced diet. The people we spoke with told us they liked the food and were involved in choosing and planning their menus, shopping and cooking their meals.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support. We looked at people’s records and found they had received support from other professionals and healthcare services when required.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. We saw staff were aware of people’s needs and the best ways to support them, and there was an emphasis on maintaining and increasing people’s independence.

The registered manager and all of the staff we spoke with and saw supporting people, had a caring approach and treated people with respect and dignity.

The service was for people with challenging needs and behaviour and staff successfully provided a very positive and calm atmosphere, and were very person centr

Most people were out, doing various activities at the time of the inspection. Four of the five people we met were able to tell us what they thought about the service. People told us they were happy living at Beech Tree Hall.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. One person said, “Staff ask me what I want. I decide.”

People experienced care, treatment and support that met their needs and protected their rights. During the inspection we spent time observing how staff members interacted with people who used the service. The staff were good at communicating with and engaging people. They were respectful of people’s wishes and feelings. One person said, “The staff are very nice here.”

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

There was an effective complaints system available.

There were a number of people who used the service who we were not able to talk with to gain their views because we were not familiar with their way of communicating. However, as we observed their care we saw that staff were very supportive and familiar with people’s ways of communicating. People were offered choices and staff respected their privacy and dignity, while encouraging them to be as independent as possible.

We spoke with three people, who lived in Elm House. They were happy with the care and support they received and felt the home was a safe place to live. They told us that they were encouraged and supported by staff to make decisions about everyday tasks.

No-one raised any concerns with us during our visit. The people we spoke with said they felt confident taking any concerns to the manager or any of the staff. They told us how they were involved in making decisions about what happened in their flats, such as what and when they shopped and cooked and what they had to eat.