The inspection took place on 11 and 12 July 2018 and was unannounced.

Beech Tree House offers accommodation and personal care for up to 31 people. The service looks after older people and people who have a dementia related condition. At the time of our inspection there were 26 people living at the home.

Beech Tree House 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.

The home is required to have manager registered with the CQC. There was a manger who was registered with the CQC. During our inspection we were supported by a support manager and an area 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 2008 and associated Regulations about how the service is run.

At the last inspection on 07 June 2017, the provider was found to be in breach of breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe Care and Treatment. We asked the provider to act to make improvements to the safe management and administration of people’s medicines and to ensure staff followed safe moving and handling practice, and this action has been completed.

Systems and processes were in place to ensure people received their medicines as prescribed. Medicines were managed effectively following manufactures guidance.

Care plans included assessments of people’s mobility and where people required assistance this was recorded and reviewed. Staff understood and practiced safe moving and handling techniques.

People told us they felt safe living at the home and staff understood how to recognise and report any signs of abuse.

Staff received training and received checks on their competency to ensure their skills and knowledge remained up to date to carry out their role and meet people’s individual needs.

The provider completed a range of checks and audits to maintain and improve the service.

We observed there were enough staff on duty to meet people’s needs. People confirmed they received care and support from regular care workers who they knew.

Staff had completed training on the Mental Capacity Act 2005 (MCA) and were able to discuss the importance of supporting people with their independence.

People received information in a format they could understand. Where people had communication difficulties, staff understood their needs and recognised their body language and expression.

The provider had systems and process in place to ensure care workers were appropriately recruited into the service and had the necessary skills and personality to support individuals with their everyday needs and preferences.

Care plans included information to ensure staff were informed and respectful of people's cultural and spiritual needs.

People were supported to maintain a healthy and balanced diet. Care plans contained details of people's preferences and any specific dietary needs they had, for example, whether they were diabetic, had any allergies or religious needs.

Care workers had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

There was information available on how to express concerns and complaints. People were encouraged and supported to raise their concerns and processes were in place to ensure these were responded to.

An activities coordinator supported people to live fulfilled meaningful lives and enjoy activities that interested them.

The inspection visit at Beech Tree House Care Home took place on 07 June 2017 and was unannounced.

Beech Tree House Care Home is a residential care home offering accommodation and personal care for up to 31 people. The service looks after older people and people who have a dementia related condition. At the time of our inspection there were 26 people living at the home.

The service had 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 2008 and associated Regulations about how the service is run.

At the last inspection on 23 October 2014, we found the provider was meeting the requirements of the regulations inspected.

During this inspection, we observed the administration of medicines at breakfast. We looked at records related to medicines and how medicines were stored. We found medicine related to one person stored in the medicine trolley was not documented on any paperwork. When documentation stated one or two tablets to be administered there was no clear instruction to guide staff on the amount to administer. Staff were unable to find guidelines and signature sheets on the administration of topical creams for two people. We noted powder used to thicken drinks was accessible to people during our inspection. This meant people were at risk due to the unsafe management of their medicines and powders.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were safely stored and secured when not in use. We checked how staff stored and stock checked controlled drugs. We found these were appropriately documented, stored and secured safely.

As part of our inspection, we looked at care plans and guidelines on how to move and handle people should they require support. We noted paperwork was not fully completed. It did not clearly show what specific support aids people required. One person did not have personalised guidelines to manage additional risks during their moving and handling procedures. This meant people were at risk of care and support that was not safe.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. You can see what action we told the provider to take at the back of the full version of the report.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems. Visiting health care professionals sp

This inspection took place on 23 October 2014 and was unannounced. The last inspection took place on 7 August 2013 and no actions were required.

Beech Tree House is a care home offering accommodation and personal care for up to 31 people. The service looks after older people and people who have a dementia related condition. It is a two storey building with bedrooms designed for single occupancy.

There was a registered manager in post at the time of this inspection and they had been in post for eleven years. 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings. 

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards.

Three people told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. One visitor said “My parent has a care plan and it has been discussed with both of us”.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people’s choices and decisions. Care records were up to date.

There were clear processes in place for what should happen when a person moved to another service, such as a hospital, which ensured that the person’s rights were protected and that their needs were met.

People who used the service received consistent care from staff who knew their needs and expectations and the service had contingency plans in place to cover for staff sickness or vacancies.

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary.

Records about people who used the service enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept behind locked doors to keep it safe and confidential.

When we visited the service in December 2012 people who used the service were satisfied with the cleanliness of their bedrooms and the home environment. We chatted briefly with people during this visit but their comments to us did not relate to the outcome we were inspecting.

We found that improvements had been made to infection control practices within the service. The provider and manager had acted on the information in the report from December 2012 and made positive changes to working practice and the environment.

We spoke with five people who used the service and two visitors/relatives as part of our visit. Individuals we spoke with were very satisfied with the care and activities within the service. One person told us “There are varied activities in the home and I get visits from my family.” Another person said “I cannot fault the place at all, the care is very good and the staff are lovely.” One relative told us “The staff are very supportive towards my mother. She can make her own decisions about what she wants to do each day and feels confident in talking to the staff about any changes to her care on a day to day basis.”

We spoke with people about the food provided in the service and they told us, ‘It is very good, I have no complaints” and “The food is lovely, there is plenty of it and it tastes nice.”

People who used the service were satisfied with the care they received and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us “Staff are friendly, helpful and supportive.”

People and relatives we spoke with were confident of using the complaints system in place and satisfied that staff or the manager would take action to solve their problems.

We found that the service was clean, tidy and there were no malodours in the building. However, we had a few minor concerns about infection control practices which we have addressed in our report.

Relatives told us they looked at information about the provider and visited the service before their relatives came for respite, and subsequently moved into the home permanently. People and their relatives told us that dignity, respect and confidentiality were maintained for them. A relative said, “They are treated like people. If there is anything to discuss, they always pull me to one side out of the way of other people.”

People we spoke with and their relatives told us how they appreciated the way the provider cared for people. One person who used the service said, “It’s all right; I’ve been 18 months in here.” A relative told us, “They listen to me and they involve me with the care of [my relative] as well.” Relatives also said they appreciated the range of activities for people and told us they participated too.

People and their relatives told us they felt safe in the home. We observed that people were supported as they needed to be while they took their medicine and were not rushed. People told us how they appreciated the staff. People and their relatives told us about surveys they completed, and that they knew how to make a complaint. A relative told us that they received a survey each year and said they were impressed that a comment they had made in the survey was followed up by personal contact.