This inspection was unannounced and took place on 13 and 15 November 2017.

When we completed our previous inspection on 27 September 2016 we found concerns relating to the administration of medicines. There were now records in place to demonstrate how many tablets people had been given if a variable dose. All handwritten entries were counter signed to reduce the risk of errors. However, people with medicine patches were not always having them administered safely.

At the last inspection, we also found concerns with people’s privacy and dignity not being respected when they were in a shared bedroom. At this inspection we found there had been improvements. People and their families were consulted prior to moving into a shared bedroom. If a person lacked capacity their best interest had been considered.

Beech Tree House Residential Home 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 House Residential Home is registered to accommodate up to 16 people in one building. The home specialises in providing care and support for older people with dementia. Most people had limited verbal communication. At the time of the inspection there were 16 people living at the home.

There was a registered manager in place who was present for the first day of the inspection. 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 was supported by a deputy manager to run the home. There were two directors for the provider who provided regular support to the registered manager and staff.

One person was at risk of choking and the speech and language therapist had not been consulted on safe practice. Staff had not received training or provided with guidance about people requiring soft diets. Most accidents and incidents had lessons learnt identified and action taken. Sometimes these actions had not been recorded.

Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from potential abuse because staff were able to recognise signs and knew how to report it. Most medicine was managed safely but the application of medicines patches did not follow relevant guidance..

The provider and registered manager promoted a clear ethos. People had a positive relationship with the registered manager and provider. There was a positive approach to improving the service Staff felt supported and the new registered manager had brought about positive improvements. The registered manager and provider had systems to monitor the quality of the service and made improvements in accordance with people’s changing needs. They had completed statutory notifications in line with legislation to inform external agencies of significant events.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. When people lacked capacity the statutory principles of the Mental Capacity Act 2005 had been followed. People and their relatives were positive about the food and meal times were treated as a social opportunity. Staff had most of the skills and knowledge required to effectively support people. People and their relatives told us their healthcare needs were met and staff supported them to see other health and social care professionals.

People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs w

This inspection was unannounced and took place on 27 September 2016.

Beech Tree House is registered to provide care and accommodation to up to 16 people. The home specialises in the care of older people who are living with dementia. At the time of the inspection there were 14 people living at the home.

The last inspection of the home was carried out in October 2013. No concerns were highlighted at that inspection.

There is no registered manager in post. However there is a manager who has applied to be 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.

The new manager of the home was described as very approachable and supportive. They had already identified some areas of practice which required improvement and had made some changes in response to these. These included additional information in care plans and changes to infection control practices.

We found that improvements were needed to make sure records of medication administration were correctly completed to minimise the risk of errors. The manager informed us they had already identified a more robust audit of medication administration records was required and planned to put this in place.

We also found that improvements were needed to make sure people had the support and information they required to help them to make choices and ensure their privacy and dignity was respected. Where people occupied shared rooms people did not have the opportunity to meet before making a decision to share. Neither were there any assessments in place to outline how the people had been identified as compatible or how privacy issues would be addressed.

People were very complimentary about the staff who supported them. One person told us “They [staff] are all very nice people.” Where people were unable to express their views verbally we saw they approached staff happily and appeared pleased when staff spent time with them.

There was a happy and relaxed atmosphere in the home. Staff interacted well with people which provided on-going social stimulation. There was also a range of organised activities for people to join in with if they choose to.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff knew how to report any concerns and had confidence that any issues raised would result in action being taken to make sure people were safe.

Generally people’s privacy and dignity was respected and people were able to make choices about how they spent their time. People were able to see visitors in communal areas or the privacy of their rooms.

Staff had a good knowledge of people and their needs. They monitored people’s health and sought advice from appropriate healthcare professionals when needed. Staff were able to adjust the care and support people received according to their changing needs.

The home specialised in the care of people who required care because of their dementia. All staff that we spoke with said they received on-going training in dementia care to ensure that they had the skills and knowledge to meet people’s specialist needs. There was a calm and relaxed atmosphere in the home and we saw that there was good interaction between staff and the people who lived there.

People said they continued to make choices about all aspects of their day to day lives. People said that they were able to choose what time they got up, when they went to bed and how they spent their day. One person told us “I decide what I do each day. Usually I get up early but sometimes I like a lie it, no one seems to mind.” Another person said “Nobody questions what you do, it’s very free and easy.”

The building was well maintained and there was a large accessible garden which was also well maintained. People we asked said that they enjoyed spending time in the garden in good weather. Some people told us that staff assisted them to walk to the village shop to make purchases and keep in touch with the local community.

The recruitment procedure minimised the risks of abuse to people who lived at the home by making sure that all staff were thoroughly checked before beginning work.

There were systems in place to effectively monitor the quality of the service offered and ensure the safety of people who lived at the home.

Some of the people who lived at the home were unable to fully express their views because of their dementia. We therefore spent time talking with staff and observing practices, as well as talking with people who used the service. We also spoke with two visitors to the home.

During our inspection we observed that staff always asked people if they were happy to be assisted before care was carried out. One person said “They always ask if you want to do things, they are very good.” Another person said “Sometimes I don’t want to do anything so they leave me in peace.” We noted that some people were unable to verbally give consent and consent was implied by the person using the service. For example when someone was discreetly asked if they wished to use the bathroom the person got up from their chair and went happily with the carer.

The people who were able to express an opinion said that they were very happy with the care that they received. One person said “I suppose they look after me very well but I wish I could do more for myself.” Another person commented “They never refuse us anything, they are all very kind.”

People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

We saw that the manager worked alongside care staff to offer ongoing guidance and support. One member of staff said “I love working here, we are a really good team and everyone helps each other.”

Beech Tree House specialises in the care of people who have a dementia. Many people living at the home are unable to fully express their opinions but all appeared comfortable and relaxed with the staff who supported them.

We saw that people were able to move freely around the communal areas and had unrestricted access to their rooms.

The care plan for one person said that they liked to lie in bed in the morning and that staff should respect this. Staff spoken with confirmed that they were aware of this care plan.

Staff said that they asked people each morning what they would like for lunch. Some people were able to tell us before the meal what they were having for lunch. We also noted that some people were able to make a choice at meal time by seeing the two alternatives. Everyone was given a choice of desserts after their main meal.

We observed that some people chose to eat in the lounge, small tables were provided and meals were bought to them. One person said that they did not want a hot meal and asked for tea and biscuits which was provided.

At the time of the visit we noticed that there was a relaxed atmosphere in the home. Staff assisted people in an unhurried manner.

Beech Tree House provides personal care for people who have a dementia. At the time of the visit not everyone was able to fully express their views on the care that they received.

People told us that they were happy with the care provided and with the staff who supported them. People said that staff respected their privacy and supported them with personal care in a sensitive manner. One person said “It’s a nice place to live” another said “We get well looked after.” More than one person said that staff were very kind if they were unwell and made sure that they were seen by a doctor or community nurse.

Some people said that they did not get choices about their daily routines. More than one person said that they were expected to get up early and were not able to choose when they went to bed. One person said “It’s nice here but I don’t do anything really.” Another person said “The day is long because there is so much time to fill.” Staff and other information suggested that people could make choices but this may not have been passed onto people in a way which was easily understandable.

Everybody asked was happy with the food and said that they always had plenty to eat and drink.

Everyone said that they had someone they could speak with if they had any complaints. One person said that staff were “Very helpful, they listen to you and discuss things.”