Beechcroft Care 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. Beechcroft Care Home is registered to accommodate 40 people. At the time of our inspection 36 people were using the service. The service accommodates people in one building and support is provided on one floor with three lounge areas and three dining areas. A garden and enclosed patio were also available that people could access.

The service had 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 our last inspection on 26 September 2016 we found the provider was not meeting all the regulations that we checked and we rated the home as Requires Improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. We found these improvements had been made and we have rated the service as Good overall. Although we did not find any breaches of the regulations, further improvements were needed to ensure the service is responsive to people’s holistic needs. Such as ensuring activities are available on a daily basis for people to participate in and that opportunities for people to socialise with each other are available within all communal areas. The registered manager had identified this and was taking action to address this.

People confirmed and we saw that there was enough staff to meet people’s needs. Individual risks to people and environmental risks were identified and staff were available to minimise these risks and maintain people’s safety.

Records were available and we saw checks on staff had been undertaken prior to employment, to confirm the staff were of good character and suitable to support people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When decisions were made in their best interests their rights were protected. The policies and systems in the service supported this practice.

Reviews of people’s care were undertaken on a monthly basis and people and relatives confirmed that they were consulted and involved.

Our observations and discussions with people and their relatives confirmed the staff were considerate and caring. We saw the staff knew people well and had a good relationship with them; they took the time to stop and chat with people throughout the day.

Staff were clear on their role on protecting people from the risk of harm and understood their responsibilities to raise concerns. There were processes in place for people to raise any complaints and express their views and opinions about the service provided.

Assistive technology was in place to support people to keep safe. Staff were provided with the right training and support to enable them to meet people’s needs. People were supported with their dietary needs and to access healthcare services to maintain good health. Systems were in place to prevent and control the risk of infection.

People who used the service and their relatives were involved in developing the service; which promoted an open and inclusive culture. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement. We saw these were being used effectively to make the improvements required.

This inspection took place on 26 September 2016 and was unannounced.

There is a requirement for Beechcroft to have a registered manager. The provider had notified us about the absence of the registered manager. This period of absence was being covered by another of the provider’s managers. 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 service is registered to provide residential care for up to 40 older people some who were living with dementia. At the time of our inspection 28 people were using the service and one area of the home was closed for refurbishment.

The provider could not demonstrate staff deployment had been planned to meet people’s needs. In addition the service could not produce recruitment records to assure us that all staff had been recruited using pre-employment checks designed to ensure staff working with people using the service were suitable to do so. Other records relevant to people’s care and treatment had not been made when required or retained. People were supported to use equipment that had not been assessed as suitable and safe for their individual use. Care plans and risk assessments did not always reflect recent changes to people’s care and support.

The provider could not demonstrate people always received care and support that followed the Mental Capacity Act 2005 (MCA) and was least restrictive. Although risk assessment identified risks to people staff did not always provide care in a way that helped to reduce risks. People were not asked for their consent to care and treatment before staff provided support.

Staff did not always communicate with people in a way that supported their privacy. For example, on some occasions, staff shouted above the heads of people at dinner time to ask people what they wanted. Not all people received the same amount of social interaction from staff.

Not all staff training was up to date and the manager had put in place actions to make sure staff training was updated.

Some people, but not all, had been involved in planning their care and support. However this care and support had not been regularly reviewed by people, their families and staff.

There was no evaluation as to whether the events and entertainment being organised met people’s needs. People’s individual preferences for hobbies, interests and pastimes was not recorded and used to plan activities that matched people’s needs. Some people were affected by the lack of activities and entertainment; activities were not to some people’s choice and preference. There had been a lack of meetings with people and families to involve them in developing the service. People had not been asked for their views on the quality of services provided. However the manager had plans to involve people more through satisfaction questionnaires and meetings.

Audits had been used to identify shortfalls in the service, however not all shortfalls had been identified and included on an action plan.

People felt safe and felt able to talk to staff about any worries or concerns. Medicines were administered safely and infection prevention and control practices were followed. People had access to other health professionals so as to maintain their good health.

The provider had a system in place to ensure any complaints were investigated to set timescales. The provider had sent in notifications when required. Notifications are changes, events or incidents that providers must tell us about. The service was managed with an open and approachable leadership style.

Some staff had built positive relationships with people and created a jovial atmosphere. People felt staff were caring and felt staff would listen to them.

People had suffic

People using the service and their visitors told us they were happy with the care they received and spoke highly of the staff that supported them. Comments included, “I think the care here is very good, the staff are very nice. I have no complaints.” And “I’m very satisfied with everything, this is an absolutely marvellous home in my opinion.”

People told us they enjoyed the meals provided and we saw that choices were available at meal times. The meals provided were nutritionally analysed to ensure they were suitable for people using the service.

We saw that staff were responsive to people’s needs and the support plans and risk assessments seen reflected the care that was given.

We checked the medication practices and saw that people received their medication as prescribed and in a safe way.

Processes were in place to ensure the services and care provided were monitored and improved upon where needed. People using the service and their visitors told us they felt confident to raise any concerns they had with the staff.

We spoke with many of the people using the service and obtained the views of four people regarding the support and services they received.

People talked to us about the activities provided. Comments included, “It’s smashing here, the food is good and there’s things to join in with if you want to.” Another person told us, “We have trips out and people come in like the exercise lady.”

People were very positive about the staff team and the way they were supported. One person said, “they’re all very nice.” Another person said, “they are friendly we’re like one big family really.”

People told us they felt confident to raise any concerns they had with the staff. One person said,” I would talk to the manager or one of the staff on duty.”

People confirmed that daily routines were flexible and felt that their privacy and dignity was respected. People were able to move around the home freely and this was observed during our visit.