This inspection took place on the 10 November 2016 and was unannounced. At our previous inspection we found that the provider was in breach of four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had found that the service was not safe, effective, caring, responsive and well led. At this inspection we found that improvements had made and they were no longer in breach of any regulations.

Beechcroft Residential Home provides accommodation and personal care for up to 25 people. There were 16 people using the service at the time of this 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.

People were safeguarded from abuse as the registered manager and staff knew what to do if they suspected a person had been abused. Staff told us they knew the provider’s whistle blowing procedure and who to contact if they thought the registered manager and provider had not acted upon allegations of abuse.

Risks of harm to people had been assessed and plans had been put in place to minimise the risk. Staff knew people’s individual risks and followed people’s risk assessments to keep them safe.

There were sufficient suitably trained staff to keep people safe. Senior staff were trained to administer people’s medicines and people’s medicines were stored and administered safely. The registered manager regularly checked that people were receiving their medicines as required. Staff were employed using safe recruitment procedures.

The principles of the MCA 2005 were being followed as people were consenting to or being support to consent to their care at the service. DoLS referrals had been made for people who lacked mental capacity to agree to their care.

People were cared for by staff who felt supported and had been trained to fulfil their role effectively. People told us that staff were kind and treated them with dignity and respect.

When people became unwell or their health care needs changed, health care support and advice was gained. People were encouraged to eat and drink sufficient amounts to remain healthy.

People’s choices were being respected and they received care that reflected their individual preferences. People had their own private space where they were able to spend time alone or with their friends and families.

The provider had a complaints procedure and people told us they would speak to the registered manager if they had any concerns and they would act upon them. People who used the service and staff told us that the registered manager was supportive and approachable.

Systems to monitor and improve the quality of service were effective in ensuring a quality service was delivered. People were regularly asked their views on the service to ensure they were happy with their care.

The inspection took place on the 29 February 2016 and was unannounced. At our previous inspection in 2013 there were no concerns identified in the areas we inspected.

Beechcroft Residential Home provided accommodation and personal care to up to 25 people. There were 21 people using the service at the time of the 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.

People were not fully safeguarded from abuse as although staff knew how to report abuse internally they did not know the safeguarding procedures if they suspected institutional abuse.

Action was not always taken to minimise the risk to people when a risk of harm had been identified following an incident or a change in people’s needs.

Staffing levels had not been assessed based on the individual needs of people. Staff felt there was not enough staff to keep people safe during the evening.

People’s medicines were not managed safely. Some medication was unaccounted for and safe systems for administering medicines were not being followed.

The guidance of the Mental Capacity Act 2005 (MCA) was not being followed when people’s mental capacity had changed to ensure they were supported to consent to their care and support.

People’s dignity was not always supported and maintained.

People, liked being at the service. However, restrictions were in place which did not demonstrate that people’s individual preferences were being respected.

The systems the provider had in place to improve the quality of the service were ineffective as people’s views were not listened to or acted upon.

People liked the food and their nutritional needs were met. People received support from a range of health care professionals when they needed it.

Staff were supported by the registered manager and received training to be able to fulfil their role effectively.

Safe recruitment procedures had been followed to ensure they were fit to work with people prior to employing new staff.

We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

This was an unannounced scheduled inspection. This meant the provider did not know we were coming.

During the inspection we spoke with some of the people who used the service and a representative of a person who used the service. We also spoke with the registered manager and the staff who were on duty during the inspection.

We considered our inspection findings to answer the questions we always ask:

Is the service safe?

People who used the service had their needs assessed and risk assessments had been completed to reduce any risks to people's health and well-being. Records were accurate and had been reviewed to ensure they were up to date.

There were procedures in place to protect people in an emergency.

Staff had been appropriately trained to meet the needs of people who used the service.

The provider identified and managed risks to the health and safety of people who used the service, staff who worked there and people who visited.

Is the service effective?

People’s health and social care needs were assessed and plans were in place to provide the support they required. People's needs were regularly reviewed and updated to ensure that care plans remained effective.

People were referred to health care professionals as required and were supported to maintain their physical and mental health care needs.

People were encouraged to be involved in their care.

Is the service caring?

The staff knew people well and the people who used the service looked relaxed and comfortable in the company of staff. We observed positive interactions between the people who used the service and staff. Staff were patient with people and encouraged them, with support, to take responsibility for their daily living tasks. A person who used the service told us: “10 out of 10 here. It is a very good home".

Is the service responsive?

The home had a complaints procedure. People we spoke with said they would tell the staff if they were worried about anything. A person told us: "You can approach the manager or any of the staff about anything. They will always listen".

People living in the home and/or their representatives were enabled to share their opinions with staff, as the provider regularly sought their views and suggestions.

Is the service well led?

Staff who worked at the home felt well supported by the manager. One person said: "This is the best home I have worked in. The manager here is really good".

There was clear, comprehensive and detailed information to support staff in caring for people.

Staff training was provided and staff received regular individual supervision. This meant that staff had the opportunity to discuss their own personal development.

There was evidence of quality monitoring having taken place to monitor, audit and improve the services provided.

We inspected Beechcroft on a responsive inspection as we had received information of concern. The inspection was unannounced which meant the service did not know we were coming.

During the inspection we spoke to people who used the service, a relative, a visiting health professional and staff members who were available on the day.

We looked to see if people who used the service consented to their care, treatment and support. We found that the service had systems in place to show that people had consented to their care.

We looked at care records and observed people’s care being delivered and found that the service was meeting the care and welfare needs of people who used the service.

We checked that equipment within the service was safe and available for use. We found that equipment was well maintained and appropriate for its intended use.

Staff we spoke with told us they liked working at Beechcroft House and felt they were supported to fulfil their role effectively.

We found that the service had a complaints procedure to receive and respond appropriately to any complaints made by people who used the service or their representatives.

Beechcroft House was compliant in the five outcome areas we looked at.

We visited Beechcroft House on a follow up inspection. On our previous inspection people who used the service told us that they were being got up in the morning very early against there wishes. We asked the manager to prevent this from happening. The manager sent us an action plan telling us how they were going to meet the compliance actions. We visited on the 20 December to see if the manager had completed the compliance actions. This inspection was unannounced which meant the service did not know we were coming.

We spoke with people who used the service who told us they were no longer being got up early.

We looked at care records and spoke with the managers.

We spoke with relatives of people who used the service who told us they were happy with the care their relative received.

We found the service was now compliant in Outcome 4 Care and Welfare of people who use services.

We visited the service on a planned unannounced inspection which meant the service did not know we were coming.

People who used the service told us they were happy with their care and they liked the staff.

Relatives of people who used the service told us that they were happy with the care their relative received.

People who used the service looked smart and tidy and dressed appropriately and appeared relaxed and comfortable.

At lunch time people were singing to the old time music playing in the dining room and we observed the food looked healthy and appetising.

The service was decorated for Halloween.

We have concerns over the routines within the home which people who used the service told us meant they had to get up unnecessarily early.

We visited Beechcroft House to look for improvements in the areas where we had concerns at a previous visit.

At a previous visit non compliance had been identified in Outcome 4 which relates to care and welfare of people who use the service. We evidenced that there was little stimulation for people and little time was spent talking with people. Relatives and people living at the service had told staff from the local authority that they do not always feel that staff were caring and that there were times when they felt they had to wait to go to the toilet.

We also saw that care plans did not cover all areas of need and were not always up to date. In addition, we saw that they were no recognised assessment and monitoring systems in place for such areas as continence, tissue viability and nutrition. We saw that one person was receiving end of life care but the care plan did not show this.

We saw that there had been a high number of falls recorded and although basic fall risk assessments and analysis had been completed the assessments did not consider foot wear, the possible effects of medication and balance issues. Fall prevention plans were limited and the analysis of falls did not fully consider where and when falls took place. It was evident that the service was reacting to falls rather then having systems and plans in place to prevent falls as much as possible.

At this follow up visit compliance had been achieved with activities for people living in the home and staff interaction with people had improved. Improvements were evidenced in some care plans however they continue to need further work in some areas and an improvement action was given to monitor the care plan changes and ensure that they are embedded and fully understood.

We visited the service due to concerns raised. The service was subject to a safeguarding investigation.

People we spoke to said that they were happy with the care they received. One person said that the staff looked after them "really well".

We observed people were spoken to in an appropriate manner but did see that there were times when no staff were there to spent time with people.

People had plans of care but these could give more details about the care people needed and were not always up to date. Where people were at risk of falls we did not think this was managed very well.

People health needs were addressed with health care staff visiting the service.

People said they received their medication when they were supposed to. One person said that she needed medicines five times a day and staff gave it to her at the correct times.

Staff were assessed as competent to move people safely. One person said that the she felt safe when being moved and that staff used the equipment she needed to move safely.

People told us they were satisfied with the care provided.