Our inspection was unannounced and took place on 17 July 2017.

At our last inspection in June 2016 the service was rated as good in three of the five questions we ask: Is the service effective? Is the service caring? Is the service responsive? And requires improvement for the remaining questions: Is the service safe? And Is the service well-led? This was because medicine and recruitment systems were not adequately safe. Additionally although governance processes were in place they had not always been effective to ensure that staff sickness levels and other staff issues had been addressed. This inspection we found that specific issues that we had identified previously had been addressed in well-led and safe but some new issues were evident in safe. As a result the rating for safe remains as requires improvement.

The provider is registered to accommodate and deliver personal care to a maximum of 50 people. At the time of our inspection 48 people lived at the home. People who lived there were elderly and had needs associated with old age and less advanced dementia.

The manager was registered with us and was present on the day. 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.

Although recruitment systems overall prevented unsuitable staff being employed checks needed more diligence. Medicine systems had improved but some further strengthening was needed to enhance safety. People were safe and systems were in place to prevent people from the risk of harm and abuse. Staffing levels were monitored regularly to give assurance that people’s needs could be met.

Staff received induction and other training that they required to acquire the skills and knowledge to provide safe and appropriate care to people. Staff confirmed that they were adequately supported in their job roles. People received care in line with their best interests and processes were in place to ensure they were not restricted unlawfully. People were supported to have the food and drink that they enjoyed.

Relationships between staff and the people who lived at the home were positive. Staff were friendly, polite and helpful to people. People were encouraged to make everyday choices and they were supported to maintain their independence.

People needs were reviewed regularly to ensure that they could be met. The complaints system was well managed and was available for people and their relatives to use. Activities were available each day for people to engage in.

People knew who the registered manager and provider were and they were visible within the service. Quality monitoring processes, the use of provider feedback forms and meetings helped to ensure that service was being run in the best interests of the people who lived there.

Our inspection was unannounced and took place on 20 June 2016. At our last inspection on 8 June 2015, although there was no direct impacts on people to determine a breach of regulation, we assessed two domains [domains are the different subject sections within the report], safe and well-led as ‘requires improvement’. We re-looked at the issues that previously required improvement. We found that some issues had been addressed, but some still needed further improvement which included staffing levels. We also found some new issues including staff sickness management that also required improvement to prevent people being at risk of not receiving the care and support they needed.

The provider is registered to accommodate and deliver personal care to a maximum of 50 people. At the time of our inspection 47 people lived at the home. People who lived there were elderly and had needs associated with old age and dementia.

A manager was registered with us as is required by law and was present on the day. 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.

Staffing levels needed further consideration to ensure that they would consistently meet people’s needs and keep them safe.

Most people and their relatives told us that the quality of service was good. Governance processes were in place but had not always been effective to ensure that staff sickness levels and other staff issues had been resolved.

Monitoring methods were used but they had not always checked that people’s likes, dislikes and preferences were current.

People were generally given their regular medicines as they had been prescribed. However, protocols were not in place for medicines prescribed on as needed basis to ensure that people also received those medicines safely.

Recruitment processes ensured that most of the checks had been undertaken on staff to prevent people being placed at risk of harm or abuse. The provider had not always however, gained enough information to ensure that all staff were in full good health.

Staff knew how to keep people safe which prevented them being placed at risk of harm or abuse. Processes were in place to prevent people being placed at risk of sore skin and accidents.

Staff received induction training and support to ensure they did their job safely in the way that people preferred.

Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had met the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People were provided with drinks and meals that they generally enjoyed in sufficient quantities to prevent them from a risk of dehydration and malnutrition.

People’s health was assessed to ensure that their health care needs were met by a varied range of external healthcare professionals.

People were cared for and supported by friendly, helpful and kind staff.

People were supported to retain their independence and undertake the tasks that they could do themselves.

People were glad that visiting times that were flexible and that their family and visitors and were made to feel welcome by the staff.

People made decisions about their care and support and they and their families were involved in how their care was planned and delivered.

Recreational activities were offered for people to participate in and enjoy but these needed to be further considered for all people’s recreational needs to be met.

A complaints procedure was in place for people and their relatives to raise their concerns or complaints if they had a need to.

The provider is registered to accommodate and deliver personal care to a maximum of 50 people. People who live there are elderly and some may have needs associated with dementia.

Our inspection was unannounced and took place on 8 June 2015. At the time of our inspection 42 people lived there.

At our last inspection in April 2014 the provider was not meeting two of the regulations that we assessed relating to staffing levels and quality monitoring. During this inspection we found that some improvements had been made concerning the specific issues. However, although the evidence gathered during this inspection did not determine a breach of regulation, further improvements were needed.

A new manager was registered with us (in January 2015) as is required by law. 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.

Some people and staff had mixed views about staffing levels. The registered manager and provider agreed to review staffing levels to ensure people’s needs would be consistently met.

Although people told us that they felt safe. We observed some risks regarding the environment that could jeopardise people’s safety.

Systems in place did not always promote safe medicine management to prevent people being placed at risk of possible ill health.

Staff were trained effectively to support the people who lived there safely.

Staff knew what to do to ensure the risk of harm to people was prevented and that people received care and support in a safe way.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

Staff supported people with their nutrition and health care needs.

People were able to make choices about their care. Where it was needed families were involved in how their family member’s care was planned and delivered.

Systems were in place for people and their relatives to raise their concerns or complaints.

People were encouraged and supported to engage in recreational activities which they enjoyed. Staff supported people to keep in contact with their family as this was important to them.

People were encouraged and supported by staff to be independent and attend to their own personal care needs when they could.

All people received assessment and treatment when needed from a range of health care professionals.

People and relatives we spoke with were all positive about the quality of service. A number of processes were used to monitor the quality of the service provided.

An inspection was carried out to help answer our five key questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well lead?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight people who used the service, three relatives, six staff supporting them and looking at six people's care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us they felt they were safe. Safeguarding procedures were in place and generally staff understood their role in safeguarding the people they supported.

We found that staff asked people for their permission before supporting them with their care needs.

Staff knew about risk management plans and we saw that they supported people in line with those plans.

The provider had robust recruitment systems in place to ensure that care staff had received the appropriate checks about their suitability to work with people.

Rotas were planned in advance but the number of staff available was not sufficient to meet the needs of people who used the service and keep them safe. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced staff employed for the purposes of providing care.

Systems were not in place to make sure that managers and staff learn from events such as accidents and incidents, complaints and checks made on the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people’s safety.

Is the service effective?

People’s health and care needs were assessed. Relatives told us they were involved in the care planning and reviews of care. We saw that care plans were regularly updated.

Visitors confirmed that they could visit when they wanted to and spend time alone in privacy if they wished.

Is the service caring?

People were supported by staff that were generally kind and caring. We saw that care staff gave people encouragement and were patient with them. One person told us, "The staff are very caring".

People’s preferences, interests and diverse needs had been recorded and care and support was usually provided in accordance with people’s wishes.

Is the service responsive?

We saw that people's views were sought by the provider about the care they received. We found that the provider did not always respond to comments made.

People and their relatives were aware of the home’s complaints procedure and knew how to raise concerns.

Is the service well led?

The service had a quality assurance system. Records seen by us indicated that shortfalls in the service were not addressed promptly.

Staff told us they were clear about their roles and responsibilities but were not aware of plans in place to manage risk and improve the quality of care people received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and managing risks relating to the health, welfare and safety of service users and others who may be at risk.

Staff told us the home was well organised and they felt supported by their manager.

There were 48 people living there on the day of our inspection. The manager told us that two other people were currently in hospital. We spoke with ten of the people living there, two of their relatives, five members of staff and the manager.

Staff knew how to support people to meet their needs and ensure their healthcare requirements were met. One person living there told us, “I’m very, very happy here. I was surprised how I have settled in to living in a care home.”

People had been given their medicines as they had been prescribed by their doctor to ensure their health and wellbeing.

The home's environment was comfortable and well maintained so it was safe for people to live in.

Staff were supported to ensure they had the skills and knowledge to meet the needs of the people living there. One person said, “The staff are very good.”

People were asked for their views about the home and audits of the quality of care that people received were completed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drinks available in the home. This inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and joined by practicing professional with a nursing background. There were 49 people in the home at the time of our visit.

We spoke with six people who lived in the home about their experience of living at Beechcroft Residential Home. We spoke with four staff and the manager of the home. We also spoke with one relative who was visiting while we were there. To help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

People’s privacy and dignity was maintained. We saw that people were spoken to politely and were given the support they needed to eat their meal. People generally felt that their needs were met in a dignified way.

People told us that they could make choices in relation to daily living for example, they could choose what time to get up and go to bed and where to spend their day. We saw that people had their own bedrooms which promoted their privacy and dignity as they had private space in which to spend time and receive personal care. .

All the people we spoke with said they had enough to eat throughout the day and did not go hungry. We saw that people special dietary needs were met. Two people we spoke with told they “enjoyed their food.”

All the people we spoke to told us they had no concerns about the care and support they received. One person said they were, “Happy with everything and were well cared for.” All of the people we spoke with told us that they would raise any concerns with their relatives or one of the carers.

We saw that there were sufficient numbers of staff available to assist people with their meal and this support was given in a way that respected people’s dignity.

Staff were aware of people’s needs but we saw that care records did not always give staff up to date information about how to meet people’s needs. This could mean that people were put at risk of not having their needs met appropriately.