About the service:

Beechlands is a care home in Loughton which provides accommodation with personal care for up to 28 older people, some of whom may be living with dementia. There were 21 people living at the service on the day of our inspection.

People’s experience of using this service:

The service had improved since our last inspection and people received good quality care at Beechlands. We found the provider had addressed the concerns we had raised at our last visit. There were improved systems for the safe administration of medicines. The registered manager had learnt from the experience and was aware of the need to act promptly when things went wrong.

Senior staff and provider representatives carried out checks on the quality of the service. These systems had improved since our last inspection.

We received positive feedback from people, families and staff about the service, especially about the family atmosphere.

There was an established management team and long-standing staff who knew people well. The registered manager was a strong leader who was responsive to people’s needs. They promoted an open culture where people and staff felt able to have a say in the service, speaking out when they had concerns. The registered manager developed positive links with external agencies and used feedback to learn from mistakes.

Risk was well managed at the service. Measures were put in place to keep people safe, however people were still able to enjoy life and have fun. There were enough safely recruited staff to meet people’s needs. Staff knew what to do if they had concerns for a person’s safety.

Staff had the necessary skills to meet peoples’ needs. Training and checks of staff competency had improved, particularly around the administration of medicine.

Staff worked well along with external professionals to maintain people’s physical and emotional wellbeing. People ate and drunk in line with their preferences and dietary needs, and there was a focus on making meal times an enjoyable event.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Senior staff carried out assessments of need prior to people coming to live at the service. Care plans were developed which provided staff with information on people’s needs and any risks. The quality of these care plans did not fully reflect the good care we found at the service, however, despite this we found staff knew people’s needs well. The provider told us they were introducing new systems to address the quality of the care plans.

Care was person centred and flexible. Care was reviewed and adjusted when changes happened. People were supported to take part in pastimes and interests. Senior staff and care staff treated people with respect and supported them to remain independent.

The registered manager and staff worked well with professionals and families to ensure people receiving end of life care could choose to remain at the service when their needs increased.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement. The last report was published on 29 September 2017.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor Beechlands to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The inspection took place on 4 July 2017 and was unannounced. The service was previously inspected on 2 September 2016 at which time it was rated as good.

Beechlands is registered to provide accommodation with personal care for up to 27 older people, some of whom may be living with dementia. There were 22 people living at the service on the day of our inspection.

At the time of 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.

The provider had recently changed to an electronic system for managing medicines which was not robust which meant we could not be sure that people were receiving their medicines as prescribed. The stock counts for people’s boxed medicines did not match with what was recorded on the electronic system. Weekly medicine audits were completed to monitor the safety and effectiveness of medicine management but these audits had not been effective in picking up on the shortfalls that we found.

Risks to people were assessed and management plans put in place. Staff were aware of the risks to people and knew how to minimise them to keep people safe.

There were sufficient numbers of staff deployed who had been recruited safely.

Staff were supported with training and supervision to ensure they had the necessary skills and knowledge to care for people effectively.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken. This ensured that any decisions taken on behalf of people were in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated codes of practice. People were supported to exercise choice and control in their daily lives and were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported appropriately in accordance with current legislation.

A choice of food and drink was available that reflected peoples nutritional needs, and took into account their preferences and any health requirements. People were supported to maintain their health as had regular access to wide range of healthcare professionals.

Staff had developed positive relationships with people and were attentive to people’s needs. People’s privacy and dignity was respected and their independence was promoted.

People were treated with kindness and courtesy by staff who knew them well and who listened to and respected their views and preferences.

People were supported to keep in contact with their family and friends who were made welcome at the service.

Staff enjoyed working at the service. Staff and people were included in the running of the home and the registered manager responded appropriately to any complaints or feedback.

The registered manager had systems in place to monitor the quality and safety of the service and to drive improvements. However, these systems had not always been effective at identifying the concerns we found.

This inspection took place on 2 September 2016.

Beechlands is registered to provide accommodation with personal care to up to 28 older people, some of whom may be living with dementia related needs. There were 26 people receiving a service on the day of our inspection.

A registered manager was 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.

Some work was needed to ensure that records relating to risk and care were effectively completed, accurate and current and that quality assurance processes were successfully implemented to identify issues that needed improvement. This included ensuring that information in care records was easily accessible.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were thorough. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs.

Care records were regularly reviewed and showed that the person had been involved in the planning of their care. People told us that they received the care they required. People had support to access healthcare professionals and services. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences.

Staff used their training effectively to support people. The manager understood and complied overall with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were aware of their role in relation to MCA and DoLS and how to support people so not to place them at risk of being deprived of their liberty.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected and they found the staff to be friendly and caring. Care records were regularly reviewed and showed that the person had been involved in the planning of their care. People told us that they received the care they required. People were supported to participate in social activities including community based outings.

People knew the registered manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response.

As part of our inspection on 7 April 2014, we looked at the care records of four of the 28 people living in Beechlands. We spoke with eight people who used the service and also spoke with four visitors who were people's friends or relatives.

We looked at staff training records, health and safety checks, staff and resident meeting minutes and records of the checks the provider’s representative completed to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that there was “…a lovely atmosphere”. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that staff were provided with training in safeguarding vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded. Training for staff on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) was planned.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care in the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

Is the service effective?

Most people's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The care records were regularly reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met safely and effectively. People told us that they received the care they needed.

We spent time observing mealtimes and saw that staff provided sensitive assistance where people required support or encouragement to eat their meal. This meant that people’s nutritional intake was effectively supported.

Is the service caring?

People told us that staff were kind and caring. One person said, “The care is marvellous as are the staff. They make me feel I am not so old. They know I like to have my nice things on and always make sure I have them”.

We observed that staff were kind to people they supported and interacted with people in a caring and professional way. Another person told us, “They do what I like, they don’t tell me what to do. They let me do the things I can do but they are there if I ring for them. If I wake up at night the staff help me and make me a cup of tea. I ring for them when I am ready to get up. They are very nice”.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities that interested them. People's choices were taken in to account and listened to. One person said, “It’s quite good here, especially the food. You get a selection. The staff really help you. The local priest brings in communion”.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. We saw for example that one person did not eat specific foods for religious reasons. Both care and kitchen staff were aware of this and ensured that this was respected.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service well-led?

Overall, the provider had procedures in place to support the manager and to ensure that quality checking systems were in place. This was used to manage risks and to assure the health, welfare and safety of people who received care at the service.

We saw that the improvements identified as required at our last inspection on18 November 2013 in relation to management of care records had been put into place. However, we found that some care records were not available for one person who used the service and that this had not been identified by the manager or staff.

We saw that staff treated people with respect and kindness and that care was delivered in a way that met people’s needs. Everybody we spoke with indicated they were happy living at the home and with the levels of care they received.

People told us that they enjoyed the food provided for them and relatives told us they felt the food was appetising. We noted that relatives were encouraged to join people who used the service for meals.

We looked at the personnel records for four staff members recruited since the last inspection. We found that people were protected by a robust process in place for recruiting staff.

The provider had a complaints policy and procedure in place. People who used the service and their relatives told us they knew how to make a complaint but had never had reason to do so. One person said, “I would just speak to the manager or one of the seniors. I am sure they would act immediately if I was concerned about anything at all.”

We found that care records lacked detailed guidance and instruction for the staff to follow to ensure they met people’s individual needs in a safe and consistent manner. We saw that personal and private information that related to the people living at the home, was not securely stored in such a manner that promoted confidentiality.

We spoke with three people who used the service about the way their medicines were handled and given to them. One person told us that staff were "Very good" and that "Everything is OK".

People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

At our previous inspection of this service in June 2011 we found that people were not protected against the risks associated with medicines because the provider did not ensure that their arrangements for managing medicines were implemented effectively. We judged that this had a moderate impact on people using this service and action was needed for this essential standard. We asked the provider to take action to improve these systems. The provider told us that they were carrying out regular ‘observational audits’ to ensure improvement in this area.

During our visit of 25 February 2013 we found significant concerns with the medication administration systems and processes.

Everyone who we spoke with when we visited the home on 13 June 2012 told us that they received the support that they needed with their personal care and health care. They were complimentary of the staff. They told us that staff were always available to support them, for example for a walk around the garden, when they asked. Two visiting relatives told us that they were consulted and kept informed about their relative’s care, and that there were always staff available to speak with if needed.

However the people who we spoke with told us that they had not seen their care plan, and they were not consulted about care provided. There was no evidence in the care plans that we saw that people had been consulted about their care needs or about the reviews of their care, and the care plans and reviews were not signed by the people concerned. There was no risk assessment for one person who had an assessed risk of falls, to provide staff with information to support the person and minimise the risks to their safety.

People told us that the staff looked after their medication, and that they had agreed that the staff should administer their medication. However the practices that we observed during our visit were not in accordance with the provider’s procedures, and we found evidence of poor recording, which meant that there was a risk that medicines may be administered incorrectly.