Beechlawn 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.

The service provides residential care in one adapted building for up to 35 older people, some of whom are living with dementia. There were 25 people living in the service when we inspected on 8 and 13 March 2018. This was an unannounced comprehensive inspection.

We last inspected this service on 11 August 2016 and rated the service Requires Improvement in four of the five key questions and Good in Effective. Overall, the service was rated as Requires Improvement. During that inspection, we found that there was not sufficient staff on duty to ensure that people remained safe and that improvements were needed in regards to the management of people’s medicines. It was also found that caring relationships between staff and the people they supported were being developed but improvements were still needed to be made. There were concerns that the environment was not dementia friendly and people did not have full access to outside areas. Care plans needed improvement to ensure that people got consistent support that met their needs.

During this inspection on 8 and 13 March 2018, we found that improvements had been made to help ensure that people received a good quality of care, but some further improvement was still needed in some areas.

Beechlawn Residential Home has a registered manager. 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.

During our previous inspection on 11 August 2016, it was highlighted that the service was not dementia friendly; we were told that the registered manager would take action and put plans into action to rectify this. During this inspection, we saw that little action had not been taken. After our inspection, the registered manger sent us plans of the action they intended to take. This would help people living with dementia to find their way around the building better and to be able to orientate themselves, which would help them to feel less anxious and more relaxed so that behaviours triggered by anxiety would decrease.

Not all of the people who lived in the service told us that they felt safe. We were told that there were people who walked with purpose for most of the day and, on occasion, during the night. People told us that these people had entered their bedrooms and, when asked to leave, sometimes became anxious and responded in a way that was disruptive or worrying to the room’s occupant. During discussions with people, staff members, the registered manager and on examination of the rotas and dependency calculations, it was established that there was not always enough staff on duty to support and keep people safe. The registered manager, in agreement with the provider, immediately took action and increased the number staff on each shift.

Risks were assessed and steps have been put in place to safeguard people from harm without restricting their independence unnecessary. Risks to individual people had been identified and action had been taken to protect people from harm. However, some of the risk assessments were generic and needed to be individualised.

Within the environment there were examples of poor fire safety practices that put people at risk. During the inspection, the registered manager took immediate action in some areas and undertook to take further action in all the areas bought to their attention. The main exit needed more than one action to open the door, which was not considered best practice; there were two locks and a door cha

This inspection took place on 11 August 2016 and was unannounced. Our previous inspection of 15 and 17 December 2016 had found breaches of regulations. We had concerns that people were not being supported in a safe manner, there were not sufficient staff, people’s consent was not obtained before providing support, people’s nutritional needs were not met, people were not treated with dignity and respect, care was not person-centred and systems were not in place to ensure the quality and safety of the service. Since that inspection the service has made substantial improvements. The provider employed two consultants to support the manager and implemented support and advice from a variety of sources.

Since our last inspection the manager has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Beechlawn Residential Home provides care and support for up to 36 older people, some of whom may be living with dementia. At the time of our unannounced inspection on 11 August 2016 there were 16 people living in the service.

We found mixed views from people as to whether there were sufficient staff to meet people their needs. There was not a system in place to ensure the number of staff was sufficient to meet people’s assessed needs. The registered manager told us they were researching a suitable method to do this. We have made a recommendation for the service to seek guidance on appropriate staffing levels. Staff had received appropriate training to meet people’s needs.

There were procedures and processes in place to protect people from abuse and minimise the risks to their safety. There were procedures to ensure people received their medicines as prescribed. However, protocols regarding medicines which people were prescribed ‘as required’ were not in place.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and met. Since our last inspection the service had re-located the dining area to make the dining experience an enjoyable experience. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People had mixed views about their relationships with staff. This was an area which was being addressed by the registered manager. We observed staff interacting with people in a respectful manner and respecting people’s privacy and dignity. Care plans had been revised since our last inspection and the service was consulting with people and their relatives to improve these.

The environment of the service was not dementia friendly and did not support people to be as independent as possible.

The provider and registered manager were working towards improving the culture of the service. Communication with people and relatives was being improved and their views taking into account when planning improvements. Quality assurance systems had been put in place and these were also supporting the service to identify where further improvements were needed.

Beechlawn Residential Home provides accommodation and personal care for up to 36 older people who require 24 hour support and care. Some people are living with dementia.

There were 30 people living in the service when we inspected on 18 May 2015. This was an unannounced inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Our previous inspection of 11 September 2015 found that improvements were needed in how people’s care was planned and delivered to ensure people’s safety and welfare and how the service was assessed and monitored to provide a good quality service to people. The provider wrote to us and told us how they had implemented these improvements. During this inspection we found that improvements had been made. However, these needed to be embedded into practice to provide ongoing safe quality care to people who used the service.

Improvements were needed in how the service protects people in relation to medicines management relating to creams and lotions.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans identified how their individual needs were met and contained information about how they communicated. Improvements were needed in how people’s ability to make decisions were assessed and recorded. The provider and the registered manager understood the recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). However, they had only made one referral to the local authority, despite having identified that others may require DoLS referrals to make sure people’s legal rights were protected. Improvements were needed to ensure that people were not unlawfully deprived of their liberty.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

There were sufficient numbers of staff with the knowledge and skills to meet people’s needs.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake appropriate referrals had been made for specialist advice and support.

A complaints procedure was in place. People’s concerns and complaints were addressed and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were in the process of being addressed. However further improvements were required to ensure the quality of the service continued to improve.

Prior to our inspection we received information of concern about this service and so we undertook this inspection to check that people were being provided with safe and effective care.

We spoke with seven people who used the service. We also spoke with the provider, the registered manager and five staff members. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at four people's care records. 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 a staff member looked at 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.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and the provider told us that they were aware of the changes relating to DoLS following a supreme court judgement in March 2014. They told us that they knew the actions to take if a person using the service was at risk of having their liberty deprived.

Is the service effective?

People told us that they were happy living in the service and that the ways that the staff supported them were effective. One person said, "I don't think you will find any problems, I am happy here." Another person said, "I have got nothing to grumble about, I am quite happy."

We saw that the staff responded to people's requests for assistance, including call bells, in a timely manner.

Is the service caring?

People told us that the staff treated them with respect. One person said, "They (staff) are kind." Another person said, "I have no problems with the staff, they are nice."

We saw that staff interacted with people in a caring, respectful and professional manner.

Is the service responsive?

We were concerned because people's care records did not reflect people's needs accurately, how these needs were met and any changes in people's needs and preferences. Therefore we could not be assured that staff were provided with the information they needed to meet people's needs and that people were provided with the care and support that they required. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The quality assurance systems in place were not robust enough to ensure that the service identified shortfalls, addressed them and continued to improve. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service had notified us (CQC) of incidents that they were required to tell us about, such as when people had developed pressure sores.

We spoke with 12 of the 29 people who used the service. We also spoke with one person's relative and three staff members. We looked at five people's care records. Other records viewed included staff training records, health and safety checks, staff and resident meeting minutes and satisfaction questionnaires completed by the people who used the service and staff. 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 the registered manager asked to see 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 they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which were updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks, this meant that people were protected in the event of a fire.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person said, "They (staff) come when I ring (the call bell)."

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I get everything I need." Another person said, "I can't fault it here." Another person said, "I am very happy here."

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 records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "I get on well with all of them." Another person said, "They are all very kind and they work so hard."

People using the service, their relatives and other professionals involved with Beechlawn Residential Home completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We carried out this inspection as we had received concerning information regarding the service. We spoke with three people using the service and four members of care staff.

People told us they were given a choice of menu and that they had enough to eat. One person told us, "There is plenty to eat and I get a choice." Care staff told us that people were offered a choice for meals and that snacks such as crisps were available between meals.

We looked at how the service administered and recorded medication. We found that there were significant gaps in the recording of the application of prescribed creams.

We checked the service's staff rota and found that during the day the number of staff on duty met the numbers assessed as being required by the provider. However, we found that on 13 occasions in the morning there was only one member of care staff on duty. This fell below the assessed need and was not sufficient to ensure the safety and welfare of people living in the service.

We spoke with three staff, the registered manager, three people who used the service and two relatives of people who used the service on the day of our inspection.

People who used the service and their relatives were satisfied with the standard of care they received. One person told us, "I only have to press my bell and someone comes to help." Another person said, "The carers are all very kind."

We saw that people were asked for their consent before care was provided. People told us that they knew how to complain if the need arose.

People benefited from a service that was clean and hygienic throughout.

We spoke with two people who used the service. One said, "The staff are very caring." Another said, "I like it here." However one person told us that they were, "Fed up with the noise from the builders."

We found that since our last inspection the provider had revised the format of the care plans. We saw that people's needs were assessed and care planned in line with the assessment. Risks relating to the care provided were assessed and monitored.

The provider had put into place a number of new ways of assessing and monitoring the quality of service provided which included a monthly managers audit and a quality development programme.

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We spoke with three people they told us they were happy using the service. One relative told us that the, "Staff were wonderful." One person told us they had been living at the service for a long time and would have moved if they had not been happy.

We found that the service did not plan and deliver care to the necessary standard. People's individual needs were not always met. Care records were not updated when a person's needs changed which could lead to care not being delivered correctly

People told us that they were happy with their care. The staff were attentive and friendly. "They can't do enough for you" said one person. People liked the meals and were pleased that their menu likes and dislikes were known and provided for. People were confident they could make a complaint. Some people thought there should be more staff to answer the call bells more promptly.

This inspection took place on the 15 and 17 December 2015 and was unannounced. Our previous inspection of 18 May 2015 found the service did not do all that was practicable to mitigate risk associated with medicines and did not have systems in place to ensure that restriction on people for their safety were lawful. This inspection found that although some changes had been made the relevant requirements were still not being met.

Beechlawn provides care and support for up to 36 older people, some of whom may be living with dementia. At the time of our inspections there were 23 people living in the service.

The service is required to have a registered manager in place. The manager registered with the Care Quality Commission (CQC) works in the service but does no longer performs the role of manager. The provider has recruited a new manager who is not registered with the CQC to manage this service.

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.

There were not enough staff to meet people’s needs. Staff had not received training to ensure they could provide care in a safe and effective manner. Appropriate recruitment checks had not been carried out prior to staff being employed.

Staff had not received up to date training in protecting vulnerable adults from abuse and were not clear what constituted abuse. The senior staff team were not clear how allegations or abuse should be reported and managed.

Due to the low staffing numbers staff did not have time to give people the care and support they required in a caring and compassionate way. The routine of the service was task led and not centred on the people receiving care. Due to improvements being needed in staffing levels, and staff skills and knowledge with regard to dementia people were not provided with meaningful and caring interactions which they needed to reduce social isolation.

Risks to people were not always effectively assessed. Where the risks had been assessed as requiring measures to be put in place to mitigate that risk these were not in place.

People’s medicines were not always administered and managed effectively and safely.

The service had made applications to the local authority under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). However, the DoLS authorisations were not monitored as required. The service restricted access to the code required to open the front door thereby restricting some people’s liberty without appropriate authorisation.

Care records did not adequately reflect the care people required and changes in people’s care needs were not always reflected in their records.

The service’s quality assurance systems were not robust. They failed to identify shortfalls in the care provided. Audits were not used to improve the quality of the service. Policies and procedures were out of date and did not reflect up to date practices.

You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.