This inspection took place on 21 and 24 May 2018 and both days were unannounced. The service was previously inspected 6 February 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. They sent us a review of their action plan in October 2017 to show us the progress they had made to complete the necessary actions.

Beechwood 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 care home accommodates 22 people in one building.

There was a registered manager in post but they were absent from the service at the time of the inspection. 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 told us they felt safe living at the home. Staff we spoke with were knowledgeable about safeguarding people and could explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans were in place to reduce the risks and ensure people’s safety. Personal emergency evacuation plans lacked some detail in relation to evacuating people in the event of a fire. Night time staffing levels were a concern and there was no system in place to accurately determine staffing levels.

Environmental checks had not been completed robustly, although the provider had plans in place to recruit additional maintenance staff to improve this. Refurbishments were taking place and the provider was working towards improving the safety of the home in the event of a fire.

Medicines management had improved since our last inspection and there were systems in place to monitor this. We saw people received their medicines in a timely way from staff who had been trained to carry out this role. People managed their own medicines where they had been assessed to do this safely and staff competencies had been assessed in line with good practice.

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. The manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had regular reminders about the principles of the Act and the peripatetic manager had worked hard to enhance staff knowledge to ensure people’s human rights were protected.

Menus had been planned with people at the home to improve their choice and plans were in place to ensure the availability of fortified snacks for people to take without the need to ask during the day. People were sensitively supported at mealtimes, which were a relaxed and enjoyable experience for people at the home. Some improvements in records relating to people’s food and fluid intake was required and the registered provider acted immediately to rectify this.

Staff interacted with people with warmth and respect and we saw the atmosphere in the home was friendly and supportive. Staff were able to spend time chatting and laughing with people.

People felt able to raise any concerns with staff which was an improvement from our last inspection where we found concerns and complaints had not been acted upon.

The provider was in the process of changing all care plans to provide better guidance for staff. Care plans which had not been updated contained person centred information but the sheer volume of records made it complicated for staff to read.

The home had not be

The inspection of Beechwood took place over two days, 6 and 8 February 2017, both of which were unannounced. The previous inspection had taken place in July 2014 and the home was rated good overall with requiring improvement in the safe domain due to a lack of staff. During this inspection we looked to see if improvements had been made.

Beechwood provides accommodation and nursing care for up to 26 adults with a physical disability. It is located in a large house with an accessible garden. On the days we inspected there were 19 people in the home.

There was a registered manager in post who had been with the home since 2002 and they were available both days of the inspection. 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 said they felt safe and staff had an awareness of what may constitute a safeguarding concern. Concerns were reported appropriately.

There were still concerns with staffing levels as evidenced during the previous inspection. This meant people were not always able to have a shower or bath when they wished or participate in their preferred activity. Call bell data was not available to look at response times but we saw continued discussion in residents’ meeting minutes and from what people told us that staff were continually busy. There was no evidence staffing was based on the needs or dependency levels of people using the service which meant people’s experiences were sometimes poor.

Risk assessments were in place but did not always address the area of risk identified, such as entrapment or suitable equipment provision. One person had been noted as at risk of falls so had specialist mobility equipment but this had not been considered in relation to their personal care needs.

Medication was recorded and administered in line with requirements but there were minor issues with storage of creams.

The environment needed considerable updating and the home was due further re-decoration.

People’s dining experience was varied with some liking the food but others saying the choices were poor. This was after the menus had been changed to accommodate people’s preferences. Staff did support people to eat and drink but not always in the most sensitive manner, by standing next to them and not engaging with people.

Staff had not received regular supervision and there were significant gaps in training received. Some of this was due to changes in Head Office but it meant staff had not received the current guidance for the day to day support of people in the home.

Knowledge of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards was poor as people were not accurately assessed in relation to their levels of capacity.

People spoke with us about the lack of choice in relation to care staff, especially in regards to gender and cited some examples of practice which lacked empathy.

Activities were organised for people on a group and individual basis but relied heavily in the input of volunteers as staff did not have time to spend with people. There was a range of activities and people we observed seemed to enjoy them.

Care records were person-centred and written in conjunction with people who helped determine how they wished to receive support.

Complaints were not handled well as low level concerns were not logged, and people told us they had not received acknowledgement or outcomes of concerns they had previously raised.

We found mixed views as to people’s experience of living at Beechwood, some people liked it and others felt it was too institutionalised. There appeared to be a lack of overall quality scrutiny and improvements focused solely on the environment, rather than quality of care provision. Ma

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced.  At the last inspection in September 2013 the home met all regulations and there were no breaches found.

Beechwood Care Home provides personal support and nursing care for up to 26 adults with a physical disability. There were 24 people resident on the day of the inspection. A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff were kind and caring and there were positive relationships with people . We saw friendly banter and evidence that staff knew people well. However, there were not always enough staff to be able to promptly attend to people’s needs.

People had access to their own care records as they kept these in their rooms and we saw they  were written in a person-centred way. People were consulted about their care plans and they contributed to the content of them.

Relatives spoke highly of the service and said they found the staff and management team responsive and approachable. People said they felt staff cared about them and listened to their views.

People who lived at the service were encouraged to voice their opinions about their care and treatment and they spoke freely with positive comments. Feedback was actively sought from people and relatives to help improve the quality of the service.

People told us they felt safe and they felt their freedom was supported and respected. The registered manager and senior staff were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

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

At the time of our inspection there were twenty five people living at the home.

We spoke with three staff, including the manager and three people who used the service.

We found there was enough permanent qualified, skilled and experienced staff to meet people’s needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

At the last inspection on the 3 April 2012 we noted that a number of areas throughout the home were in need of redecoration/ refurbishment and this included several bedrooms and corridors which had areas of dampness. The provider had an action plan as to when they would address the environmental issues and had already started work on making improvements. The action plan included painting communal areas, replacement lighting, refurbishment of bedrooms and a bathroom, along with changing the manager’s office back into a lounge.

Following our inspection on the 3 April 2012, we met with the provider and agreed that although the Care Quality Commission (CQC) found the outcome area to be compliant, we would continue to monitor the progress of the refurbishment and redecoration programme and would visit later in the year.

At this inspection we did not attempt to speak with people who use the service because the visit was to check compliance of the safety and suitability of the premises and not care practises. However one person told us they had chosen the colour of their bedroom and carpet and expressed their appreciation that they were encouraged to do this.

We carried out this inspection to check on the progress of the compliance actions we made at previous inspections carried out on the 14th November 2011 and the 29th February 2012.

People told us that they were happy living at Beechwood. One person spoke about being a dignity champion and how they work with staff to help maintain people’s dignity. An example of this was when a person had dropped something on their clothing and the dignity champion said that they had informed the staff, and this meant the person was assisted to change their clothing in a timely way whilst maintaining their dignity.

One of the people spoken with said they had chosen the colour in their room. They also were aware that the corridor and the communal rooms would be repainted.

People told us that they were happy living at the home, and although they mentioned the use of agency staff we saw evidence to suggest that the same staff were used to provide continuity of care and that the use of agency staff has now been replaced by more permanent staff.

The purpose of this inspection was in response to a concern received by the Commission and to check that the home was being managed properly and there were sufficient staff on duty.

We also visited the service on the 14th of November 2011, when further compliance actions were made, and we will follow these up in the near future.

We will also consult with people further at that monitoring visit to ensure their needs are being met.

People were very positive about their experience of living in Beechwood. They said that staff are good. However, people are not involved in and supported in their care in a way that upholds their dignity and empowers them. One person said how people keep saying how lucky they are to be at Beechwood.

Many people commented on the food.” If I wake in the night and want a cup of tea I can have one” “The food is great” People said they had a choice and if they did not like the food they could have something else.

Many people said they took part in activities and any outings and enjoyed them. Others said that they would prefer more choice in activities.

We decided to visit the home between 6pm and 11pm to gain a wider view of the service provided. This was part of an out of normal hour’s pilot project being undertaken in the North East region.

Following the initial evening visit, we also returned to the service the morning of a second day. This was because some of the information we required to make our judgments, was not accessible at the evening visit.

At the time of our inspection we talked with five people who used the service, two relatives and five staff.

Comments from people who used the service about the care they received included:

“The staff here is are A1. It is unbelievably good and we are well looked after.”

“If I had any concerns I would know who to talk to. I would go to the manager and he would sort it out.”

“We get good care, 24 hours a day.”

“(The Manager) keeps people up to date. There have been lots of changes since he has come, which have been good. He keeps it clean. He is hands on.”

“I am really settled here. I have a laptop in my room and the internet.”

“Don’t use much agency staff.”

People also told us that during the day there were plenty of staff on duty however, in the evening the staffing levels were reduced and sometimes people had to wait longer for assistance.