Beechwood Gardens is registered to provide accommodation and personal care for up to 30 people. The home provides a service for older people living with dementia. There were 12 people living at the home on the day of our inspection visit. Seven people lived at the home permanently and five people were staying at the home for a short period following time spent in hospital.

We inspected Beechwood Gardens on 31 May 2017. The inspection was unannounced. At our previous inspection in February 2016 the service was in breach of Regulation 9, Personal Care, of the Health and Social Care Act 2008 because people were not receiving choice about their food or activities. Following our inspection the provider sent us a plan of how they would improve the choices people receive. At this inspection we found that improvements had been made and the provider was meeting the legal requirements.

There was a registered manager in post at the 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.

People, their relatives and staff said Beechwood Gardens was a safe place to live. Staff understood their role in keeping people safe and for reporting concerns about abuse or poor practice within the home. There were systems and processes to protect people from risk of harm. These included a risk management process, a thorough staff recruitment procedure and an effective procedure for managing people's medicines.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards DoLS). Staff had completed training in the MCA and understood how to support people to make decisions about their daily lives. Where people lacked capacity to make decisions about their care, decisions had been made in the person's best interests.

People told us staff were friendly and caring. Throughout our visit staff showed people kindness and treated people with respect. People were treated as individuals and were encouraged to make choices about their care. Staff protected people's privacy and dignity when providing care.

Staff had up to date information about people's care and a good understanding of people's needs and preferences. People's care records contained individualised information about how people liked to receive their care.

There were enough suitably trained staff to keep people safe and to meet people's needs. Staff received the training and support they needed to meet people's needs effectively. All staff had been trained to understand dementia so they could interact effectively with people living in the home.

People's health needs were monitored and people were referred to healthcare professionals when a need was identified. There were processes to ensure people's nutritional needs were met and people had enough to eat and drink during the day.

Visitors were welcomed and relatives and friends could visit at any time. There were processes in place for people and relatives to express their views and opinions about the home. People and relatives told us they were listened to and were confident they could raise any concerns with staff and the managers.

People told us they were happy with their care and had no complaints about the service they received. People who lived at the home, relatives and staff said the home was well managed. There were systems in place to monitor the quality of the service. This was through feedback from people and their relatives, staff meetings and a programme of checks and audits.

This inspection took place on 1 and 4 February 2016 and was unannounced.

Beechwood Gardens is a care home which provides residential care for up to 20 people who live with dementia. During our inspection there were 17 people who lived at the home. Bedrooms were on the ground and first floor and there was a combined lounge and dining area on the ground floor which was split into two areas for people with differing stages of dementia.

The home had a registered manager in place. 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.

Most staff ensured they maintained people’s privacy and dignity and treated people with compassion and respect. However, we observed two occasions where this was not the case.

Weekly menus were planned that met people's nutritional needs however people did not always have a choice of meals.

The service was not consistently responsive to people's needs. Although people's choices were respected and listened to, people who had difficulties communicating had limited stimulation and opportunities for their social care needs to be met.

Background information about people’s interests and preferences was recorded but was not always included in people’s daily care. This meant there were people who did not experience person centred care.

People we spoke with told us they liked living at the home and felt safe. There were sufficient numbers of staff to meet people's needs on the day of our visit. New staff went through recruitment checks to ensure their suitability prior to working with people in the home.

People received their medicines as prescribed and checks were undertaken to ensure they received them in a safe way.

Mental capacity assessments were completed when needed and specified the nature of the decision the person was being asked to make. This demonstrated that the provider was following the principles of the Mental Capacity Act (2005). When people had a DoLS authorisation in place for continuous monitoring, it was reviewed within the specified time frame to ensure that people were not being deprived of their liberty unlawfully.

Individual risk assessments were completed and reviewed regularly to help prevent avoidable harm to people who lived in the home.

People were supported to maintain relationships with people important to them.

There was a system to record complaints and people told us they felt able to approach the manager if they had any concerns.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited Beechwood Gardens on a weekday morning and spoke with staff and people who lived there. We looked at records and observed interactions in the home. Four people remained in their rooms. We visited one person in their room and looked at the care given to them. Other people spent much of the time in the two linked communal areas. There was always at least one staff present in the communal area. Staff supported and spent time with people on an individual basis or organised group activities. We noted how engaged and stimulated a number of people became when taking part in a ball throwing game with a member of staff at one point in the morning.

We saw staff being attentive to people’s needs throughout our visit. There was much personal attention and reassurance being given to people. Staff showed a good knowledge of individual needs and how to best meet them.

We spoke with two relatives and a visiting health professional. They were very positive about the service. One person told us they were “More than happy with the care.” Another person said “They manage the care very well.”

We visited the home without advance notice. We observed interactions and the care and support being offered to people who lived at the home, and spoke with six people who lived there. These people’s views were coloured by their dementia but the comments they gave, as well as their general well-being, indicated they felt well-supported and cared for. “Oh yes” was a typical response when we asked people if they liked the food, the staff and the home.

We spoke with the manager and three of the staff on duty. Staff demonstrated a good awareness of people’s needs and how to meet them.

The owner also visited while we were at the home and we spoke with them. We spoke with the relative of one person at the home, who told us they were happy with the care, but was not so happy about laundry items being lost.

We also spoke with a visiting health professional, who was impressed by the home’s “Responsible” attitude and the “Extra effort” that staff and management put in to ensure people were well looked after. The home was clean and free from unpleasant odours. People were well-groomed and interacted positively with each other and staff.

Although most people did not comment directly on the quality of care, their general demeanour indicated they were content and comfortable. The home has a friendly, homely air, with lots of smiles, and a warm, friendly, respectful, atmosphere and ethos. Staff and relatives commented favourably on the personal individual nature of the home; ‘It’s more like a home than an institution,’ ‘People are treated as individuals.’ One resident said ‘It’s calm here – I like it,’ adding ‘everyone is very kind.’