Beechwood Lodge is a care home registered to provide personal care and accommodation to 66 older people including people living with dementia. The service has four units; two on each of the two floors. All bedrooms had an ensuite shower and toilet. Two larger rooms were shared rooms, to accommodate couples. All other rooms were single. When we inspected the service there were 62 people living at Beechwood Lodge.

The service had a registered manager in place at the time of our inspection. 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.

We last inspected Beechwood Lodge in October 2017. At that inspection we found breaches of the Health and Social Care Act relating to the deployment of staff and insufficient information provided in people’s care records. The service was rated Requires Improvement. A previous inspection of Beechwood Lodge in January 2017 had also identified breaches and was rated Requires Improvement.

After the last inspection the service sent us an action plan detailing how they would address the issues we raised with them. During this inspection we checked to see how they had progressed. We found that improvements had been made to deploy staff more effectively and to ensure records were accurate and up to date. However, we found further concerns, and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to regulation 17; good governance, as systems to manage the service were sometimes ineffective, and quality assurance systems were not consistently applied. You can see what action we told the provider to take at the back of the full version of this report.

The building was secure, and when we spoke with people who used the service they told us they felt safe. The environment was well maintained, and the staff we spoke with understood how to identify any safeguarding concerns and how to report them. Environmental safety checks were undertaken, and whilst maintenance records were up to date system systems to ensure checks were undertaken in a timely fashion were not kept, leading to a risk that certificates may lapse.

There were appropriate staffing levels across the service and staff were effectively deployed on each unit. Recruitment was safe but we found that recruitment records were incorrectly filed.

We saw that there were systems in place to monitor and manage medicines, and the home was clean. Systems to minimise the spread of infections ensured staff were diligent and maintained a good level of infection control. During our inspection new carpets were being laid with plans to re-carpet all communal areas.

When we spoke with people they told us that the staff knew them well and knew how to meet their needs. Staff were kind and caring, showed knowledge of the people they supported, and people appeared well cared for. Their privacy and dignity was respected. They told us that staff attended to their health needs and responded quickly when they became ill.

We saw plans were in place to support people at the end of their lives, and staff we spoke with demonstrated good knowledge and understanding of people’s needs as they approached death. Further training had been arranged to improve their knowledge and we saw that the service liaised well with other professionals to ensure people were given the right support at this time in their lives.

Care plans provided sufficient information about people’s needs and how to meet them. Daily records and notes showed good monitoring of people’s daily routines and choices. However, reviews of care plans sometimes overlooked changes in people’s circumstances. Similarly, risks were sometimes overlooked, or where a risk

Beechwood Lodge is registered to provide personal care and accommodation for up to 66 older people including people with a dementia. The service had four separate units; two on each floor. It is located in the Norden area of Rochdale and is close to local amenities. When we inspected there were 65 people using the service. All bedrooms had an ensuite bathroom.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection was brought forward following concerns raised about the safety and welfare of the people who lived at Beechwood Lodge. The service was inspected in February 2016 and January 2017. At both inspections it was rated Requires Improvement. At the last inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. This was because medicines were not managed effectively, the service did not record and monitor complaints effectively and the service had failed to make all the required notifications to the CQC. The service had produced an action plan and at this inspection we found improvements had been made in these areas.

However, we identified concerns in other areas. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the deployment of staff and insufficient information to guide staff in care records. You can see what action we told the provider to take at the back of the full version of this report. We also made two recommendations regarding activities and systems to maintain records.

People told us they felt safe and secure at Beechwood Lodge. Precautions were in place to ensure the security of the premises. There were robust systems in place to ensure that when staff were recruited they had the right character to work with vulnerable people, and the staff we spoke with demonstrated a good knowledge of safeguarding and whistleblowing procedures. We observed good interactions between staff and people who used the service, including good and patient support when helping people with mobility.

When we inspected Beechwood Lodge there were twelve care staff on duty , and this number was reflected in the staff rotas we reviewed. However, the layout of the building meant that staff could be away from communal areas whilst they were supporting people with personal care needs. Staff had access to regular training, but when we looked at the induction process we saw that the records did not reflect how new staff were monitored and supervised during their probation period.

We looked around the home and found the communal areas, toilets and bedrooms were clean and free from offensive odours. There was a good standard of hygiene and the home had been awarded a 5 star Food Hygiene rating, the highest available. The home was spacious, well decorated and bright. Furnishing were modern and in very good condition. There was a stained carpet in one area and the manager told us that an order for a new carpet had already been placed.

Staff we spoke with were able to demonstrate a good understanding of mental capacity and consent issues, and where people were unable to consent to care and treatment at Beechwood Lodge the service had sought appropriate authorisation to provide support.

People told us the staff were caring and friendly, and we observed good interactions between staff and people who used the service. One person told us, “They don’t force themselves on us, but they are there when we need them. All the staff are good and kind”.

Whilst the service employed an activity co-ordinator, we

Beechwood Lodge is a large detached property in its own grounds. Accommodation is provided over two floors and divided into four separate suites. The upper floor can be accessed via a passenger lift. The service provides accommodation and personal care for up to 66 older people, some of whom are living with dementia. At the time of our inspection there were 63 people living at the home. This was an unannounced inspection which took place on the 18 and 20 January 2017. The inspection was undertaken by two adult social care inspectors, a pharmacist inspector and an expert by experience.

The service was last inspected in February 2016. During that inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This resulted in us making three requirement actions for; medicines not being managed effectively, recruitment procedures were not robust enough to ensure people were protected from unsuitable staff and staff had not received all the induction, training and supervisions necessary to enable them to carry out their duties effectively. Following the inspection the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made. We found that improvements had been made and two of the requirement actions had been met.

However during this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. This was because medicines were not managed effectively, the service did not record and monitor complaints effectively and the service had failed to make all the required notifications to CQC.

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

Staff had received appropriate training in the safe handling of medicines and had regular assessments of their competency. We found that protocols were not always in place to guide staff on administration of as required medicines and staff did not always record when these had been administered. Routine checks of stocks of some medicines were not carried out. Records were incomplete and body maps were not always completed to guide care staff when and how to apply topical creams. One person had not received their pain relief as prescribed.

We saw evidence that complaints had been responded to, but the service did not operate an effective system for recording and monitoring complaints.

The service had not notified CQC of all events they are required to. They had notified CQC of safeguarding concerns, serious incidents and events but had not notified CQC when DoLS authorisations were authorised.

The service is required to have a registered manager in place. There was a registered manager in place at Beechwood Lodge. 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. The registered manager was present during this inspection. Most people were positive about the registered manager, the service and the way it was managed.

The home was very clean, tidy, brightly decorated, well maintained and well furnished.

People told us they felt safe living at Beechwood Lodge. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. Staff were confident the registered manager or the provider would deal with any issues they raised.

Recruitment procedures were in place which ensured staff had been safely recruit

This was an unannounced inspection, which took place on 11 and 12 February 2016. We had previously inspected this service in May 2015. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to failure to manage medicines safely. This resulted in us making one requirement action. Following the inspection in May 2015 the provider wrote to us to tell us the action they intended to take to ensure the regulation was met.

At this inspection we found that improvements had been made. However, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines such as eye drops and creams were not always dated on opening. This is necessary to ensure medicines remain effective. There was one month when there was no record of audits to ensure that people who used the service were receiving their medicines. There were not robust recruitment procedures in place and staff did not always receive the induction, training and support they needed to carry out their roles effectively.

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

Beechwood Lodge is a purpose built service, which is registered to accommodate up to 64 people who have personal care needs. The service is divided into four units on two floors. At the time of our inspection there were 62 people living at Beechwood Lodge.

Systems for recruitment of staff were not always safe. In two staff files we found gaps in staff previous employment history had been identified, but there was not a written explanation of the reason, as required by law. This meant people were at risk of being cared for by unsuitable staff. Staff felt supported but we found three instances of newly employed staff not being given the formal induction needed to carry out their roles effectively, although the manager told us they had shadowed an experienced member of staff for two weeks.

People received their medicines as prescribed. Since our last inspection improvements had been made in the way medicines were managed. We saw medicines management policies and procedures were in place to guide staff on the storage and administration of medicines. We found that protocols were in place to guide staff on administration of “as required” medicines.

People told us they felt safe at Beechwood Lodge. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

The service did not have a registered manager. The current manager was in the process of applying to the Care Quality Commission (CQC) to become registered. A service cannot be judged as good in well-led if there is no manager registered with the CQC. 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. A new manager had been in post since December 2015.

During our inspection, we observed that call bells and requests for assistance were answered promptly and there were sufficient staff to meet people’s needs. Staffing levels had recently been increased. Despite this increase in staffing provision some people we spoke with thought that at times there were not enough staff available to support people promptly. The service did not have a formal system in place for assessing staffing levels.

People told us the staff were caring, kind and that they were well cared for. During the inspection we found the manager and staff to be c

Beechwood Lodge is registered to provide personal care and accommodation for up to 64 older people including people with a dementia. It is located in the Norden area of Rochdale. This was the first inspection since the home was registered with the Care Quality Commission (CQC). The inspection was an unannounced inspection and took place on 12 May 2015. There were 34 people living in the service at the time of our inspection.

The home had 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.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm. Staff said they would report poor practice and felt confident that the registered manager would take appropriate action. We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We saw that the systems in place for the management of medicines did not properly protect people who used the service. Care plans lacked guidance for staff to follow about when people should be given medicines prescribed to be taken ‘when required.’

The home was clean and appropriate procedures were in place for the prevention and control of infection.

Members of staff employed at the home had previous experience of caring for older people. Records kept by the registered manager identified when each member of staff required further training in order to ensure they were kept up to date with current practice.

Members of staff had been trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

People were offered a choice of menu at mealtimes. We saw that hot and cold drinks and snacks including fresh fruit were available throughout the day. People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

People who used the service told us they liked living at the home and received the care and support they needed.

People were supported by staff to make decisions about their care and daily routine. Leisure activities were also organised at the home including bingo and pamper days.

A copy of the complaint’s procedure was displayed in the home and included in the service user guide. There had not been any complaints made to the CQC or the local authority since the home was registered.

Members of staff told us they liked working at the home and found the registered manager approachable and supportive.

We saw that systems were in place for the registered manager to monitor the quality and safety of the care provided.

We found there were systems in place for assessing and monitoring the quality of the service provided.