This inspection was undertaken on 31 October and 02 November 2018 and was unannounced which means the provider did not know we were coming. At our last inspection in February 2016 we rated the service as Good in each area and Good overall. Following this inspection, the rating of Good overall remains. We have however changed the rating of the safe question to Requires Improvement.

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.

Beechwood accommodates up 38 people in one purpose build building across four separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. There were 28 people living at the home at the time of the inspection. This was because one unit was closed for refurbishment.

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 were supported to have their medicines and checks were undertaken to ensure these were administered as prescribed. Some creams left unsecured were removed once we brought this to the attention of staff.

Infection control procedures were in place although there were incidents when these were not always met which could potentially place people at risk.

Due to recent staff shortages the permanent staff were supported by agency staff. The provider had held recruitment drives to cover the vacancies. They were determined to recruit the right staff to ensure they could care and meet the needs of people who live at the home. Checks were made on the suitability of staff.

People were cared for by the staff who had knowledge of how to keep people safe and what to do if they believed people to be at risk. People’s wishes were taken into account to ensure people’s preferred life styles were met.

People’s needs were assessed before they moved into the home and these were reviewed as to ensure they could be met. Healthcare professionals were involved in people’s care and support so decisions could be made about their needs. Staff ensured people had enough to eat and encouraged people to drink. People were complimentary about the food provided. Where concerns were identified these were brought to the attention of healthcare professionals.

Staff were supported by their managers and received the training they needed to provide the care and support people required to keep them safe and maintain their wellbeing.

People were supported to have maximum choice about their lives and were supported in the least restrictive way possible. Staff spent time with people talking about important things in their life and had developed a caring relationship. People were encouraged to make decisions about their day to day life. People’s privacy and dignity was respected.

People were encouraged to take part in fun and interesting things while at the home. People were confident their views would be acted upon.

The provider was working to make improvements in the home in areas such as staffing as well as in refurbishment.

We undertook an unannounced comprehensive inspection on 29 February 2016. Beechwood Residential Care Home offers accommodation for up to 38 older people. The home also provides accommodation for people with physical disabilities, sensory impairment and dementia. There were 33 people living at the home at the time of our inspection, including people who were staying at the home for a short time. People had the use of a number of comfortable communal areas, including kitchens and dining areas, lounges, gardens and areas where people could spend time doing things they enjoyed. People had their own rooms.

A registered manager was in post at the time of our 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.

We carried out an unannounced comprehensive inspection of this service on 20 May 2015. One breach of legal requirement was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the safe care and treatment of people living at the home. The provider told us action would be taken by June 2015. During our inspection on 29 February 2016 we found the provider had followed their plans and now met legal requirements. We found actions had been taken to further develop the safety of the physical environment, including the installation of keypads to external doors at the home. Checks were also undertaken on the security of the exterior of the home. Systems had been put in place to initially and continually assess the needs of people living at the home, so plans could be put in place to care for people in ways which promoted their safety.

Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People managed risks to their safety with support from staff. Staff were trained in recognising and understanding how to report potential abuse. We saw there were enough staff to care for people and meet their safety needs. People were supported by staff to have their medicines, and there were systems and checks in place to promote people’s safety around medicines.

Staff had received training and understood people’s individual care needs so they would be able to care for people in the best way for them. People’s rights and freedoms were respected by staff. Staff encouraged people to have things they enjoyed to eat and drink so they remained well. People’s health was monitored and there were good links with health and social care professionals and staff sought and acted upon advice received. People had regular access to healthcare professionals and told us staff acted quickly when they asked for help to maintain their health.

Staff had developed caring relationships with people living at the home and people enjoyed chatting to staff. People were encouraged to make decisions about their daily care and staff respected the choices people made and recognised people’s need for independence. Staff considered people’s need for privacy and dignity in the way they looked after them.

People had developed plans for their care with support from relatives, staff and other professionals where needed. Plans were regularly reviewed and care adjusted as people’s needs changed. People had opportunities to do things they enjoyed both within and outside of the home, and were encouraged to let staff know further things they would like to do. People were supported to keep in touch with relatives and friends who were important to them. People knew what to do if they needed to make a complaint or raise a concern and staff knew how to support people to do this. There were systems in place so if a complaint was made prompt ac

The inspection was unannounced and took place on 20 May 2015.

Beechwood Residential Home is registered to provide accommodation and personal care for a maximum of 38. There were 33 people living at home on the day of the inspection. There was 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.

In response to a serious incident in April 2015 the provider was working with external agencies to make changes to the environment and internal procedures to reduce the risk to people’s safety. These changes will need to be reviewed to ensure they were effectively managing people’s safety.

People told us they felt safe and well cared for and there were staff available to meet their needs. Staff told us about how they felt they kept people safe and help reduce their risks. We saw that staff were available to meet people’s care and social needs and spent time in communal areas of the home. People got their medicines when they needed them and as prescribed. Medicines were stored and staff knew how which medicines needed to be monitored or changed.

People told us the staff knew them well and understood how to look after them. Staff felt the training reflected the needs of people who lived at the home and had provided them with the skills required.

People had been able to choose their care and treatment and were supported to make decisions if they had not been able to do this on their own. They were supported by relatives, staff and other health professionals. Where restrictions had been placed on people, the provider had followed the correct procedure.

People enjoyed the food and where needed staff supported them to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. Staff had been understanding and supportive of people’s choice and decisions. People had been involved in the planning of their care.

People told us they had plenty of things to do during the day and said that they also spent time in the garden or out on planned trips. People told us that if they had comments or concerns that they would raise these with care staff.

The provider and registered manager made regular checks to monitor the quality of the care that people received and look at where improvements may be needed. However, we found that improvements were needed to ensure recent changes were reviewed and the provider reflected on the impact the changes had made on people’s care.

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

During our inspection we spoke with four people who lived at Beechwood Care Home about their experiences of the care and support that they received. We also spoke with two members of staff and the deputy manager.

All the people who lived at the home that we spoke with told us that they were supported when they made day to day decisions about the care they received. People's values and diversity were respected and promoted. For example, people told us that they chose the times they wanted assistance or support. One person told us: "They (care staff) do the care for you where you need it, they are there at your side.”

It was clear from what we saw on the day of our inspection that staff knew people’s social and health care needs. This was demonstrated in the individual support people received from staff. What we saw matched the care plans that were personal to each person and written with and for people who lived at the home. One person who lived at the home told us: “I have every faith in the care I am getting here.”

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This made sure people’s health needs were effectively met.

We saw that the provider had effective systems in place that made sure staff training was planned and delivered including dementia awareness. This meant staff knew how to provide care and support to people with dementia care needs.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary. One person who lived at the home told us: “Very happy and contented person because I live here. Better than living on my own.”

Thirty-five people lived in the home when we visited. We talked with some of them about their experiences of living there on the day of our visit.

Some of the people that lived in Beechwood Care Home have dementia and therefore not everyone was able to tell us about their care. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our observations we saw that there were good relationships between the staff and the people that lived in the home. Staff were mostly friendly and respectful when speaking with people. We saw that staff offered people assistance with their personal care discreetly. Staff offered people choices during the day these included, how they wanted to spend their time.

Many of the people we spoke with were happy with the quality of the care provided. They said, ‘’The girls do what they can and try their best’’ and ‘’I am very happy and certainly enjoy my time here.’’

We observed lunch being served to people during our visit. Staff were seen to offer people choices of where they would like to eat their meal and assistance was provided at people’s own pace. Many of the people who lived in the home who we spoke with told us that they were happy with the meals provided at Beechwood Care Home. They said, ‘’Meals are good really, menus on the table for us to choose’’ and ‘’Very good choices’’.

One person told us that if they needed extra support or if they needed to see a doctor, staff arranged this quickly.

All of the people who lived in the home that we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to. One person who we spoke with told us, ‘’This is a safe place and I like it here.’’

This visit took place to review what improvements had been made following us serving a Warning Notice in August 2011, as the home was not meeting people’s care and welfare needs in relation to the management of medicines.

We were told that systems had improved and the staff team were working together to make sure people were being given their prescribed medicines.

We saw one member of staff giving a person their medicines with care and patience. We spoke with the member of staff who was knowledgeable and understanding about the person’s medicine requirements.

We did not speak directly to people about their medicines.

We found that people were protected against the risks associated with the unsafe use and management of medicines by means of making appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines.

This visit took place to review what improvements had been made following us serving a Warning Notice in August 2011, as the home was not meeting people’s care and welfare needs.

When we visited the service we spoke with people who used the service in all four units of the home. We asked people about their experience of the care and they told us, we ‘get all the help needed’. ‘If you ask they will do anything’. ‘They keep me very clean’. ‘You only have to ask for something and it’s done’. ‘Very good they are’.

‘Nothing to grumble about’. People told us that the care had improved since our last visit; they said that before the changes ‘it was a case of when I could have a bath not when I wanted it’. Now ‘I have a bath and hair wash when I want it’. ‘More people are bathing regularly’. We asked people if they felt safe living at the home and they told us, ‘yes very nice, lovely people’. ‘I have been content from the day I came’. We saw that people were neatly dressed in clean clothes and had clean glasses, hair and nails, indicating that staff knew the importance of helping people look their best.

We saw that staff interacted with people who used the service in a friendly, courteous and respectful manner at all times. We saw care workers supporting people to move around in a kind and caring way and encouraging people to maintain their independence.

People told us the food was ‘very good’. ‘Quite reasonable’. They told us they had enough choice and had ‘more than enough to eat’. You ‘can’t fault it’. One person told us the food was ‘better than it was, but mixed, but they do not get enough fruit’.

We saw staff asking people for their choice of meals for the next 24 hours. We saw that people were able to order a cooked breakfast; they had a choice of main course, sandwich fillings and were also offered a snack at supper time, such as cheese and biscuits. We saw baskets of snacks were available in each unit and that people had access to a drink either in their room or in the lounge.

People told us the staff were ‘very kind’. ‘Can’t speak too highly of the staff’. The ‘everyday carers are lovely’. ‘Mostly will do all they can for us’. The ‘care staff are my friends’. The ‘new managers are on the floor, you see them about. They are accessible’. One person told us that ‘some staff are good but some agency staff aren’t very good and don’t know how I like things done’.

Improvements have been made to the care experienced by the people who use the service, through better communication, assessment and care records. Some further improvement is needed to ensure that information is available for all staff to ensure that people receive appropriate and consistent care at all times.

We did not speak directly to people about their medicines.

We found that people were given the choice to look after their own medicines if they were able and wished to do so. We were told that support systems and procedures were in place to ensure people were safe from harm.

We found arrangements for the storage of people’s medicines had been improved.

We found that systems were not always in place to ensure that prescribed medicines were available to give to people and to ensure that people had been given their medicines as prescribed.

When we visited the service we spoke with people who use the service in all four units of the home. We asked people about their experience of the care and they told us ‘we get all the attention we need’, and they ‘look after us well’. We saw that people were neatly dressed in clean clothes and had clean hair and nails, indicating that staff knew the importance of helping people look their best.

People told us the food was ‘very good, very nice’, ‘what I have I enjoy’, it’s the ‘sort of food I like’. They said for breakfast you ‘can have cereal, bacon and egg, and sometimes sausages’. People told us they had plenty to eat and one person said ‘if I needed more I would say so’. We saw staff offering people a drink and biscuits mid-morning and there were snack baskets in each lounge with food items for people to help themselves to if they were hungry between meals.

We saw that staff interacted with people who use the service in a friendly, courteous and respectful manner; although on one unit staff were calling people ‘darling’ and ‘sweetheart’, which may not be their preferred form of being addressed. We saw that staff showed a patient and caring attitude to people when assisting them with their medication, and when supporting people with their mobility.

We found that people’s care records were not up to date, which meant people may be at risk of not receiving appropriate care and support.

The safe handling of medicines was assessed by a pharmacist inspector. One person told us they got very upset when their medication was not available when they requested it from the care staff each month. They told us they were of the opinion that the management of medication by the home was very disorganised. We found that systems were not in place to ensure that prescribed medicines were available to give to people. Medicine administration records were not always clear or complete, which increased the risk of a medicine error. We found that people were given the choice to look after their own medicines if they were able and wished to do so; however support systems and procedures were not in place to ensure people were safe from harm.

In the entrance hall of the home there was a strong smell of stale urine, which may be unpleasant for the people who live there and for people visiting the home, and a source of cross infection if spillages were not being managed appropriately.

People told us the staff were ‘very nice’, ‘all very kind’; ‘they do a really good job here’. People said they were ‘nice friendly people’, ‘they’re all good, so kind to me’, they were ‘very considerate’, they ‘felt very safe’ and had ‘no complaints’.

This visit found significant concerns about the care and welfare of the people who use the service. Due to these concerns we have referred the service to the safeguarding team at Worcestershire County Council.