This announced inspection took place on 22 June 2018. The service was last inspected in July 2017 when we found breaches of two regulations relating to fit and proper persons employed and good governance. The service had taken action to address the issues regarding staff employed, but had failed to address our concerns around governance. We had also made two recommendations, about end of life care and supporting people with their healthcare needs. The service had not followed our recommendations.

When we completed our previous inspection in July 2017 we made a recommendation about supporting people to plan for the end of their lives. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is now included under the key question of Responsive.

Beechwood Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Beechwood Residential Home is a terraced house where adaptations have been made to give one bedroom en-suite bathroom facilities. Beechwood Residential Home can accommodate up to five people, at the time of our inspection four people were living in the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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.

During the inspection we found medicines information, care plans and risk assessments had not been kept up to date and were missing important information about how to support people in a safe way. The registered manager updated the records during the inspection to ensure information was available to all staff involved in providing support to people.

Staff had information about how to prevent and control the risk of infection, and had access to personal protective equipment to support them to mitigate the risks. However, bathrooms had not been appropriately maintained to fully mitigate the risks. The provider had not identified the style of window restrictor in use could be over-ridden.

There were enough staff working in the service to meet people's needs and they had been recruited in a way that ensured they were suitable to work in a care setting. Staff received the training and support they needed to perform their roles.

People were supported in line with the principles of the Mental Capacity Act 2005. The provider had submitted requests for appropriate authorisation to deprive people of their liberty. However, they had not notified us when these had been granted.

People were supported to access healthcare services. However, records were not well maintained and staff had not consistently recorded monitoring information about people’s health, or escalated when people’s information changed.

Care plans contained information about people’s preferences and goals.

People were supported to attend a range of activities and other services. We saw staff from the home liaised with other services supporting people.

People were supported to be involved in choosing the menu and records showed they were supported to eat a balanced and varied diet.

People had developed positive relationships with sta

The inspection took place on 12 July 2017 and was announced. The provider was given 48 hours’ notice as the service is a small home and people are often out during the day. We needed to be sure someone would be in.

Beechwood Residential Home is a five bedroom care home for adults with learning disabilities. It is based in an adapted house in a residential area. At the time of our inspection four people were living in the home.

The home was last inspected in May 2015 when it was rated ‘Good.’

The service did not have 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. The previous registered manager had left in November 2016. The provider was in the process of recruiting a new registered manager.

People’s care plans and risk assessments were detailed and personalised. There was detailed information about people’s communication and preferences within the care plans. Care plans and risk assessments had been reviewed annually. However, parts of the care documentation had not been updated and there were discrepancies including about people’s end of life wishes.

People told us they felt safe in the home. Staff were knowledgeable about safeguarding adults from harm. Incident records showed the provider had taken appropriate action when incidents happened.

Recruitment records did not show staff had been recruited in a safe way.

Staff received the training and support they needed to perform their roles.

The home supported people to take their medicines. The home completed regular audits of people’s medicines to ensure they were correct. However, the home was not always following the prescriber’s instructions for when medicines should be taken.

The home was working within the principles of the Mental Capacity Act 2005. Where people lacked capacity to make decisions appropriate best interests processes had been followed. Staff supported people to make their own choices where they were able to do so.

People told us they liked the food. The home encouraged people to be involved in choosing the menu and supported people to eat a healthy, balanced diet in line with their preferences.

Records relating to people’s health and the support they needed to access healthcare services was old and out of date. They had not been updated since 2015.

People and staff had developed strong, caring relationships with each other. Staff supported people to maintain their dignity and respected their privacy.

Care plans contained details of people’s religious beliefs and people were supported to practice their faith if they wished to do so.

People were supported to maintain their friendships and relationships. Care plans considered people’s sexuality and their support needs in relation to their sexuality.

People attended regular one-to-one and house meetings where staff listened to and responded to their feedback about the service. The home had a complaints process in place that was accessible to people who used the service.

The provider had not identified that health and safety checks were not being completed as required, or that some records were no longer being maintained. The provider had not identified that some information in staff and care files was out of date, incomplete or inconsistent.

We found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we asked the provider to take at the back of the full version of this report. We also made two recommendations about supporting people to have their healthcare needs met, and identifying and recording people’s end of life wishes.

We carried out an unannounced comprehensive inspection of this service on 27 October 2014, at which breaches of legal requirements were found. This was because the service did not have systems in place to reduce the risk of financial abuse or monitor the quality of care and safety at the service. We also found the service did not have effective systems in place for managing medicines. The complaints procedure was not accessible to people that used the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 20 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topisc. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ Beechwood Residential Home’ on our website at www.cqc.org.uk’

Beechwood Residential Home is registered to provide care and accommodation for up to six adults with learning disabilities or autistic spectrum disorder. Four people were living at the service at the time of our visit.

The provider had recently appointed a new manager to the service. They are not currently registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

At our focused inspection on the 20 May 2015 we found that the provider had followed their plan which they had told us would be completed by the 30 April 2015 and legal requirements had been met.

Systems were in place to protect people from the risk of financial abuse. Medicines were managed safely.

People were supported to eat sufficient amounts of food and they had a choice over what they ate.

The service had appropriate complaints procedures in place and people told us they knew how to raise any concerns they had.

The service had systems in place for monitoring the quality of care and support provided. Some of these included seeking the views of people that used the service.

The inspection took place on 27 October 2014 and was unannounced. At the previous inspection of this service in February 2014 we found the provider had not met all the regulations we checked. This was because staff were not properly supported with supervision and appraisals and medicines was not properly recorded. The provider sent us an action plan detailing what steps they were going to take to address these issues and stated that issues would be addressed by 1 April 2014. At this inspection we found that staff received supervision and appraisals but the service was still not managing medicines safely. You can see what action we told the provider to take at the back of the full version of the report.

Beechwood Residential Home is registered to provide care and accommodation for up to six adults with learning disabilities or autistic spectrum disorder. Five people were living at the service at the time of our inspection. A condition of the service’s registration is that it has a registered manager in place, however, the service has not had a registered manager in place since December 2012 and so were in breach of the conditions of their registration. 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 people said they felt safe living at the service. Risk assessments were in place which set out how to support people in a safe manner. The service took steps to support people that exhibited behaviours that challenged the service. Appropriate safeguarding adults procedures were in place and staff understood their responsibility with regard to safeguarding adults. There were enough staff working at the service to keep people safe. But suitable arrangements were not in place to safeguard people from the risk of financial abuse.

Staff had regular supervision and undertook training to provide them with the skills and knowledge to support them to meet people’s needs. People were able to make choices for themselves where they had capacity to do so. Where they lacked capacity decisions were made within the principles of the Mental Capacity Act (MCA) 2005. No one living at the service was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation. However, the provider told us that they would restrict people’s liberty under certain circumstances in line with MCA and DoLS. MCA and DoLS is law that supports people to make choices where they have the capacity to do so.

People were treated with respect and their privacy and independence was promoted. People were supported to communicate their needs.

Care plans were in place which set out how to meet people’s individual needs in a personalised manner. Staff had a good understanding of how to support people and meet their needs. People had access to a range of leisure, educational and employment opportunities. The service had a complaints procedure in place but this was not accessible to people.

The service did not have sufficiently robust and effective quality assurance and monitoring systems in place. People told us the manager was accessible and approachable.

We spoke with one member of staff about consent. They told us that they always asked people if they wanted the support on offer before providing support.

We observed during our visit that people engaged in various activities such as attending day centres and shopping with staff. On the day of our visit three people were out of the home and one was taken out during our visit.

We were not able to speak with people who used the service as they were not able to verbalise their needs. We tried to make contact with the relatives of people who used the service, but did not receive any response.

The provider had two policies regarding managing medicines. One was dated as last reviewed in 2010 and the other had been reviewed in 2013. We noted that the policies provided conflicting information to staff.

We found that staff did not receive supervision and appraisals in line with the provider's supervision policy.

We found that each person who used the service had a care file which contained details of their care plan, finances and other professionals involved in their care.

We found that the provider had not notified us of a change to the registered manager.

Beechwood Residential Home had five residents at the time of our inspection. They were able to give us limited feedback on the quality of the service due to their learning disabilities. The atmosphere was homely as staff treated the place as it was the residents’ home. We observed that people decided how they spent their time and whether they joined in the activities that were provided in the home. One person showed us the photographs of their holidays and other activities they were involved in. They participated in a music therapy session in the morning which they enjoyed. We observed that people were comfortable at the home and approached the staff to ask for help when they needed it.

Staff told us they were well-supported and happy to work at the home. They received ongoing training and knew how to look after the people who used the service.

We found that people’s individuality was recognised, their needs were met and their well-being was monitored. They were involved in a range of activities both in the home and in the community.

People told us that they were happy living in the care home. They liked the manager and staff and they were supported to participate in the daily life of the household. People also told us that they liked the food and social activities provided.