This inspection took place on 17 April 2018 and was unannounced. This meant no-one at the service knew we were planning to visit.

We checked progress the registered provider had made following our inspection on 25 January 2017 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in; Regulation 9; Person-centred care, Regulation 11; Need for consent, Regulation 12; Safe care and treatment, Regulation 15; Premises and equipment, and Regulation 17; Good governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led. We found improvements had been made and the registered provider was no longer in breach of regulations.

Beechy Knoll Care 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. Beechy Knoll Care Home is a care home providing accommodation and personal care up to 40 older people with a range of support needs, including people living with dementia. There were 24 people living at Beechy Knoll Care Home at the time of this inspection.

There was a registered manager employed 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.

Staff had not been provided with supervisions and appraisals at the frequency identified in the registered provider’s policy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

People’s care records contained detailed information and reflected the care and support being given, but we found there were no records of best interest decisions for the use of restrictive equipment, such as bed rails.

There were systems in place to monitor and improve the quality of the service provided and make sure full and safe procedures were adhered to.

People spoken with were very positive about their experience of living at Beechy Knoll Care Home. They told us they were happy, felt safe and were respected.

We found systems were in place to make sure people received their medicines safely so their health needs were met.

Staff records showed staff were provided with relevant training, which gave them the skills they needed to undertake their role.

The service employed a part-time activities coordinator and we saw a stimulating programme of activities was offered at the service. We received positive feedback from people who used the service about the quality of activities provided.

We carried out this inspection on 25 January 2017. The inspection was unannounced. This meant no-one at the service knew we were planning to visit.

Beechy Knoll Care Home is a residential care home based in Sheffield. The home provides care for older people and people living with dementia. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for 40 people and on the day of our inspection there were 26 people using the service.

It is a condition of registration with Care Quality Commission that there is 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. There had not been a registered manager at the service since September 2016. The current manager was recruited in October 2016 and was in the process of applying to CQC for registration. The manager was present on the day of our inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they felt safe living at Beechy Knoll. Comments included, “I feel very safe here” and “[Staff are] Nice people now and they look after me now.”

People living at Beechy Knoll and their relatives told us staff were mostly caring, and their privacy and dignity were respected. We saw and heard positive interactions between people and staff throughout the day of our inspection.

We found effective systems were in place to ensure medicines were managed, stored and administered in a safe way. However, improvements were still required in the administration of topical medicines, such as prescribed skin creams and with ‘as and when required’ medicines.

Staff knew how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

Safe recruitment procedures were followed to ensure that all the required information and documents were in place before staff commenced employment. Staff received regular supervision to support them in their job.

There were enough staff employed to meet the needs of people living at Beechy Knoll. The manager reviewed staffing levels regularly and reassured us she would be able to increase staffing levels as and when required.

The service did not always follow the requirements of the Mental Capacity Act 2005 Code of Practice and Deprivation of Liberty Safeguards as not all people’s care plans clearly recorded whether the person had the capacity to make significant decisions about their care and treatment.

People were provided with a nutritious diet. People told us they enjoyed the food served at Beechy Knoll.

Some activities were provided. An activities co-ordinator was in the process of being employed. People living at Beechy Knoll told us that more activities were being made available to them and this was an improving area.

The heating and hot water system was not consistently effective throughout the building. People told us there was not always hot water and some windows were draughty. Some rooms were intensely hot.

Some parts of the premises were not clean and this increased the risk of cross infection.

More quality assurance systems needed to be introduced to look at the quality of the service provided. Those that were in place were not fully effective at identifying shortfall

The inspection took place on 8 and 9 August 2016. The inspection was unannounced which meant the provider did not know we would be inspecting.

Beechy Knoll Care Home is a residential care home based in Sheffield. The home provides care for older people and people living with dementia. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for 40 people and on the day of our inspection there were 35 people using the service.

The home had a registered manager in place and they were present on the first day 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 spoke with a range of different team members; the deputy manager, care staff, kitchen staff domestics and maintenance staff who gave us mixed reviews about the registered manager.

From looking at people’s care plans we saw they were written in plain English but not in a person centred way. The care plans did not all contain people’s personal history and information on care needs was task orientated. These were not regularly reviewed by staff or updated by the registered manager.

Individual care plans contained risk assessments. Some were individualised but others were generic. The risk assessments identified risks but did not describe the measures and interventions to be taken to mitigate risks and ensure people were protected from harm. Some of the care plans we viewed showed us that people’s health was monitored and referrals were made to other health care professionals where necessary but others indicated this was not always the case.

On the day of our inspection people who used the service were not supported by sufficient numbers of staff to meet their care needs. We could see in the staffing rotas that there had been recent staffing issues and people who used the service had not been supported by enough people on a regular basis.

When we looked at the staff training records they showed us that staff were not always supported to maintain and develop their skills through training and development opportunities. We found that some training had expired and staff needed to attend refresher training.

When we looked at supervision and appraisal records we saw that these had been carried out, however they were ineffective and did not address staff wellbeing or performance.

We also viewed staff recruitment records which showed us recruitment practice was not always robust.

We observed how the service stored and administered medicines. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication. We found that medicines were not stored safely and numerous medication errors had taken place. Audits had not identified these issues and staff did not all have the knowledge and skills to appropriately administer medicines.

During the inspection we witnessed some positive interactions between staff and people who used the service. However staff did not always respect people’s dignity when communicating and supporting people.

Activities were not always provided. We saw that some activities took place and also saw evidence that people were being supported to go out but this was not regular or consistent.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We saw people enjoying their meals however the daily menu was not developed with the people who used the service to incorporate their likes and preferences.

We saw the service had a complaints and compliments procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should

People’s personal records including medical records were accurate and fit for purpose. We saw that records contained a high level of detail. Records described how support and care should be delivered so that people were kept safe and treated according to their preferences.

We observed care taking place within the home and saw that staff routinely treated people with dignity and respect. Some people were anxious or confused and staff ensured they gave reassurance and took time to reorient people.

We observed games taking place in the home. The staff facilitating this took time to ensure that everyone taking part was included, and led the game in a way that meant everyone was involved and benefited from the activity. The people we spoke with told us that they enjoyed this activity. One person said: “They do look after me, and we always have a laugh.” Another person told us they thought that the staff had “hearts of gold.”

People were protected from the risk of infection because appropriate guidance had been followed. There were hand wash points throughout the home, and guidance at each point for staff and visitors. We observed staff carrying out care tasks and saw that they used the appropriate personal protective equipment (PPE) for each activity. PPE was available throughout the home.

Staff were provided with a range of training opportunities to ensure that their skills and knowledge remained up to date and that they understood the needs of people they were supporting.

We checked care records. We saw that records were not all completed to a sufficient standard to ensure the provider held appropriate information about people or the care provided to them.

This inspection was to check if the provider had taken action to address the shortfalls we found regarding records when we carried out our last inspection in December 2012.

At this visit we saw the provider had addressed the shortfalls we identified at our last inspection by introducing new forms and audit tools. These had helped to make sure things like the amount of food people were eating and changes in their weight was being monitored and acted on as necessary.

On this occasion we did not speak to people who used the service. However their experiences were captured through information received from the provider, checking records and speaking with the manager.

People were asked for their consent before they received care or treatment. We observed care workers explaining to people and getting their agreement before delivering support. One person said,” Carers always let me know when I have a hospital appointment. They let me decide whether I want to go with my family or with one of them.”

People’s needs were assessed and care and treatment was planned and delivered mostly in line with their individual care plan. We found staff turnover at Beechy Knoll Care Home was very low. Therefore staff knew people who lived at the home well and were familiar with their changing needs. We observed people receiving appropriate care in line with their needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Our observations at meal time confirmed that all staff including the cook got involved during meal time. They made sure all the people who were able to eat had a choice at meal time and received support where needed.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. All the people who lived at the home had access to the complaints procedure. Three people said they knew how to make formal complaints. One person said, “I don’t like to complain. They have a hard enough job to do. I tell them if I am not happy about something. They soon put it right.”

People that were able told us that overall they were happy living at the home.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said,

"I am very happy here." "It's a nice home." "It's great." "We're all comfortable."

"It's OK but it's not home."

We spoke with 3 relatives who were visiting the home and they confirmed that they were satisfied with the care provided. One told us “We have no worries or concerns about the home and think it's good in every aspect." And another confirmed that "Our mother's quality of life is much better here than it was before she came to live in the home."

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding and they told us that they had not identified any concerns at the home.