About the service: Signature at The Beeches is a residential and nursing home which is registered to provide support to up to 110 people. Care is provided across four floors in one large purpose-built building. At the time of our inspection, there were 97 people living at the service.

People’s experience of using this service:

People spoke highly of the quality of the care that they received. People gave positive feedback about the staff, management, activities and food on offer. Staff were committed to the people that they supported and knew people well. Systems were in place to involve people in their care and staff identified personalised ways to make people happy. There were a variety of dining experiences available based on people’s needs and wishes, people’s dietary needs and food preferences were met. There was a wide selection of activities on offer to cater to a variety of tastes and interests. The service was clean, and the environment was tailored to people’s needs. The facilities included spaces such as a cinema, garden areas, bistro and lounges for people to spend their time.

People told us they felt safe at the service and we saw that staff proactively identified and responded to risks. People received their medicines safely and where we identified areas for improvement within medicines record keeping, these were immediately actioned. There were enough staff to safely met people’s needs and appropriate checks were carried out to ensure staff were suitable for their roles.

Care was planned in a personalised way with regular reviews undertaken to identify and respond to changes in people’s needs. Staff knew people’s needs well and there were a variety of systems in place to enable staff to understand what was important to people. People were encouraged to be independent and staff provided care respectfully to ensure people’s privacy and dignity was promoted.

People spoke positively about the management at the service and we saw there was a clear structure in place to ensure staff were supported. There were a variety of checks and audits and systems to involve people in the running of the service. People knew how to raise a complaint and felt confident any issues would be addressed. Where there had been incidents or complaints, these had been responded to appropriately and the provider had systems to monitor and learn from these.

Rating at last inspection: Good. (report published 23 September 2016)

Why we inspected: This was a planned comprehensive inspection.

Follow up: We will continue to monitor the service and will return to carry out an inspection in line with our policies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We previously carried out an unannounced comprehensive inspection on 7th and 8th May 2015 at which time a breach of the legal requirements were found in relation to the safe management of medicines. We also found that the providers systems to check on the quality and safety of the service provided were not always effective in identifying areas needing improvement.

Following the inspection, the provider sent us an action plan, which set out what they would do to meet the legal requirements in relation to the breach and to improve the service. We then undertook a further comprehensive inspection to check that the service had implemented their action plan and to confirm that they now met the legal requirements.

The inspection took place on the 8th and 12th July 2016 and was unannounced. Signature at the Beeches provides accommodation for up to 110 people who require nursing or personal care. There were 85 people living at the service at the time of our inspection.

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.'

At this inspection we found that the service had followed its action plan to address the previous breach which meant that the service now met the legal requirements and was no longer in breach of the regulations. Improvements had also been made with regard to monitoring the quality and safety of the service.

People were safe at the service as their medicines were managed safely and there were sufficient numbers of suitably skilled staff who had been recruited safely to meet people’s needs.

Risks to people were identified and managed to keep people safe whilst protecting their rights and independence.

Staff were aware of their whistle-blowing and safeguarding responsibilities. They knew the signs to look for that might indicate that people were being abused and who to report any concerns to.

Staff received regular supervision and support from the management team which provided an effective method of assessing staff competency and promoting learning and development.

People were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported by staff who were aware of their responsibilities under the Mental Capacity Act (2005) legislation. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS), making applications when necessary.

An excellent choice of food and drink was available that reflected peoples nutritional needs, and took into account their preferences and any health requirements.

People were supported to maintain their health and wellbeing and had access to a wide range of healthcare professionals as required.

The service organised a comprehensive programme of group and individual activities that were tailored to meet the specific needs of people.

People were supported and encouraged to follow their interests and maintain routines that were important to them.

The service helped people maintain important relationships and stay in contact with their family and friends.

The registered manager was held in high regard by people, relatives and staff and took a hands-on approach and was visible within the service.

The management team encouraged an open culture that listened to people’s views and wishes and took appropriate action.

Staff enjoyed working at the service and felt that they were included in the running of the home.

We spoke with five of the 42 people who were using the service at the time of our inspection. We also spoke with two people's relatives and seven staff members. We looked at five people's care records. We also looked at staff records, health and safety checks, staff and resident meeting minutes and records of the checks the provider’s representative completed to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were given information about the security at the service and told us they felt safe living there. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded from abuse.

Selection and recruitment processes were thorough to protect people who used the service from being cared for by unsuitable people. Staff attended training to support them to care for people safely.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care at the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

We found that care records were not always complete, accurate and fit for purpose. This meant that care was not accurately planned for the individual to limit the risks to their safety and well-being.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care records, and the improvements they will make in relation to their accuracy and completeness.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs.

One person said, "You can lock your door. They knock and wait to be invited in. You can choose your own lifestyle. They respect you in the way they speak to you, they respect your choices, you can live independently as much as possible.”

Another person said, “The care is excellent.”

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. One person said, “The care is excellent, the carers are marvellous and very friendly. They are really caring. When my sister died, they came by one by one and gave me a hug.”

Another person said, “Staff are wonderful, they are so caring and so nice.”

Is the service responsive?

The service offered accommodation in individual apartments and studios depending on people’s preference. Support varied from some assistance with everyday tasks, to nursing and dementia care, in response to people’s varying needs.

People who used the service were provided with the opportunity to participate in activities which interested them. Information was provided in a way that made it easy to see and understand. People's choices were taken in to account and listened to.

People had opportunities to express their views and these were listened to and acted upon.

Systems were in place to monitor people’s dependency levels and to determine the staffing levels required from day to day.

Is the service well-led?

The service had a recently appointed manager who had experience in leading care services. Staff had clearly defined roles and responsibilities so that all aspects of the service were effectively managed.

Staff were allocated specific tasks on a daily basis to ensure all tasks were completed properly. This was checked by their senior or head of department. Staff said that they felt well supported and able do their jobs safely.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed. As a result the quality of the service had improved.

When we inspected Signature at The Beeches on 23 December 2013 we found that people’s needs were assessed and that care was planned and delivered in line with those individual needs.

Staff members understood people's needs and were responsive to changes in those needs.

People told us that their experiences of the home were positive and that their needs were met. One person who was living at the home said, "I get everything I need." Another person told us, "There has never been a time when I did not get what I wanted." The relative of one person who was visiting the home on the day of our inspection said, "They care for [my relative] very well indeed. I don’t think we could have found a better place.”

People who had specific nursing needs had those needs met through local NHS arrangements.

This inspection took place on 7 and 8 May 2015.

Signature at the Beeches is registered to provide accommodation for 110 older people who require personal or nursing care. People may also have needs associated with dementia. There were 58 people living at the service on the day of our inspection, including two people who were in hospital.

At our last inspection on 14 May 2014 we identified concerns relating to the accuracy and detail of people’s care records.

At this inspection we found that care plans included all areas of people’s needs and were completed so as to promote people’s safety and well-being.

A registered manager was not in post in 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.

Medicines were not safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. You can see what action we told the provider to take at the back of the full version of the report.

The current records to guide staff about people's care needs were not always available to staff.

The service was not consistently well led. The provider’s systems to check on the quality and safety of the service provided were not always effective in identifying areas needing improvement.

Staff had attended training on safeguarding people. They were knowledgeable about identifying abuse and how to report it. Recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe.

People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs, and took into account their personal preferences or health care needs.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People felt their dignity and privacy was respected and they all spoke in a complimentary way about the kind and caring approach of the staff. Visitors felt welcome and people were supported to maintain relationships and participate in a wide range of social activities and outings.

Staff were well trained and with the exception of medicines management used their training effectively to support people. Staff understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People living and working in the service had opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response.