The inspection took place on 27 June 2018 and was unannounced. At the last inspection on 22 and 23 May 2017, the service had an overall rating of ‘Requires Improvement.’ We had found concerns with medicines management and governance systems. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Is the service safe and well-led? to at least good. We received a comprehensive action plan. At this current inspection, we looked at the previous breach of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found good improvements had been made.

The Beacon Intermediate Care Unit 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.

The Beacon Intermediate Care Unit is registered to accommodate 27 people in one adapted building. At the time of the inspection 20 people were using the service. The service provides short term reablement to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care, therapy (occupational therapy and physiotherapy) and social work intervention all based in the same building. The service also provides a range of facilities and equipment to support people’s reablement needs.

The service had a new 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.

We found improvements had been made to the medicines management systems to ensure they were safe. Staff administration and recording practices had improved through additional training, assessment, supervision, participation in work-shops and regular meetings.

Quality assurance systems had been reviewed and maintained since the last inspection and we saw action had been taken when issues had been identified. The provider had worked hard at implementing positive changes and was committed to ensuring improvements were sustained and developed further, to ensure people received high quality care. Staff described the culture of the organisation as open and management as supportive and approachable.

A robust recruitment process was in place, which ensured staff had the necessary values, skills, experience and were suitable to work with people who used the service. Staff received the training and support they needed to carry out their roles and meet people’s needs. The provider monitored staffing levels regularly, to ensure staffing levels were sufficient and staff deployment was effective.

Staff had received training and had procedures to guide them in safeguarding people from the risk of harm and abuse. In discussions, staff were clear about how they would escalate concerns and which agencies they would contact for advice.

People told us they felt safe. Staff had completed assessments with people to identify risk areas and the steps required to minimise risk. People received care tailored to meet their individual needs and the care recording systems were being fully transferred over to the electronic format.

The service was operating within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People’s health and nutritional needs were met. Records showed people had access to a range of community healthcare professionals for advice and treatment. These i

The Beacon Intermediate Care Unit provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care, therapy (occupational therapy and physiotherapy) and social work intervention all based in the same building. The service provides a range of facilities and equipment for up to 26 people who require rehabilitation and at this inspection all placements were occupied.

The service has 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.

At the last inspection on 21 and 22 April 2015, the service was rated Good. At this inspection on 22 and 23 May 2017, we found some inconsistencies in the safe and well-led questions and the overall rating for the service has changed to ‘Requires Improvement.’

Medicines were not always managed in a safe and proper way; we saw there were shortfalls in the administration and recording of some people’s medicines. This was a breach in regulation. You can see what action we have asked the registered provider to take at the back of the full version of the report.

Although some staff were not happy with the staffing levels, people and relatives felt there were enough staff and this was confirmed in our observations. We saw staff were available and responded promptly to people. In recent months, staffing levels had increased on day shifts with regular support from the staff who worked at the registered provider’s community intermediate care service.

Robust recruitment procedures were in place, which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. There were procedures in place to manage risk effectively and we found evidence throughout the inspection that all efforts were made to support people’s safe mobility and prevent falls.

We found people’s nutritional needs were met. There were plenty of choices for meals and fluids and dietetic advice was obtained when required. The lunchtime experience was relaxed and had a social atmosphere with lots of chatter and interaction from staff. People liked the meals provided to them.

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

People and relatives praised the staff who were described as kind, caring and considerate. People told us they were treated with respect and this was confirmed in our observations. We saw staff engaged positively with people, encouraging and supporting their independence. Staff had a good knowledge and understanding of people’s needs and worked together as a team.

People and relatives told us they felt able to raise any issues or concerns and were confident these would be dealt with appropriately. They were consulted about their care and the service through discussions, reviews and surveys.

We saw people received care tailored to meet their needs however the registered manager recognised the care plans needed more work to fully reflect the person centred care being delivered and to ensure the records were more user-friendly. We saw people had access to healthcare professionals such as GPs and district nurses. A healthcare professional who visited the home regularly told us it was, "A very good service." They said staff communicated well, reported any issues promptly and appropriately and acted on any advice they

During our inspection we spoke with five people who used the service, six members of staff and two relatives. People who used the service told us, “Staff can’t do enough for you”, “Everyone is really respectful, they all call me by my first name, I like that”, “They are very respectful, I couldn’t fault them in any way” and “No one is ever disrespectful.”

The registered manager told us, “All the activities people are involved with are based around the skills that people will need when they go home.” Activities included the breakfast club, walking, gardening and cooking.

Care workers supported people to take their medicines in a variety of different ways that met the individual needs and preferences of people who used the service. Where possible, people were encouraged and helped to take responsibility for their own medicines in preparation for their return home.

The service’s quality assurance officer said, “All new and agency staff complete a health and safety induction which covers all aspects of the building.”

The council health and safety officer was visiting the home at the time of our inspection. He told us, “I have no issues, in my opinion it’s a well run professional location.”

A person who used the service told us, “If I had any concerns I would just speak to the staff. Everyone is very approachable.” Another person said, “I suppose I would report any problems I had to the manager but I have never had the need.”

People that used the service told us that staff listened to them and helped them to regain their confidence and be as independent as possible.

People that used the service told us they were “grateful” for the care they received. One person told us that staff were “prompt in answering calls.”

We saw feedback from people that used the service that stated “nursing staff have cared for me very well and contacted my doctor on my behalf.”

We saw that another person had stated “I enjoy the activities that I have been involved in and I like the fact my husband can visit twice a day…I am now walking again, thank you.”

People that used the service told us that staff treated them with respect and courtesy and that they felt safe using the service.

People said they were confident any concerns would be taken seriously and that action would be taken to follow these up.

We saw recent feedback from people that used the service which stated “staff are excellent….they helped me get home to my wife."

We also saw that following feedback about activities that were provided, the provider had responded and indicated that the comments received would be included in plans to help develop and improve the service.

We carried out an unannounced inspection of the service on 21 and 22 April 2015. The last inspection took place on 28 May 2013 during which we found there were no breaches in the regulations.

The Beacon Intermediate Care Unit provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care, therapy (occupational therapy and physiotherapy) and social work intervention that are all based in the same building. The service provides a range of facilities and equipment for up to 26 people who require rehabilitation.

The service has a new registered manager, their registration was completed on the 26 April 2015. 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.

Although only in post since January 2015 the registered manager demonstrated clear management and leadership of the service. They were knowledgeable and inspired confidence in the staff team, and led by example. The registered manager had a proactive approach to developing a positive culture in the service.

Staff were recruited in a safe way and full employment checks were completed before they started work in the service. There were sufficient staff on duty to meet the range of care, support and treatment needs of people who used the service. Staff were well trained. They also had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills and knowledge. We saw staff had completed safeguarding training and knew what to do to keep people safe from abuse or harm. There were policies and procedures for additional information and guidance.

People praised the staff for their kindness and were satisfied with the care they received. We saw staff engaged positively with people, encouraging and supporting their independence. Staff had a good knowledge and understanding of people’s needs and worked together as a team.

The environment was safe, equipment was checked and maintained and risk assessments were carried out. There was evidence throughout the inspection that all efforts were made to support people’s safe mobility and prevent falls.

People were supported to maintain links with the community and participate in meaningful activities that interested them and met their individual needs.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) legislation, and whether these needed to be considered for people who lived at the service. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. Changes to the law regarding the DoLS were understood and appropriate referrals had been made to the local authority to make sure people’s legal rights were protected.

We found people’s health care and nutritional needs were met. There were plenty of choices for meals and fluids and dietetic advice was obtained when required. The lunchtime experience was relaxed and had a social atmosphere with lots of chatter and interaction from staff. We noted improvements had been made to the recording of people’s fluid intake overnight, which the registered manager confirmed she would continue to monitor closely.

We observed the culture of the organisation was one of openness and sound values based on putting the people who used the service at the centre of what they provided. There was a quality monitoring system to enable checks of the service provided to people and to ensure they were able to express their views so improvements could be made.