This inspection site visit took place on 18 October 2018 and was unannounced.

The Beaufort 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 Beaufort Care Home provides nursing and residential care to older people. The home has two floors accommodating up to 29 people in one adapted building. On the day of our visit 22 people lived at the home, most of whom had complex medical needs. The home is located in Coventry in the West Midlands.

We last inspected The Beaufort Care Home in November 2017 we identified areas for improvement in three of the five key questions we inspect against. These were safe, responsive and well-led. We gave the service an overall rating of ‘Requires Improvement’.

At this inspection we checked to see if improvements had been made in these areas and if they were effective. We found some areas had been effectively addressed, whilst others continued to require improvement. We also identified some previously evidenced standards had not been maintained. The rating remains Requires Improvement.

This is the third consecutive time the home has been rated as requires improvement.

The service had 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 provider had not ensured people’s medicines were consistently managed and administered safely and in line with their procedure.

Staffing levels meant staff were not always available to respond to people’s requests for assistance in a timely way and staff practices were task focused. People told us they felt safe living at home.

Systems and procedures were in place to ensure risks associated with people’s care, the premises, equipment, and emergencies were assessed. However, these were not always effective and some staff did not follow risk management guidance.

People’s care plans were personalised and regularly reviewed. People and relatives were involved in care planning and knew how to raise concerns or complaints. Complaints were managed in line with the provider’s procedure. Other records related to people’s care were not always completed.

Staff received an induction into the organisation, and a programme of on-going training supported them to meet people's needs effectively. Staff received management support through individual and team meetings. However, staff did not feel supported by some nursing staff. People and relatives were confident staff had the skills and knowledge needed to meet their needs.

Pre-employment checks were completed before staff started working at the home. However, some checks had not be actioned in line with the provider’s procedure to ensure staff were of a suitable character to provide care and support to people who lived at the home.

The provider’s systems to check, monitor and improve the quality and safety of the service provided were not always effective. People and relatives spoke positively about the way the home was managed and the service they received.

The management team and staff understood how to protect people from abuse and their responsibilities to raise any concerns. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People received the support they needed to meet their nutritional needs and had access to health care services when needed. The management team and staff worked with other health professionals to support people to maintain their health and well-being.

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This inspection took place on 2 November 2017.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most people who lived at the home had complex medical conditions. The home provided permanent accommodation for people, as well as 10 temporary beds for people who had come from hospital for further nursing care before going back to their own home. At the time of our visit, 25 people were living at the home.

The home had 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.

We previously inspected this service in August 2016 when we found four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in February 2017 and found the provider had taken sufficient action in response to the breaches in regulation to remove the breaches. However, there were some areas where further improvements were required.

At this inspection we found the momentum for improvement had been sustained, but there were still further improvements required to ensure people consistently received a safe and responsive service. The leadership and management of the home continued to improve, however the oversight of the provider had not always been consistent due to significant changes at a regional level. We were assured that the new structure of the regional management team would provide more focussed support to the management team at The Beaufort Care Home.

People felt safe at the home, but sometimes had to wait for staff when they requested assistance. The registered manager had recruited additional staff and was confident that consistency of care and responsiveness to requests for support would improve when all shifts were covered by their own permanent, experienced staff.

People’s risks in relation to their health and wellbeing had been assessed and plans put in place to manage any identified risks. Staff monitored people who were at risk and obtained advice and support from other health professionals to maintain and improve their health. However, records we looked at did not always evidence that specialist advice to reduce risks to people’s health was always being consistently followed. Medicines management was safe, although some minor improvements were required.

People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support from the registered manager. Staff worked within the principles of the Mental Capacity Act 2005 and involved people in decisions about their care by offering them choices. The registered manager understood their responsibilities under the MCA and applied to the supervisory body for authority to deprive people of their liberty when it was necessary for their safety.

Interactions between staff and people were warm and compassionate. Staff had a caring approach and were sympathetic and kind to people. People were offered opportunities to engage in activities and socialise. The registered manager regularly walked around the home and on occasions helped support staff on the floor. This gave them the opportunity to observe staff practice and how staff engaged with people.

Care plans were sometimes task and problem orientated rather than focussing on promoting wellbeing and independence. However, staff spoke about people in a very person centred way demonstrating they knew people’s likes and preferences.

The provider had systems and processes for reviewing the quality of the care provided. These were reviewed monthly to ensure any identified actions had been taken.

This inspection took place on 7 February 2017 and was unannounced.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people who lived at the home had complex medical conditions. The home provided permanent accommodation for people, as well as 10 temporary beds for people who had come from hospital for further nursing care before going back to their own home. At the time of our visit, 21 people were using the service.

The home had a new registered manager. They were appointed in August 2016 and registered in January 2017. 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 our previous inspection on 24 August 2016 we identified four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this inspection the home was placed into special measures.

We asked the provider to improve staffing arrangements; ensure people's individual and social needs were met; improve medicine management; and improve their quality assurance systems and management support. The provider sent us an action plan and was in regular contact with the CQC informing us of the changes they had made to improve the service.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations to remove the breaches. Because of this the home is no longer in special measures. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Our previous inspection identified there were not enough staff to meet people’s needs, and the high level of agency staff meant there was little continuity of care. During this visit we found the home had significantly reduced the level of agency staff used to support people’s care, and staffing levels corresponded to the assessed dependency needs of people. People and their relatives were mostly happy with the care provided, but some felt staff did not respond to their needs as quickly as they would like.

Our previous inspection identified that people were not receiving enough personal care such as showers or baths to support their dignity. During this visit we found this had improved but some people still did not have the number of baths or showers they preferred.

Our previous inspections had identified a high turnover in management at the home. Since our last visit, the home now had a new senior management team who, whilst new to the service, were experienced managers within the company.

A manager from another of the provider’s homes had registered with the CQC to be the manager at The Beaufort. They were familiar with the quality assurance systems which were now being completed, and were seen as open and supportive by staff and people who lived there. New senior management were working with the registered manager to continue to improve the service.

Our previous inspection identified that people’s risks were not being managed safely. During this visit we found risks to people’s health and social care had been identified, and staff were aware of the risks and acted accordingly to minimise them.

Our previous two inspections highlighted concerns about the management of medicines at The Beaufort. During this visit we found the management of medicines had improved and people received the medicines they required.

Staff were kind and caring to people, but did not have time to sit and talk with them. Most interaction with people who lived at the home was whilst staff carried out personal care tasks. People told us staff r

This inspection took place on 24 August 2016 and was unannounced.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support, or highly specialised nursing. 17 people lived at the home at the time of our inspection, however four were in hospital.

We inspected the home in November 2015 and found there were breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people's care and treatment needs. Staff did not always receive the appropriate support to enable them to carry out their duties competently. The provider did not continually assess, monitor and improve the quality of the service.

We issued the provider with a warning notice in relation to how they monitored and assessed the quality of the service and asked them to provide us with an action plan outlining the improvements they intended to make.

We carried out a follow up inspection at the home in May 2016 and found some improvements had been made but further improvements were still required. The provider had recruited a new manager, deputy manager and a new regional manager.

At that inspection we found there were two breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people's care and treatment needs and the proper and safe management of medicines. We also found sufficient equipment necessary to meet people's needs, was not available at all times. The provider sent us an action plan outlining how they would make improvements.

We completed a further unannounced inspection on 24 August 2016. This inspection was in response to concerns we received about how people's care was managed. There had been a recent incident in the home which had resulted in investigations from a number of organisations including local commissioning, the clinical commissioning group and police.

At this inspection, we found there had been inconsistent management and clinical leadership in the home since our last inspection in May 2016. This was because the manager and deputy manager at the time of our last inspection had recently left the service. There had also been a change in the regional manager and managing director.

There was no 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.

A new manager was in post however they had only started at the service two weeks before our visit and there had been another temporary manager supporting the home. The provider was looking to recruit a new deputy manager.

The provider and manager were responsible for completing a range of checks to ensure the quality of the service was maintained. These checks had not been completed consistently to identify when improvements were required and they were not robust. This also meant that any improvements made had not been sustained.

Some people and relatives were unhappy with the care provided, and expressed concerns about the length of time they, or their relations, had to wait to receive care. Individual staff members were committed to providing a good standard of care but we saw delays in attending to the needs of people, and call bells were not always in reach for people to request support.

Staff were kind and caring when they provided personal care. However, sta

This inspection took place on 10 May 2016 and was unannounced.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support or highly specialised nursing. 19 people were living at the home at the time of our inspection.

We last inspected the home in November 2015 and found there were two breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people’s care and treatment needs and staff did not always receive the appropriate support to enable them to carry out their duties competently. The provider did not continually assess, monitor and improve the quality of the service.

We issued the provider with a warning notice in relation to how they monitored and assessed the quality of the service and asked them to provide us with an action plan outlining the improvements they intended to make. At this inspection we found some improvements had been made but further improvements were still required.

There was no 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.

There was a new manager in post who was in the process of registering with us. They had started working at the home at the beginning of April 2016. The provider had also recruited a new deputy manager and there was a new area manager in post.

Some people and relatives were unhappy with the care provided, and expressed concerns about the length of time they, or their relations, had to wait to receive care. Staff were committed to providing a good standard of care but we observed there were delays in attending to the needs of people and call bells were not responded to promptly. People did not consistently receive baths and showers when they wanted them.

At our previous inspection in November 2015 the home had been reliant on agency nurses to provide nursing care in the home. At this inspection we found the provider had recruited permanent nursing staff and the use of agency staff had reduced. However, the occupancy level at the home had increased and we found there were not enough care staff to provide care and support to people at the times they needed it.

At our last inspection in November 2015 we found a breach in the regulations as quality checks had not been completed consistently to identify when improvements were required. At this inspection we found regular quality audits of the home were conducted to monitor and improve the care provided by the service. Analysis of incidents and accidents were carried out to minimise the likelihood of them happening again.

People did not always receive their medicines as prescribed and on some occasions the correct equipment to deliver medicines had not been ordered.

Improvements had been made so that permanent staff had received training required to undertake their work safely. However the provider had not kept an accurate record of staff training needs. We found staff had started to receive sufficient support and supervision to help them work effectively

The manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (permission needs to be sought when a person who does not have capacity has their liberty restricted).

Staff were kind and caring when providing personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff

This inspection took place on 16 November 2015 and was unannounced.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support or highly specialised nursing. 11 were living at the home at the time of our inspection.

We last inspected the home in December 2014. After that inspection we asked the provider to take action to improve the management of medicines in the home. At this inspection we found improvements had been made but further improvements were still required.

There was no 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. There was a peripatetic manager (a manager who provides support as required) who had been at the home for four weeks.

There had been no consistent management or clinical leadership in the home as the registered manager, deputy manager and the majority of the nursing staff had left the service. There was now a peripatetic manager in post, but it was clear they had limited knowledge of the medical needs of people living in the home or the skill sets of the staff working there. The majority of relatives were happy with the care provided, but expressed concern about the inconsistency of management. Staff were committed to providing a good standard of care, but did not feel valued and had not been kept informed by the provider of the changes within the service.

The home had been reliant on agency nurses to provide nursing care in the home. Although the provider had tried to ensure they used the same agency staff, people were not always provided with care by staff who knew them well. There was a concern that some people had been admitted to hospital because agency staff did not have the necessary skills to meet their needs and were not familiar with people’s health history.

Permanent staff had received training required to undertake their work safely. We found they had not recently received sufficient support or supervision to help them work effectively. Nursing staff had not received clinical supervision.

We found the service met the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

Staff were kind and caring when providing personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff and people at any other time of the day. Relatives were not always confident their family member’s dignity was maintained. Some relatives felt their family members did not receive the personal care required to promote their dignity.

People spoke highly of the activities co-ordinator, but there was little for people to do when the co-ordinator was not in the home. Some families were concerned their family members were left in their rooms a great deal which could lead to social isolation.

Care plans and assessments contained detailed information that supported staff to meet people’s needs.

The provider and manager were responsible for completing a range of checks to ensure the quality of the service was maintained. These checks had not been completed consistently to identify when improvements were required.

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

This inspection took place on 10 December 2014 and was unannounced.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support or highly specialised nursing.

We last inspected the home in June 2014. After that inspection we asked the provider to take action to improve the staffing of the home. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found improvements had been made in the staffing arrangements within the home. This meant the provider met their legal requirements.

This home is required to have 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 the time of this inspection there was not a registered manager in post. A manager had been appointed and the process for registering the manager had commenced.

People were not always protected from the risks associated with the management of medicines as there were inconsistencies in recording the administration of medicines.

People and their relatives told us they felt safe at the home. Staff told us they had attended training about keeping people safe and were able to explain what they would do if they had any concerns. Any potential risks to people’s health were assessed and managed appropriately. There were processes in place to ensure staff had the skills and competencies to meet the medical needs of people living in the home.

Where people had capacity to make decisions staff respected decisions people had made. Where people did not have capacity, decisions were made in their ‘best interests’.

Care plans were detailed and provided staff with clear guidance on how to support people as they wished. Care plans were reviewed regularly with the person and those closest to them. Any changes in health were responded to promptly and where a need was identified, referred to the appropriate external healthcare professional.

During our visit we saw many positive examples of caring. Staff were patient and kind. We observed they were inclusive, respectful and showed humour. People told us that staff respected their privacy and dignity when providing personal care. All the staff members we spoke with felt staff were caring and were able to explain what they meant by this and give examples. It was clear many of the staff enjoyed being at the home and worked well as part of a team.

The new manager had been in post for three months and the consistent feedback from staff was positive about changes that had been made within the home. One member of staff told us, “There has been continuous improvement and the manager is on the right track.”

During our inspection we looked to see whether we could answer five key questions: Is the service safe, effective, caring, responsive and well led?

Two inspectors carried out this inspection on Monday 16 June 2014. We visited the service from 7.00am to 4.00pm. At the time of our visit there were 22 people living at the home. We spoke with the deputy manager, the regional manager, one visitor, three people who used the service and ten members of staff. The manager was absent from the service. We also observed the care people received to understand the experience of people who could not talk with us.

Below is a summary of what we found. The summary described what we observed, the records we looked at and what people using the service, their visitors and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Equipment was safe, clean and hygienic. We saw the equipment used to support people in moving was maintained regularly and was of a required standard for safety. Staff were clear as to their responsibilities for checking the safety and suitability of equipment.

The service was not always working with a full complement of staff. Staff we spoke with told us they found it difficult when they were working with too few staff. The procedures and policies of the service were not being followed to ensure safe staffing levels were always maintained.

Staff had received training in the Deprivation of Liberty Safeguards (DoLS) and had an understanding of how the safeguards operated. There was nobody living at The Beaufort who had a current DoLS in place.

Is the service effective?

People had an assessment of their nursing and care needs prior to moving to the home. We saw care was planned and delivered in a way that ensured people’s safety and welfare and incorporated people's individual needs.

Where needed, care plans had been adjusted to reflect changes in people's health and provide staff with guidance on what action to take to address people's changing needs.

Is the service caring?

People we spoke with were positive in their comments about the care provided and the staff delivering that care. A visitor told us, “I feel the care is attentive and I feel that the patients are always dealt with very respectfully. I feel with X they are getting the details right. I have just watched a young man deal with her. Her eyes were closed but he spoke with her the whole way through the care and touched her at the end to say ‘I’ll be back later’.”

We observed a member of staff supporting a person to eat in their bedroom. There was lots of chat and laughter with the staff member turning the mealtime into a social activity.

Is the service responsive?

Care records we looked at confirmed people were referred to other healthcare service providers when a need was identified. For example, we saw the service was working with dieticians, speech and language therapy and physiotherapy. Professional visits were recorded in detail and advice given was added to the relevant care plans.

Is the service well led?

The service had a quality assurance system. The regional manager carried out monthly quality monitoring visits. Where issues had been identified the regional manager was supporting managers and staff to ensure they were addressed.

Plans were in place to encourage people and their relatives to complete the annual quality assurance questionnaire to identify what the service was doing well and where improvements needed to be made.

Staff we spoke with were positive about the support of the management team, but acknowledged how busy the manager was. One member of staff told us, “When you have management that motivate staff, it energises you to be there.” Another staff member said, “Good. I just know they are very, very busy. X (the deputy manager) has always got time for you.”

The Beaufort Care Home provides nursing care for up to 29 people. Most of the people living at The Beaufort Care Home have highly complex medical conditions requiring a lot of care and support or highly specialised nursing. When we visited on 30 July 2013 we found medication management was not sufficiently robust to ensure medicines were always administered safely to people. We visited the home on 18 September 2013 and checked whether actions had been put in place to ensure the safe administration of medicines to people.

We found the service had appropriate arrangements in place for the management of medicines.

Medicines were kept securely and safely.

Staff administered medication safely and recorded the administration of medicines accurately.

There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.

Staff administering medication had assessments to check their competency. Managers were completing regular medication audits.

Most of the people living at The Beaufort Care Home have highly complex medical conditions requiring a lot of care and support or highly specialised nursing. At the time of our visit the home was providing care to 23 people. Due to the high level of needs we were limited in gaining the views of those who lived in the home. We spoke with one person, four visiting relatives, four members of staff and the manager.

People we spoke with were positive about the care and support provided. One person told us, "I'm very pleased. We tried to find the best place and I think this is it."

We saw care plans were developed from a detailed assessment of people's needs prior to their admission to the home. They provided staff with information to meet people's needs safely and appropriately. Records demonstrated that there was good communication with relatives about any changes in people’s health. The service facilitated discussions between relatives and visiting healthcare professionals.

We looked at people's medication and found that some improvements were needed in the recording of medications.

Staff spoke positively about their roles and told us they had access to training and support on a regular basis.

The home sought the views of people and their relatives to monitor the quality of care and service provided.

We visited The Beaufort on 18 October 2012. There were 24 people living in the home at the time of this visit. Some were in the home under “continuing health care.” This meant they had a highly complex medical condition requiring a lot of care and support or needed highly specialised nursing. We were therefore limited in gaining their views of the home. We spoke with four visiting relatives and a visiting professional who were all positive about the care provided. One family member said, “I personally wouldn’t have wished my relative to be anywhere else.”

We saw that people had care plans in place which detailed their care needs. They provided staff with information so they could deliver care safely in a way people preferred. People and their relatives were involved in reviewing care plans to ensure they remained relevant to changing needs.

Relatives spoke favourably about the level of care provided by staff. One relative told us, “I come in every day and I am left with the feeling they are good people, professional and dedicated.” Staff spoken with were knowledgeable about people’s individual needs. One staff member said, “That is what care is about, knowing the actual person, the individual.”

We saw staff engaged with other health professionals to deliver the nursing support required. One visiting professional told us staff followed medical advice provided. “You don’t worry because you know it will be carried through.”