About the service: The Beeches is a residential care home providing personal care and accommodation for up to 23 people. At the time of the inspection there were 17 people living at the service.

People’s experience of using this service:

Since the last inspection the registered manager had failed to assess and monitor staff training, to equip staff with essential skills and knowledge. They had not considered that training was out of date and not assessed whether the training staff had received was effective. This had a potential impact on people’s safety, for example, around infection control and medicines management.

Staff were not supported through the home’s formal supervision process and those supervisions that had taken place were not always effective. Improved quality monitoring and record keeping would have highlighted the above improvements.

Despite the above improvements required, there was no doubt that people were very happy living at The Beeches. They spoke fondly of the provider, registered manager and all staff. Likewise, although staff wanted to be better supported by the registered manager, they enjoyed caring for ‘their residents’ and felt proud when they went home.

Satisfaction and views around feeling safe were positive. One person told us, “We all feel very safe, it’s one of the main reasons we decide to live in a care home. Staff are kind and support us 24 hours a day, we have good food, we are warm and safe and have a nice home to live in”.

Staff understood their responsibility to keep people safe from harm. People were supported to take risks and promote their independence. Risks were assessed, and plans put in place to keep people safe. There was enough staff to safely provide care and support. Checks were carried out on staff before they started work to assess their suitability to support people in a care setting.

Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. 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 were provided a healthy, nutritious, balanced diet whilst promoting and respecting choice and they confirmed this when we spoke with them.

Everyone we spoke with agreed that staff were caring and kind. Comments included, “Oh they are a super bunch”, “I like them all. I feel they genuinely care about us and enjoy their job”, “I have no concerns they are very respectful and always have a smile on their faces”.

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. The service was responsive to people’s health and social needs. People received person-centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing.

People were encouraged and supported to make their views known and the service responded by making changes. Although improvements had been identified the provider and registered manager had good intentions and people and staff said positive things about them. The registered manager was genuinely disappointed that training and supervision had lapsed, and they had missed this. They agreed that quality assurance needed to improve to ensure the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (published September 2016)

Why we inspec

The Beeches is a care home registered to accommodate up to 23 older people. At the time of our inspection 15 people were using the service. Since our last inspection one bedroom had been converted into an office for staff and two shared bedrooms were being used by single occupants.

This inspection was unannounced and took place on 28 and 29 July 2016. We previously inspected the service on 25 November 2015. At that inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. The provider sent us an action plan saying what they were going to do to make the necessary improvements. We were also provided with regular updates on action being taken to ensure the service was safe and well-led. During this inspection we found improvements had been made.

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.

The Beeches is a small family run care home. Some people told us that this was why they had chosen to live at the home. People were satisfied with the way they were looked after and said they enjoyed a good quality of life. Relatives also said they were content with the service provided. People liked the registered manager and provider and found them approachable.

People received a service that was safe. Staff understood their role and responsibilities in keeping people safe from harm and knew how to raise any concerns. There was enough staff to safely provide care and support to people. Medicines were well managed and people received their medicines as prescribed. Infection control measures were in place. Risks were assessed and plans put in place to keep people safe.

The service was effective. Staff received regular training and the support needed to meet people’s needs. People were supported to make choices and decisions. People had enough to eat and drink. Arrangements were made for people to see their GP and other healthcare professionals when required. People’s healthcare needs were met and staff worked with health and social care professionals to access relevant services. The provider had plans in place to develop and improve the accommodation.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. Information was provided in ways that were easy to understand. People were supported to maintain relationships with family and friends.

The service was responsive to people’s needs. People received person centred care and support. The provider had introduced a computer based system for care planning. The registered manager and staff felt the system helped in identifying and planning to meet people’s individual needs. The introduction of this system had resulted in improvements to care planning. People were encouraged to make their views known and the service responded to this by making changes.

The service was well-led. The registered manager and provider had worked in co-operation with other health and social care professionals to improve the service provided. This had resulted in significant improvements. People now benefitted from a service that was well led. The registered manager had an open, honest and transparent management style. The quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.

We carried out an unannounced comprehensive inspection of this service on 8 July 2014. During this inspection we found breaches of legal requirements. As a result of this we undertook a focused inspection on 18 February 2015 to follow up whether action had been taken to meet the legal requirements. At this inspection in February we found that some of the improvements had been made however the provider and registered manager still needed to familiarise themselves with the new Care Act 2014 and regulations, that came into force on 1 April 2015.

We have now carried out a further focused inspection because of concerns in relation to keeping people safe and the leadership and management of the service

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

The Beeches is a care home registered to accommodate up to 23 older people. At the time of our inspection 16 people were using the service.

This inspection was unannounced.

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.

The service was not well led. The registered manager and provider did not have comprehensive systems in place to check on the care and support provided to people. This had resulted in people not receiving high quality care that met their needs. Care records were disorganised and not always up to date or accurate. Policies and procedures had not been reviewed with some being out of date. The registered manager and provider were not always clear when notification forms had to be submitted to CQC. They had not always shared concerns regarding people’s safety with the appropriate authorities in a timely manner.

The service was not always safe. This was because the registered manager, provider and staff were not clear regarding the action to be taken to keep people safe. There was enough staff to safely care people. Checks were carried out on staff to assess their suitability before they started work. The registered manager and provider had plans to further improve these checks. We have made a recommendation regarding the management of medicines at the service.

The Beeches is a small family run care home. Some people told us that this was why they had chosen to live at the home. People were satisfied with the way they were looked after and said they enjoyed a good quality of life. Relatives also said they were content with the service provided. People liked the registered manager and provider and found them approachable.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection on 8 July 2014. During this inspection we found breaches of legal requirements. As a result of this we undertook a focused inspection on 18 February 2015 to follow up whether action had been taken to meet legal requirements.

Comprehensive Inspection 8 July 2014.

The inspection was unannounced. There were no outstanding breaches of legal requirements from the last inspection that we needed to follow up.

The Beeches is a care home, registered to provide accommodation for up to 23 older people. The home has two bedrooms which are registered as double rooms. These are being used for single occupancy. Six of the bedrooms had en-suite facilities of a toilet and wash hand basin. At the time of our inspection 16 people were in residence. The staff team were led by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The Beeches is a small family run care home and some people told us that this was why they had chosen to live at the home. People were satisfied with the way they were looked after and said they enjoyed a good quality of life. People’s choices and preferences were important to staff who made sure each person received personalised care. People enjoyed the food served at The Beeches and if they needed specific diets or foods, these were easily available. People were asked about their preferences and interests and a range of different social activities were arranged. People were helped to influence how the home was run on a day to day basis and were consulted on changes. For example, they were asked for their opinion about paint colours when the lounge was redecorated and they were asked where the best places would be to place grab rails. These are pieces of equipment which can help people to be more independent.

Improvements need to be made with two aspects to ensure that people are safer. Staff had not participated in a recent of fire drill, with the last recorded drill having taken place in November 2013. This has the potential to mean that staff may not react appropriately if fire evacuation procedures were required. Secondly, although the hot water temperatures were being checked on a regular basis, the advice that temperatures should be no more than 43°C had not been acted upon when temperatures were recorded as 48°C and 49°C on two separate occasions. Other recordings were above 43°C but these two were the highest. This is a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

However, people were kept safe by the staff recruitment procedures. These ensured that only suitable staff were employed to work in the home. Staff received safeguarding training to ensure they knew what to do to report any bad practice.

People were encouraged to be as independent as possible but precautions were in place to protect people from injury were risks had been identified. Staff were kind and caring and had a nice approach with the people they were looking after. Many of the staff had worked at the home for a long time and were therefore very familiar with people’s individual needs and preferences. Staffing numbers each shift were appropriate to meet everyone’s needs.

People were supported to live their lives in the way they wanted and their choices and preferences were respected. People were treated well and supported to express their views. They were actively involved in making decisions about the way they were looked after and their day to day lives.

The manager and assistant manager provided leadership for the staff team but improvements were needed to ensure that the systems in place for monitoring quality and safety were more robust.

Focused Inspection 18 February 2015.

Following our inspection on 8 July 2014 the provider was asked to take action to meet the requirements of the regulations. The provider sent us an action plan and advised us they would comply with the regulations by 31 August 2014.

This was an unannounced follow up inspection to ensure the provider had taken action to meet legal requirements. There were 17 people in residence at the time of this inspection.

We found the provider had made the required improvements. In respect of the lack of practice fire evacuation procedures (fire drills), there had been four sessions arranged. Ten staff had participated in the drill held 4 August 2014. A further two drills had taken place in November 2014 and one drill in February 2015. Records evidenced that new members of staff had also received fire awareness training.

Temperature valve regulators had been fitted to all wash hand basin’s in people’s bedrooms and the shared toilet rooms and bathrooms. Hot water temperatures were checked and all recordings were within safe limits.

At the last inspection on 8 July 2014 we found the arrangements in place for checking that the service was running well needed to be improved. The arrangements in place at that time had not picked up the shortfalls referred to above. Some improvements have been made however the provider and registered manager need to familiarise themselves with the new Care Act 2014 and regulations, that come into force on 1 April 2015.

Since the last inspection concerns had been raised with South Gloucestershire Council regarding management cover when the registered manager and assistant manager had both been away. The registered manager explained that people who lived in the home, their relatives and friends and the staff team had been advised that either of the two deputies provided management cover during these occasions.

Overall summary We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. There were no outstanding breaches of legal requirements from the last inspection that we needed to follow up.

The Beeches is a care home, registered to provide accommodation for up to 23 older people. The home has two bedrooms which are registered as double rooms. These are being used for single occupancy.Nine of the bedrooms had en-suite facilities of a toilet and wash hand-basin. At the time of our inspection 16 people were in residence. The staff team were led by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The Beeches is a small family run care home and some people told us this was why they had chosen to live at the home. People were satisfied with the way they were looked after and said they enjoyed a good quality of life. People’s choices and preferences were important to staff who made sure each person received personalised care. People enjoyed the food served at The Beeches and if they needed specific diets or foods, these were easily available. People were asked about their preferences and interests and a range of different social activities were arranged. People were helped to influence how the home was run on a day to day basis and were consulted on changes. For example, they were asked for their opinion about paint colours when the lounge was redecorated and they were asked where the best places would be to place hand rails. These are pieces of equipment which can help people to be more independent.

Improvements need to be made with two aspects to ensure that people are safer. Staff had not participated in a recent of fire drill, with the last recorded drill having taken place in November 2013. This has the potential to mean that staff may not react appropriately if fire evacuation procedures were required. Secondly, although the hot water temperatures were being checked on a regular basis, the advice that temperatures should be no more than 43°C had not been acted upon when temperatures were recorded as 48°C and 49°C on two separate occasions. Other recordings were above 43°C but these two were the highest.

However, people were kept safe by the staff recruitment procedures. These ensured only suitable staff were employed to work in the home. Staff received safeguarding training to ensure they knew what to do to report any bad practice.

People were encouraged to be as independent as possible but precautions were in place to protect people from injury where risks had been identified. Staff were kind and caring and had a nice approach with people they were looking after. Many of the staff had worked at the home for a long time and were therefore very familiar with people’s individual needs and preferences. Staffing numbers each shift were appropriate to meet everyone’s needs.

People were supported to live their lives in the way they wanted and their choices and preferences were respected. People were treated well and supported to express their views. They were actively involved in making decisions about the way they were looked after and their day to day lives.

The manager and assistant manager provided leadership for the staff team but improvements were needed to ensure the systems in place for monitoring quality and safety were more robust.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the way in which staff manage people's medicines. We found that safe systems of administration of medicines had been introduced. The provider had taken action to ensure that the staff had the necessary skills and competency to administer medicines safely.

We spoke with eight of the 16 people who lived at The Beeches and five separate visitors. We received positive comments about the way people were looked after. “I am very satisfied here” and “the staff help me with all the things I cannot do for myself”. Relatives told us that they were kept informed of any changes and that “the staff genuinely care”.

We found that the provider had good recruitment procedures in place, staffing levels were adequate and that staff received sufficient training and supervision to enable them to fulfil their role.

We have told the provider that they need to make changes to the way that medicines are managed, as the staff were following routines that were bad practice. There was the potential that medicines could be given to the wrong person.

We undertook this inspection as part of our scheduled programme of inspections. We were also following up that progress had been made to some required areas of improvements we had highlighlighted to the provider, when we visited in September 2011.

People told us about what it was like to live at The Beeches and how they felt they were cared for by the staff. "It is a nice place and we are happy, the staff work hard", "the food is lovely here” and “I am very satisfied with the way I am looked after”.

We were able to speak with three sets of visitors to the home. They told us “I am very satisfied with the way my relative is looked after”, “my relative’s health has greatly improved since living here” and “everything is marvellous and the staff are so kind and caring. As a family we have nothing to grumble about”.

Each person we met and spoke with told us they felt safe living at The Beeches. We observed and heard staff talk to people in a manner that showed empathy and respect. People told us that staff treated them very well and would never be rude to them.

People said "the staff are very good at their jobs" and "everyone knows what they are doing. I feel very well looked after" and "whenever you need help the staff are there to do so".

The provider had no systems in place to monitor environmental and safety issues and we have asked for improvements to be made.

The people we spoke with said that staff were kind and that they were treated with care and respect, one person also told us that felt that they were listened to by the staff.

We asked people how staff assisted them and asked them what the staff were like. People told us that they were assisted with their personal care, that staffwere patient and caring. One person said “the girls here are very good to me, nothing is too much bother, I am happy here”.