This inspection took place on 3 October 2017 and was unannounced. The service was last inspected on 31 March 2015.

The Beeches Care Home can provide accommodation and personal care for a maximum of 17 older people and specialises in the care of people who may have dementia. At the time of the inspection there were 16 people living at the home.

There was 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.

Staff were aware of their responsibilities when it came to responding to any concerns and reporting them to the appropriate authorities. Where safeguarding concerns were raised they were responded to appropriately.

People were supported by staff who were aware of the risks to people’s safety and how to manage those risks. People felt safe and were supported by staff who were safely recruited and had received training and guidance to enable them meet people’s needs. Staff were trained to support people to take their medicines as prescribed by their doctor. Medicines were stored safely and securely.

Staff were provided with an induction and training that equipped them for their role and gave them the confidence to support people in line with their care needs. Communication systems in place ensured all staff were up to date in the changes in people’s healthcare needs and were able to support them accordingly. People enjoyed their meals and were supported to have enough to eat and drink. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People described staff as kind and caring. Staff treated people with dignity and respect and supported people to make choices about their daily living. People were supported to maintain their relationships with loved ones and visitors were made welcome in the home. Staff were mindful of maintaining people’s independence and knew when to step in and provide support.

People were involved in the planning of their care ensuring staff had the correct information to support people in line with their needs and wishes. People were given the opportunity to take part in a variety of activities that were of interest to them, both in and outside of the home. People were complimentary about the service and had no complaints. They were confident that if they did raise concerns they would be dealt with appropriately.

People were happy with the care and support they received and considered the service to be well led. Staff felt supported and listened to. Management were approachable and staff were motivated and enjoyed their work. A number of audits were being used to identify areas for improvement across the service for the benefit of the people living at the home.

This was an unannounced inspection that took place on 31 March 2015. We last inspected this home on 15 April 2014. There were no breaches of legal requirements at that inspection.

The Beeches Care Home can provide accommodation and personal care for a maximum of 17 older people and specialises in the care of people who may have dementia. At the time of the inspection there were 17 people living at the home.

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.

People told us that they felt safe in the home. Families told us they were confident that their relatives were cared for by staff who knew how to keep them safe. Staff were able to describe in detail the needs of the people living at the home and their roles and responsibilities in respect of keeping people safe. Care records were detailed and risk assessments were in place and regularly reviewed and updated.

We received mixed responses with regard to the staffing levels at the home. People living at the home and some families spoken with felt there were enough staff. However, some other relatives and staff commented on the staffing levels. The registered manager had assessed that staffing levels needed to be reviewed and had introduced an additional member of staff to the shift pattern and had changed the structure of the staff group to ensure staff worked more efficiently. Staff spoke positively about this improvement.

Medicines were stored and secured appropriately. The medication audit system had identified some concerns regarding the recording of medicines and booking in of new stock but the training put in place for staff to address this was not completed in a timely manner. There were no protocols in place for ‘as and when required’ medicines which could mean these medicines could be administered inconsistently.

People and their families spoke positively about the care and support they received in the home. The staff group, many of whom had worked at the home for a number of years, spoke positively about the support they received from both the registered manager and the provider and told us they felt well trained to do their job.

Staff obtained consent from people before they provided care. The registered manager and staff all had an understanding of the Mental Capacity Act (2005) and care records reflected this.

People were supported to eat and drink enough to keep them healthy and were offered choices at mealtimes. Staff were aware of people’s individual dietary needs and provided discreet assistance at mealtimes, where required. People were supported to access a variety of healthcare professionals to ensure their health care needs were met and were assisted to see their GP as and when required.

People living at the home and their relatives told us that they felt the staff were very supportive and caring. Relatives told us they found the provider, registered manager and the staff group very welcoming and approachable.

Staff were aware of people’s likes and dislikes and how people liked to spend their day and what was important to them. There were a number of activities planned during each week and arrangements were in place for people to visit the organisation’s other homes to take part in other activities and meet other people.

People and their relatives told us that they had not had to raise any concerns or complaints but if they did, they knew who to speak to and were confident that they would be dealt with satisfactorily.

People living at the home, their relatives and staff alike, all thought that the home was well-led. They all spoke positively about the provider, the registered manager and the staff group. Visitors to the home felt welcomed and always listened to.

Staff understood their role and felt supported and well trained. A new system for allocating workload had been introduced and staff had welcomed the difference this had made. The provider and the registered manager had worked to improve training for staff and actively encouraged them to take on additional training, offering support where needed and financial incentives.

Annual surveys were in place to assess the quality of the service and attempts had been made to invite families to meetings. A page on a social media website had also been created to try and engage more with families.

Staff felt supported and listened to and were confident that if they raised any concerns they would be dealt with. However, there were no formal staff meetings in place to enable staff to be involved in the running of the home and have their voice heard as a group.

At the time of the inspection there were seventeen people living at The Beeches. Due to their health conditions and complex needs not all people were able to share their views about the care they received. We observed their experiences to support our inspection. We spoke to the registered manager, area manager and three care staff. The methods we used to gather information helped us to answer our five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This is a summary of what we found.

Is the service safe?

People are treated with respect and dignity by the staff. We saw that people were given choice in their care and all the relatives we spoke with told us they were very happy with the service. Safeguarding vulnerable adults procedures were robust and staff understood how to safeguard the people they supported. A relative told us, “My relative is well supported. If I have any concerns I would talk with the manager”.

We saw that the home had systems in place to make sure that managers and staff learn from any accidents, complaints, whistleblowing or investigations. This reduces the risks to people and helps the service to continually improve.

We spoke with staff and the registered manager about Deprivation of Liberty Safeguards (DoLS). This applies to all homes. The registered manager told us there had been no applications and showed us the policy and procedures they followed. They told us that staff had received relevant training and had access to the policy and procedures. Staff told us that they had received this training.

Is the service effective?

People we spoke with told us they were involved in decisions about their care. One person commented, “I like it here. The staff are so good. When I first came here I couldn’t do some things for myself. I can now do things again for myself, the staff have really helped”.

People explained how their care and welfare needs were met. People told us that they had support with health appointments and felt that the service was flexible. One person told us that, “If I am not feeling well the staff will call a doctor”.

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home. Relatives we spoke with said they felt the care was very good. One relative told us, “I have only excellent things to say about the home”.

People using the service, their relatives, friends and other professionals involved with the service had completed an annual satisfaction survey. We spoke with five relatives who all told us that they were very happy with the service. One relative told us, “They do a really good job at the home. The staff are very good.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

The home had activities co-ordinators after people had requested more activities. People told us that they now have a range of activities, often helping them become involved in their community.

People who used the service and their relatives were able to raise any concerns or make comments about the home and these were responded to promptly. The home had an 'open door' policy which meant that people could raise issues of concern to them at anytime.

Is the service well-led?

We found that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality care service at all times.

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We spoke to one person who said, “I chose to wear this cardigan”. We saw staff promote people's independence in different ways. We found that people and their family members were involved with their care planning and delivery. One relative we spoke with said, “I come to care plan reviews”.

We found that people's needs were appropriately assessed and planned for to ensure that care received was safe and appropriate. People told us they were happy with the care they received. One person told us, "Staff are alright”. A family member we spoke with said, “The home gave me a copy of the care plan to look over, I have no complains at all”.

There were gaps in safeguarding training and we found inconsistencies in staff knowledge around safeguarding. This meant that safeguarding issues may not be sufficiently recognised, with the result that interventions can be indecisive or delayed resulting in people being put at risk.

Staff were not properly supported so that they could provide safe care to people living in the home as there were gaps in staff training.

Staff were not properly supported so that they could provide safe care to people living in the home. This was because there were gaps in staff training.

There were 16 people living at the home on the day of our inspection. Due to their health conditions or complex needs not all people were able to share their views about the care that they received. We observed their experiences to support our inspection.

We spoke with two people who lived there, four relatives, five staff and a visiting professional. One person said, “Every day is a happy day here.” Another person said, “The staff are very kind to us.” Visitors told us they were very happy with the care given to their relative.

People were involved in decisions about their care and were asked for their consent before care was given. Where people did not have full mental capacity to consent, care was provided in their best interests.

We looked at the records for six people. Staff had information to support people with their needs in the way they preferred. We saw good interactions between people living there and the staff. People were involved in a variety of interesting activities to join in with, if they wished to.

People were offered food, drinks and snacks that they liked and were supported and encouraged to eat and drink sufficiently to prevent their ill health.

All staff had received training including caring for people with dementia so that they had the knowledge to support the people safely in the way that they chose.

Robust audit systems were in place for monitoring and improving the quality of the service for people living in the home.