Our inspection took place on 2 November 2018 and was unannounced.

At our last inspection in September 2017 we rated the service as ‘Requires Improvement’, and identified two breaches of regulation in relation to safe care and treatment and need for consent. On this inspection we looked to see what action had been taken to make sure the service had achieved compliance with these regulations.

The Beeches is a care home. People living 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 Beeches provides accommodation and personal care for up to 23 older people, some of whom were living with dementia. The accommodation is over two floors, with a passenger lift to provide access. There are communal lounges and a dining room on the ground floor.

There was a registered manager in post when we inspected 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.

People told us they felt safe living at The Beeches. Premises were well maintained and staff understood how to recognise signs of potential abuse and their responsibilities to report these. The home was clean and well maintained. Improvements had been made to make sure medicines were managed safely.

Staff were recruited safely and received training and support appropriate to their role. People told us there were enough staff available to meet their needs safely and in a timely fashion.

When accidents occurred we saw these were reported and investigated appropriately. The registered manager audited accidents to look at ways in which the risk of reoccurrence could be minimised.

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. Improvements had been made in relation to the process for making decisions in the best interests of people who lacked capacity and conditions on Deprivation of Liberty Safeguards were being met.

People told us they enjoyed the food at the home and had plenty of choice. We saw the food was of good quality and people were supported to enjoy the mealtime experience. Visitors were invited to share a meal with their relative.

People were supported to access health and social care professionals when needed. A visiting district nurse told us they were very happy with the health care provided at The Beeches.

People and relatives were unanimous in their praise of the standard of care provided. Our observations during the inspection confirmed this.

Some care plans required further development to demonstrate the person-centred approach we observed.

People told us they enjoyed the activities provided at the home.

Processes were in place to make sure complaints were managed appropriately. People told us they would not hesitate to speak to staff if they had any concerns.

Systems were in place to monitor and improve quality and safety in the home, including audits, meetings and surveys. The management team had responded well to suggestions made at the previous inspection to improve the auditing process.

People who lived at the home, relatives and staff were complimentary of both the registered and deputy manager.

We found sufficient action had been taken to comply with regulations identified as being breached at the last inspection and did not identify any breaches of regulation on this inspection.

Our inspection took place on 25 September 2017 and was unannounced.

At our last inspection we rated the service as ‘Good’, and did not identify any breaches of regulation.

The Beeches provides accommodation and personal care for up to 23 older people, some of whom were living with dementia. The accommodation is over two floors, with a passenger lift to provide access. There are communal lounges and a dining room on the ground floor.

There was a registered manager in post when we inspected 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.

People told us they felt safe living at The Beeches. Premises were well maintained and staff understood how to recognise signs of potential abuse and their responsibilities to report these. Premises were well maintained. However, we found medicines were not always managed safely, and identified a breach of regulations.

Staff were recruited safely and deployed in sufficient numbers to provide safe care and support, and the registered manager planned to work with the provider to develop a tool to help calculate safe staffing levels based on people’s needs.

When accidents occurred we saw these were reported and investigated appropriately.

People’s capacity to make decisions was not always well recorded, and where best interests decisions were required there was not always documentation in place. The registered manager was recognising when applications for Deprivation of Liberty Safeguards (DoLS) were needed, however we saw one DoLS had conditions attached to the authorisation which were not being met. We identified a breach of regulation associated with this.

People told us they enjoyed the food, however we saw people did not always receive effective support at mealtimes. We observed the lunchtime meal was not well organised, and the registered manager was candid in raising this with us before we gave feedback.

We saw people were supported to access health and social care professionals when needed.

Staff received an effective induction and had good access to on-going training. Supervision and appraisal meetings were regular and meaningful. People told us they had confidence in the staff’s ability to provide effective care.

People and relatives told us the staff were caring, and we made observations that confirmed this. We saw a good approach to maintaining people’s privacy and dignity, and staff we spoke with knew people well.’

The provider assessed people’s needs before they began using the service, and used this information to write a series of individualised care plans, which were kept up to date. Care plans reflected people’s individual needs and preferences, although we did not see evidence of people or their relatives being involved in this process.

There was a programme of activities and relatives confirmed activities took place.

We saw there were processes in place to ensure complaints were managed appropriately, and people and their relatives told us they would be happy speaking with the registered manager if they had any concerns.

We received good feedback about the registered manager. Staff described them as approachable and said the registered manager regularly worked alongside them providing care.

There were a number of systems in place to monitor and improve quality in the home, including audits, meetings and surveys. Although audits were up to date we discussed some changes which could be made to strengthen this activity.

During the inspection we identified two breaches of regulation. 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 27 April 2015 and was unannounced. This is the fifth inspection that CQC has carried out since July 2013. In July 2013 the provider was found not to be appropriately managing medicines or assessing and monitoring the quality of service provision. In November 2013 the provider had improved systems to assess and monitor the quality of the service but had not improved how they managed medicines so a warning notice was served. An inspection in March 2014 found they had improved their arrangements for managing medicines and they achieved compliance with the Regulations.

At the last comprehensive inspection in July 2014 we found breaches in regulations because people were not protected against the risks associated with unsafe or unsuitable premises, staff were not adequately trained and people were not protected against the risks of unsafe care arising from a lack of proper information about them by means of an accurate record. The provider did not have suitable arrangements for assessing and monitoring the quality of the service or for ensuring people were consenting to their care and support.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to each breach. We also met with the provider and discussed our concerns about the continued breaches in regulation. At this inspection we found that the provider had completed their plan and legal requirements had been met. We rated one domain as requires improvement. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

The Beeches is a care home registered to provide personal care and accommodation for up to 23 older people. The home has several communal areas including three lounge areas and a dining room. Accommodation is provided on the ground and first floor. There are four double rooms and 15 single rooms. 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.

At this inspection we found people were happy living at The Beeches. They told us the staff were kind and caring. We saw people received good support and enjoyed the company of staff.

People enjoyed a range of social activities and had good experiences at mealtimes. Health professionals told us people were well cared for and the home contacted other professionals appropriately which ensured people’s health needs were met.

The provider had systems in place to protect people from the risk of harm. Staff understood how to keep people safe. We found people lived in a safe environment and were protected against the risks associated with medicines.

Staff demonstrated they knew people well and had a good understanding of their support requirements. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs.

There were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. The provider had a programme of training and supervision, and staff felt supported.

The service had good management and leadership. People were involved in the service and helped to drive improvement. Effective systems were in place that ensured people received safe quality care. People told us they would feel comfortable raising concerns or complaints.

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 is 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.

This was an unannounced inspection carried out on 30 July and 13 August 2014.

This is the fourth inspection that CQC has carried out since July 2013. In July 2013 the provider was found not to be appropriately managing medicines or assessing and monitoring the quality of service provision. In November 2013 the provider had improved systems to assess and monitor the quality of the service but had not improved how they managed medicines so a warning notice was served. An inspection in March 2014 found they had improved their arrangements for managing medicines and they achieved compliance with the Regulations.

The Beeches is a care home registered to provide personal care and accommodation for up to 23 older people. There were 17 people staying at the home when we visited. The home has several communal areas including three lounge areas and a dining room. Accommodation is provided on the ground floor and first floor. There are four double rooms and 15 single rooms.

The home has 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.

We saw people’s safety was being compromised because the provider did not always make sure people were protected against the risks of unsafe premises. Some décor around the home was damaged and worn. The provider had identified they needed to decorate but there was no plan to show when this would be carried out. Appropriate systems were in place to ensure the home was clean and people were protected against the risk of infection.

Staff were not always following the requirements of the Mental Capacity Act 2005 which meant people who lacked capacity were not being supported to ensure they received appropriate care. The provider had not completed mental capacity assessments even though people could not make some decisions.

Our observations showed some aspects of care focused on getting the job done and did not take account of people’s welfare and individual preferences. Staff were getting some people up early in the morning and one person was regularly bed bathed during the night. We also observed caring interactions between staff and people who used the service. Staff were attentive and showed respect and kindness when they offered support. People told us they well cared for and did not raise any concerns about the home.

People were supported by sufficient numbers of staff. Checks were carried out prior to the staff starting work; however, they did not receive a comprehensive induction when they started work. And although they had a programme of training, supervision and appraisal, staff competency was not checked following completion of ‘workbook’ training.

People received a choice of suitable healthy food and drink ensuring their nutritional needs were met. At meal times appropriate assistance was provided.

People’s needs were assessed and care and support was planned. However, accurate records were not always maintained in relation to the care provided so at times we could not be sure the care delivered was in line with their individual care needs.

The provider had a system to monitor and assess the quality of service provision although this was not always effective because there was evidence that risk was not always assessed and managed.

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 the report.

At previous inspections we had found that appropriate arrangements for safely handling medicines were not in place and in December 2013 a warning notice was issued in respect of non-compliance with Regulation 13. At this inspection we found significant improvements had been made and overall we found medicines were now being safely and appropriately managed.

We checked the medicines records and stocks of nine people who used the service. None of these people were able to speak with us about their medicines on the day of our visit, however we looked at a recent resident survey and saw that no-one had expressed any concerns about how their medicines were handled.

At our previous visit in July 2013 we found people were not protected against the risks associated with medicines. Also, the provider had not been appropriately reporting to the Care Quality Commission (CQC) as per legal requirements.

At this visit we saw formal applications had been submitted to the CQC to remove Regulated Activities relating to the provision of nursing care to reflect the change to the service provided. There was a Registered Manager in post, and a process was in place to submit statutory notifications about incidents that affect the health, safety and welfare of people who used the service.

We spoke with five of the 16 people living in The Beeches who told us they were happy living in the home. One person commented, “I’m very well looked after.” We also spoke with two visiting relatives who also said they were happy with the care provided by the home and said they had no concerns. They told us they felt able to speak with staff if they had any issues.

We found all care workers handling medicines had completed certificated medicines training and had been assessed as competent in the homes medicines procedures. However, we found that the action plan had not been fully effective in bringing about improvements in medicines handling. For example, we again found that appropriate arrangements were not in place for recoding the application of prescribed creams. This meant it was impossible to tell whether creams were being used correctly, as prescribed.

At the time of our visit there were 13 people living in The Beeches. Throughout our visit was observed staff treated people with dignity and respect. We spoke with five people who lived at The Beeches. They said they were happy living in the home. They told us staff looked after them well and the felt able to express their views.

Staff told us they had a good working relationship with professionals from other agencies and how they sought advice and support from these specialists to provide appropriate care to meet people’s needs. We spoke with a visiting health professional who confirmed this and told us that the staff at the home followed their clinical recommendations to meet the needs of the people in their care.

Care workers administering people’s medicines had not completed assessed training in the safe handling of medicines. The manager showed us that a course had been chosen, but care workers had not yet been enrolled onto it.

During this visit we the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We found a programme of redecoration and general maintenance was in place.

The Beeches were not reporting important events that affect the health safety and welfare of people who live in the home to the CQC as required. We discussed this with the manager who acknowledged he had overlooked the submission of statutory notifications. He provided assurance he would comply with this from now on.

People told us they liked living in the home and they felt safe .One person said they have everything they needed. Another said they liked their bedroom.

People told us they liked those caring for them.

Two visiting relatives said they were very happy with the care and support offered by the home and felt that their relatives care needs were met. They said that they were more than happy with the care staff and the nurses working in the home and felt they were kept up to date about their loved ones progress.They also said if they have any complaints they can speak to staff and it is sorted right away.

However one person living in the home said they had to complain twice once about the food and once about a member of staff but nothing was done about them.

People say they like living in the home. One person says the staff are really very good, the meals are good and they can chose what to do. One relative said they are fully involved and have a say in how their relative is cared for. They went on to say that their relative has come on in leaps and bounds since moving to the home. Another person said moving into the home was the best thing they had ever done.

People living in the home say that they like living in the home and they feel safe and supported. One relative said the care staff are very good indeed and their relative is treated with dignity at all times. Another person using the service says they are well cared for and treated very well indeed.

People say they like living in the home and have their own living space as they want. One person says they have everything they need. One visiting relative said their relatives’ room is very nice, is clean and well kept.

People say they like those caring for them. One person said the staff are very good and listen to what they say. One visiting relative says the staff are wonderful and very caring.

People say they like those caring for them. One person said the staff are very good and listen to what they say. One relative says the staff are wonderful and very caring. They went on to say that there are always staff around if they need them.