This announced comprehensive inspection took place on the 25 and 26 July 2017. At the last inspection on 15 and 23 June 2016 we asked the provider to take action to make improvements to systems and processes to support and record that staff had the required up to date qualifications, skills and experience necessary to ensure they were competent in undertaking their role and that this was regularly reviewed. This action has been completed.

The Beeches is a care home for up to 11 people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. The service has spacious grounds with a parking area, good transport links and within walking distance of the local amenities.

A registered manager was 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.

Risk assessments were detailed and included the necessary information about each individual's specific needs and guidance on how to provide person centred care. Staff had excellent knowledge of people’s needs and how to adopt a positive approach to supporting those needs.

Emergency evacuation plans were in place. The manager was considering whether or not to include a photograph of each person which would assist in the event of a fire occurring. We also discussed a specific folder to hold everyone’s Personal Emergency Evacuation Plan (PEEP) for quick access by the fire warden. The manager advised he would look at putting these in place.

Care was planned in partnership with people living at the service and their relatives. The management and staff were committed to working with people. This created a family atmosphere which was apparent from talks with staff and people living at The Beeches.

People were treated with respect and compassion and were relaxed with staff. They told us they felt safe and that there was always enough staff on duty to meet their needs. Staff could identify different types of abuse and knew what actions to take if they witnessed any abuse or had concerns.

Everyone living and working at the home felt valued for their contribution in creating as close to a family environment as possible. This was regularly referred to as the, ‘The Beeches family’ during the inspection. The management were continually trying to improve their service and ensured staff and people living at the home were able to give feedback and ideas to feed into this process. Regular staff and residents meetings were held to plan future events and discuss any concerns or ideas for improvement.

The Beeches encouraged reflective practice in their staff team. Systems were in place to monitor and check the quality of services to identify where improvements were needed or where best practice had been effective.

The management structure was clear and all staff and people living at the service knew the manager by name. We observed positive interactions between people, staff and the manager and could see that the ethos of allowing staff to be led by individuals living at the service was embedded across the organisation.

People were supported to cook meals for the group or for themselves and staff encouraged independence by offering assistance to go shopping for ingredients. We could see that people’s preferences were in their care plans, and had also been catered for on the day of this inspection. Staff understood people’s specific dietary requirements and these were catered for accordingly.

People’s capacity to make decisions was regularly assessed and where people lacked mental capacity other options were exhausted before decisions were taken in their best interests. Involvement with health professio

The inspection took place on the 15 and the 23 June 2016. The inspection was unannounced. The previous inspection was completed in August 2015 and was a focused inspection to look at compliance against a previous breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was compliant with the outcomes assessed.

The Beeches is a care home for people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. It can accommodate up to 11 people under the age of 65. The home is located on the outskirts of the village in spacious grounds with parking and is close to local amenities and transport routes.

The Beeches has two registered managers who work as a job share. 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 we spoke with were positive about the care and support they received and it was evident from our inspection that care was person centred. People told us they felt safe and we found that staff knew how to protect people from avoidable harm. Staff knew how to recognise different signs of abuse and they were clear about what action to take if they suspected abuse was taking place. The registered provider had a safeguarding policy in place that had been updated to align with local authority guidelines.

We looked at staff rotas. Staff and people living at the home told us there was enough staff on duty and staffing levels were regularly reviewed to ensure that there were sufficient numbers to meet people’s changing needs. However, we saw the registered provider did not have a robust system or process in place to support and record that staff had the required up to date qualifications, skills and experience necessary to ensure they were competent in undertaking their role and that this was regularly reviewed. This was a breach of regulation 17(2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of this report.

People were encouraged to live as independently as possible and we saw detailed risk assessments and risk management plans were in place to enable people to live independently and undertake a variety of daily activities in a safe way.

We saw risk assessments for the home and the environment. However, these did not include personal emergency evacuation plans (PEEPs) for each individual person. PEEPs are documents that advise of the support people need in the event of an emergency evacuation taking place.

We looked at monthly checks on portable appliances, fire extinguishers, water temperatures and saw that these were all up to date and helped to ensure the safety of the premises for people.

The registered provider had a policy and procedure in place for the safe management of medication. However we saw where medication was required to be refrigerated it was stored in the food refrigerator in the kitchen. The registered provider told us a recent medication audit had failed to identify this as a breach of regulations and they told us they would obtain a separate refrigerator from their provider to store medication. We made a recommendation for the registered provider to followed guidance in this respect from The Royal Pharmaceutical Society.

Management and staff had received training in and understood the requirements of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Where people may have lacked capacity

We carried out an unannounced comprehensive inspection of this service on 19 February 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach in respect of poor recruitment and selection practices.

We undertook this focused inspection to check that they had followed their plan and to check that they now met legal requirements. This report covers our findings in relation to those requirements. 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 for people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. It can accommodate up to 11 people under the age of 65. The home is located on the outskirts of the village but still close to local amenities and transport routes. 

The registered provider is required to have a registered manager in post and on the day of the inspection the home was being managed by two people on a ‘job share’ basis. Although neither manager was registered with the Care Quality Commission (CQC), both had submitted applications for registration. 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 inspection on 5 August 2015 we found that the registered provider had carried out the improvements that were recorded in their action plan. There was a policy in place on the use of CCTV cameras, people at the home were aware of the location and purpose of the CCTV cameras and there was evidence that their consent had been sought.       

The inspection took place on 20 February 2015 and was an unannounced inspection.

The last inspection of this service was on 29 July 2014 when the service was meeting all of the relevant requirements.

The Beeches is a care home providing care and accommodation for up to 11 people under the age of 65 who have learning difficulties and mental health conditions.

There was no registered manager in post on the day of the inspection, although the current managers told us they are in the process of applying for this role. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the Mental Capacity Act 2005 (MCA) legislation which is designed to ensure that the human rights of people who may lack capacity to make decisions are protected. Some staff had completed training on the MCA and discussion with the manager indicated that there was a clear understanding of the principles of the MCA and DoLS.

A security camera was in use in the home but people had not been consulted about this and no information was on display to help people be aware of this. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now replaced by 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.

People felt safe living in the home. Staff had completed appropriate training and systems were in place to support people should an allegation of harm be raised.

People were supported with risks and systems were in place to reduce risks and support people to live their lives.

People were supported by adequate numbers of staff who were recruited correctly. Recruitment checks were in place to help make sure potential staff were suitable to work with vulnerable adults.

People were supported by staff to make sure their needs in relation to their health were met; this included any medication needs. Some of the paperwork in relation to people’s health needs required improvement.

People were supported by staff who received an induction and training in their role. However, some improvements were required with staff training.

People were happy living in the home and felt staff respected them. We observed positive interactions between the people who lived in the home and the staff team. People were supported to make choices. This included what to do each day and what to eat.

People were supported through care planning systems which identified their needs and the support they required. Information recorded the person’s choices, likes and dislikes.

People felt able to approach the managers and professionals felt there was a “Good working relationship.”

People who lived in the home and staff were consulted about the home. Quality audits were taking place but there were no systems to identify any improvements needed or how learning from audits would be shared with staff.

One inspector carried out this inspection 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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

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

Is the service safe?

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people’s choices and decisions. Care records were up to date.

People told us “We get our medicine on time and when we need it” and we found that appropriate arrangements were in place in relation to recording, handling and safely administering medicines to people who used the service.

The provider set the staff rotas. Records showed that at times there were fluctuating levels of staff which had the potential to impact on the staff’s ability to meet people’s care needs. We have asked the provider to send us additional information showing how they are monitoring the staffing levels to ensure they continue to meet people’s care needs.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was some evidence of people being involved in assessments of their needs and planning of their care. People said they could discuss their care with the staff or manager and on the whole felt well supported and cared for. One person who used the service told us “I like living here. I can do lots of things myself, but the staff are around when I need them.”

Is the service caring?

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives.

We spoke with four people who used the service. One person said "The staff couldn't do more for us. I like living here in the home." Another person told us "The staff take good care of me." We saw that people who used the service were encouraged to live individual lifestyles in what they did each day, what they wore, what their interests were and what support they received.

Is the service responsive?

We saw that there was a complaints policy and procedure on display that was accessible to people who used the service. We spoke with four people and they said they could talk to the staff or care managers if they had any problems. They told us they felt happy and safe within the service and that any issues they had were dealt with quickly. We saw that a record of complaints was kept by the provider, however the recording of these could have been clearer.

Is the service well led?

We found that the service was being managed by two care managers who were not registered with the Care Quality Commission (CQC). We have asked the provider to notify CQC about the recent change in registered manager so that we can update the information we hold about the service.

We found sufficient evidence to indicate that the care managers had made a start on developing an effective quality assurance system within the service, so that people who used the service were not at immediate risk. However, we also saw that further work was needed to develop the audit paperwork and action plans in order to move the service forward and enable the provider to sustain their compliance.

We wrote to the provider following our inspection. We asked the provider to send us additional information on a fortnightly basis to evidence how the service was being assessed and monitored and how risks were being managed.

We undertook this inspection to review previous areas of non-compliance for infection control and also concerns raised in relation to medication.

People we spoke with did not raise any concerns and told us they were happy in the home.

We found that the provider had taken action to address the previous areas of non-compliance, this included additions to the policies in the home, the introduction of a cleaning schedule and the purchasing of new washing and drying machines.

Staff teams had been developed and roles amended to ensure that cleaning took place and people who lived in the home were now more involved in the daily maintenance.

Some work was still required to ensure that the cleaning of the pet areas was to an acceptable standard. Formal audits in relation to infection control were not yet in place.

We found that medication systems were established in the home but improvements were required to ensure that people continued to receive their medication in a timely manner. This included improvements to the recording systems in use to reduce risks.

We visited The Beeches and looked at the care and welfare of people who used the service. We found that people were very happy with the support they received. One person told us “I like living here and I feel very well cared for”. We saw that people signed their care plans to consent to the support they were given. We also observed care staff asking for people’s consent before giving any support.

There was clear evidence of the provider working co-operatively with other services and appropriate referrals were made when people required input from health and social care professionals. Staff showed a good understanding of infection control procedures. The service required some improvements and development to ensure cleanliness and hygiene were improved and infection control was maximised.

We saw evidence that staff received effective development, supervision and training. Staff told us they felt well supported. One staff member told us “I feel well supported in my role and get the help I need from managers”. There was a robust system in place for quality assurance and this was being further developed by the managers. People who used the service and staff were given opportunities to give feedback and this was acted upon.

People told us that “I tell staff what I am doing and I say I am doing … today” and “I choose what to do, when I get up or go to bed” and confirmed that they could choose their meals. People confirmed to us, “Yes” when asked if they were supported to access other professionals to ensure their needs were met. They said that the food was “Alright” and that they felt supported to have their needs met. Additionally people told us they felt safe living in the home.

People were supported with decision making in their lives and were able to live their lives as they wished. People had choices in their days and felt that they had plenty of activities to undertake and their needs were met.

Staff were recruited through a formal recruitment process and had been trained in and were aware of the safeguarding of vulnerable adults.

There was a quality assurance system in the home and records of any accidents or incidents were kept.

We spoke to three residents informally about their care. One resident was proud of her room and expressed her satisfaction with the care she receives. Two other residents spoke approvingly of the programme of activities the home provides, and the opportunities for travel and family contact.