The Beeches is a care home that provides accommodation and support for up to 54 people with a variety of physical conditions, disabilities and long term conditions. Some people living at the service were living with dementia. 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 home is set over two floors and divided into four separate living areas. Each living area has its own lounge and dining facilities. At the time of our inspection 45 people were living in the home.

This inspection took place on 5 March 2018 and was unannounced.

There was a registered manager however they had been on maternity leave since August 2017 and were not due back at the service until later in 2018. 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 and associated Regulations about how the service is run. The acting manager, who was overseeing the service in the absence of the registered manager, assisted us with our inspection. We have referred to the deputy manager as the acting manager in our report.

Safeguarding concerns had not always been notified to CQC which is a requirement of registration. We also found that records in relation to people were not always up to date. The Beeches was clean and people received the medicines they required, however we found some poor medicines management processes. We have made a recommendation to the registered provider. People told us they felt safe living at The Beeches and staff were able to give us examples of what might constitute signs of abuse.

Although quality assurance audits were carried out to check the quality of the service, we found these did not always identify shortfalls. However, there were other audits undertaken which were robust and we found actions raised were addressed.

People could take part in activities if they wished and staff actively encouraged this. The acting manager had developed new activities within the service to help people feel included. However, people told us they would like to go out of the service more.

People and staff told us there were sufficient staff to care for people and we did not see people having to wait for their care on the day. Recruitment processes were in place to help ensure that there were only suitable staff working at the service. Accidents and incidents relating to people were recorded and action taken to help mitigate reoccurrence and staff discussed events for lessons learnt.

Regular fire checks and fire drills were carried out to help ensure staff would know what to do in the event of an emergency. Individual fire information was available should the emergency services require it.

People who were unable to make their own decisions had the necessary processes carried out to help ensure that any decisions made for them were made in their best interests. Before people moved into the service their needs were assessed to ensure staff could provide the care they required. People were supported to eat a good range of nutritious foods and staff recognised people’s dietary needs.

People were cared for by staff who had access to relevant training and the opportunity to meet with their line manager on a regular basis. People were also cared for by staff who took time to involve health care professionals to help ensure people remained healthy and received effective care.

People were supported to make their own decisions and remain as independent as possible. Staff showed people respect and recognised that people may wish privacy at times. People were supported and enabled to spend time with those close to them and staff showed people empathy and attenti

The Beeches is a care home that provides accommodation and support for up to 54 people. Some of whom are living with dementia. Accommodation is arranged over 4 units each with its own dining and lounge facilities. A lift provides access to the first floor. The home is owned and oTperated by Anchor Trust.

The home had a registered manager in post on the day of our inspection. 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 and associated Regulations about how the service is run.

People told us they were treated well by staff who were kind and caring. People’s privacy and dignity was respected. We saw staff knocked on people’s doors before they entered, and personal care was undertaken in private.

People told us they felt safe. Staff had undertaken training regarding safeguarding adults and were aware of what procedures to follow if they suspected abuse was taking place. There was a copy of Surrey County Council’s multi-agency safeguarding procedures available in the home for information and staff told us this was located in the office for reference.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be kept safe. However we noted that not everyone who required a DoLS authorisation had an application in progress.

Staff had a good understanding of the Mental Capacity Act 2005 and had undertaken training in this. We observed that some mental capacity assessments had not been completed correctly and were not signed or dated.

Risk assessments were in place where people had an identified risk. For example a person was required to have a soft diet because they were at risk of choking, and people who were at risk of falling had manual handling risk assessments in place to protect them from being hurt due to excessive falls.

Care plans were well maintained, easy to follow and information was reviewed monthly or more frequently if needs changed. For example someone was having ongoing speech and language intervention for swallowing difficulties which was clearly documented.

People’s health care needs were being met. People were registered with a local GP who visited the home weekly. Visits from other health care professionals for example care managers, and district nurses also took place.

People had sufficient food and drink to keep them healthy. We saw lunch was well organised and people had the choice of four dining areas. There was sufficient staff support available for people who required help to eat. Where people had an identified risk in relation to nutrition this was managed well by staff.

We looked at the medicine policy and found all staff gave medicine to people in accordance with this policy. Medicines were managed safely, stored securely and people received their medicines in a safe and timely way. Staff were trained appropriately in the administration of medicine.

There were enough staff working in the home to meet people’s needs. People said the staff were very good and they did not have to wait too long when they required assistance. We saw several examples of staff responding to call bells in a timely way throughout the day.

Staff recruitment procedures were safe and the employment files contained all the relevant documentation and safety checks to help ensure only the appropriate people were employed to work in the home.

The activity coordinator showed us the activity arrangements in place. People were engaged in activities during the day and these were organised on individual units. People had been provided with a complaints procedure and knew how to make a complaint should they need to. They told us they knew who to talk to if they had issues or concerns.

People had been provided with a complaints procedure and knew how to make a complaint. They told us they knew who to talk to if they had any issues or concerns.

There were effective quality assurance systems in place to monitor the service being provided, for example reviews of care plans, risk assessments, and health and safety audits.

The home was being well managed. People relatives and staff said they found the registered manager approachable and available. Staff told us they felt valued and feedback from people about the quality of the service was positive.

Records relating to the care and treatment of people were stored securely and maintained accurately.

This was a follow up inspection because at our last inspection on 19 November 2013 we found the registered person was not fully meeting the regulations set out in the Health and Social Care Act 2008. The registered person sent us an action plan telling us what actions they would take and gave us 31 March 2104 as the date they would become compliant with the regulations.

At this inspection we found the provider had taken appropriate steps to ensure that people who used the service now had records including medical records in place that were accurate and fit for purpose.

We also looked at the staffing arrangements in the home to ensure that there were sufficient staff employed in the home to meet the assessed needs of the people living there.

During the inspection we spoke with twelve people who used the service, four relatives, the business manager, care manager, chef manager and six members of care staff.

People told us that they received good care from staff who knew their needs well. They said that they enjoyed the food provided by the home and that there was a good choice of meals available. We saw evidence that where dietary needs had been identified, they had been communicated to the catering staff and referrals to appropriate professionals had been made.

Since our last inspection, concerns about the management of medication at the home had resulted in a multi-agency safeguarding investigation. At this inspection we found that the provider had taken action to improve the management of medication

At our last inspection we found that staff did not have adequate opportunities to receive feedback about how they were performing or to discuss their training needs or professional development. At this inspection we found that the systems in place to support staff had improved but would benefit from further development.

We checked a sample of care records and found that some contained inaccuracies that could have affected people’s safety or welfare. For example the information recorded on some falls risk assessments was incorrect and, as a result, the assessments did not identify any measures to manage the risks to people.

During the inspection we spoke with 12 people who used the service, five relatives, nine care staff and the registered manager. We found that people were happy with the care they received. Residents told us that staff were available when they needed them and that they knew the staff who provided their care, which was important to them. They said that staff were polite and treated them with respect.

Relatives confirmed that their family members received good care and support. Relatives said they were consulted about their family member’s care and involved in any important decisions that were made. We found that, whilst staff knew the needs and preferences of the people they cared for, the sharing of information about any changes to the delivery of care needed to improve.

We found that the provider had an effective complaints procedure and that complaints were investigated and responded to appropriately. The staff we spoke with during the inspection were aware of their responsibilities in relation to recognising and reporting abuse. Staff told us that they had received a comprehensive induction when they started work and that they had access to the training they needed. However we found that staff did not have regular opportunities to receive feedback about their performance or to discuss their professional development.

People told us that they liked living at The Beeches. They liked the idea of individual units because it provided a small and friendly atmosphere. They told us that they liked their rooms and that it was important to them to be able to bring personal possessions with them. They said it made the decision of living in a care home easier having a little bit of home with them.

Service users told us that the staff were kind and considerate and were always available when required. They said some were better than others.

They told us that they are consulted about their care and how this is delivered. They are aware of care plans and are involved in reviews of care.

Relatives were satisfied with care outcomes They said they are kept informed of changing needs, and invited to participate in events in the home. Generally there was good feedback about the food provided and people said that the meals were tasty, appetising, with plenty of choice.

Some people told us that they enjoyed the activities. They said they liked to visit other units and join in the planned activities. Music, bingo and visiting the café were some of their popular choices.