We inspected the service on 3 January 2018. The inspection was unannounced. The Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is also registered to provide domiciliary care to people who live in their own home.

The Beeches is registered to provide accommodation and personal care for 22 older people. There were 20 people living in the service at the time of our inspection visit. The service was also providing care calls for two people who lived in their own home to provide assistance with tasks such as washing and dressing, promoting continence and managing medicines.

In this report we refer to the two services as being the ‘residential provision’ and the ‘care at home provision’. In addition, when we speak about issues that affect the staff working in both parts of the service we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 1 February 2016 the service was rated, ‘Good’.

At this inspection the service was rated, ‘Requires Improvement’.

We found two breaches of regulations. This was because the registered persons had failed to suitably assess risks to the health and safety of people who used the residential provision and had not done all that is practical to keep them safe. As a result people had not always received harm-free care and had not been safeguarded from the risk of avoidable accidents and other untoward events.

We also found that the registered persons had not suitably assessed, monitored and improved the quality and safety of the carrying on of the regulated activity that was delivered in the residential provision. This was because quality checks in relation to this part of the service had not always resulted in shortfalls quickly being quickly put right. In addition and in relation to both parts of the service, the registered persons had not made robust arrangements to ensure that the service complied fully with a number of regulatory requirements. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. We found that background checks on new care staff had not always been completed in the right way. However, in both parts of the service most of the necessary arrangements had been made to manage medicines safely. In addition, people were safeguarded from the risk of abuse and sufficient care staff had been deployed. Furthermore, in most instances lesson had been learned when things had gone wrong.

Some parts of the residential provision were not designed, adapted and decorated to meet people’s needs and expectations. However, suitable arrangements had been made in both parts of the service to promote positive outcomes for people including seeking consent to care and treatment in line with legislation and national guidance. Although in practice care staff knew how to care for people in the right way, some of them had not received all of the training that the registered persons considered to be necessary. However, in both parts of the service arrangements were in place that were designed to assess people’s needs and choices so that care was provided to achieve effective outcomes. Also, in both parts of the servi

The visit on 02 September 2014 was a follow up visit from our inspection on 09,12 and 14 May 2014. The provider sent us an action plan telling us how they were going to become compliant. They told us this would be achieved by 30 August 2014.

We did not speak with any people who used the service on this occasion but we spoke with the manager and staff.

Since our last visit the provider had reviewed how they were checking on the quality of the service provided. A number of audits had been put in place to check different systems, gather the views of people who used the service and took into consideration staff views.

Any actions had been completed and signed by the manager when this had taken place.

At the time of our inspection there were seventeen people living at the home, and the provider's domiciliary care service was providing care and support for fourteen people living in their own homes.

We spoke with five people who lived at the home and the relatives of one person who lived at the home.

One person who lived at the home told us “There is enough staff to look after us but the activities coordinator has been off sick for a month and we haven’t been doing anything since.”

Another person told us “There have been considerable changes since I first came to live here. We don’t have any meetings to discuss how we would like things to be done.”

We also spoke with two members of care staff. One member of staff told us she had not undertaken an induction programme and that she had not been given any training in care related issues.

During our visit we found that the provider was not meeting the required standards in relation to consent, care and welfare of people who use services, the safety and suitability of premises, supporting workers, and records.

Everyone we spoke with talked positively about the staff and felt they supported their care needs. People told us the staff spoke with them in a calm and respectful manner. One person said, "This is my home."

The people we spoke with told us their care was personalised to their needs. People's preferred names were used. All but one person living there, who we spoke with, told us they knew staff kept records on them and had seen those records and discussed their content.

People told us they felt safe and if they were concerned about anything they would discuss it with a member of staff. One person said, "All the staff are pleasant and approachable." Another said, "I feel safe in their hands." People confirmed their views were sought through regular meetings with staff, quietly in the privacy of their rooms and by group meetings and questionnaires. This was confirmed by the records reviewed.

We inspected The Beeches on 3 & 10 November 2015. This was an unannounced inspection. The service provides care and support for up to 22 people. When we undertook our inspection there were 22 people living at the home. They also provided a service where people were looked after in their own homes.

People who used the service were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provides end of life care.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect them. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff. The staff knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. Staff took into consideration the times people in their own homes said they wanted staff to visit and those times were respected.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.