About the service: 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, both were looked at during this inspection.

The care home accommodates up to 26 older people, some who may be living with dementia, in one adapted building. At the time of our inspection 16 people lived there.

People’s experience of using this service:

¿The provider had not made sufficient improvements since our last inspection and we found a continued breach of Regulation 17 and Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, we found a breach of Regulation 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿People’ did not receive timely care. There were insufficient numbers of staff deployed to meet people’s needs safely. Not all staff had evidence that the required pre-employment checks had been completed by the provider.

¿At this inspection, the provider had still failed to identify and provide a method to safely evacuate people who resided on the first floor down the stairs in the event of a fire.

¿The provider had failed to ensure all pressure relieving mattresses had been set correctly. They had failed to ensure all accidents and incidents were reviewed to identify learning and preventative measures and reduce the risk of reoccurrence.

¿We found continued evidence to suggest staffs’ competency in moving and handling people required assessment for competency. Staff competency in moving and handling people had not been assessed since our last inspection.

¿Some staff had no evidence available to show they had been training in such areas as safeguarding people. Some staff were not confident in what incidents would require a safeguarding referral to be made to the local authority safeguarding team. Incidents of abuse and potential abuse were not assessed in line with the local authority safeguarding criteria to establish when safeguarding referrals were needed and what other actions were needed to reduce the risk of abuse.

¿Overstocks of medicine had not always been acted on and returned to the pharmacy. Actions had not always been taken to seek medical advice when a person had refused their medicines for a number of consecutive days. Creams were not always stored securely.

¿Not all steps were taken to help prevent and control infections.

¿Not all prepared foods were refrigerated in line with the provider’s policy.

¿Not all steps were taken to ensure people could be actively involved in choosing balanced and nutritious food. Fresh fruit was not always available as a snack as advertised.

¿People’s care was not always given in a way that promoted their dignity and respected their privacy. People felt most, but not all staff were caring.

¿The system to accurately monitor and track the training needs and achievements of staff was ineffective. There was limited evidence to show all staff had received up to date training to ensure their knowledge in areas relevant to people’s needs was up to date.

¿Records showed some, but not all decisions had been considered in line with the principles of the MCA.

¿Records did not show, apart from people’s religious beliefs, how any other equality and diversity needs would be assessed and discussed with people.

¿There was limited evidence people and their relatives were actively involved in their care plans and reviews.

¿Activities and resources for people living with dementia were not always made available or provided in line with the provider’s plans.

¿Assessments of people’s healthcare needs used recognised assessment tools. However, care plans did not always reflect staff practice and there was the risk people could receive inconsistent care.

¿The system in place to manage, respond and to identify learning from complaints was ineffective as not all c

This inspection took place on 11 and 17 September 2018; the first day of the inspection was unannounced.

The Beeches is a ‘care home with nursing’. 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 Beeches accommodates up to 26 people in one adapted building. At the time of our inspection 18 people lived at The Beeches.

At our last comprehensive inspection in December 2016 we rated the service as 'Requires Improvement.' At this inspection the service had not made sufficient improvements and the service has been rated 'Inadequate' overall.

A registered manager had not been in place since August 2017. 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 were not always protected from the risks associated with the use of equipment, as this was not always used as intended.

Medicines were not always managed in line with the provider’s own policies and records did not show people always got their medicines as prescribed, or in the line with the least restrictive principle.

Information for pre-employment checks completed on staff before they started work had not always been sought and records retained.

Evidence was not in place to show all staff with direct contact to people had been trained in safeguarding vulnerable adults. The acting manager had not contacted the local authority safeguarding team to advise them of potential allegations of abuse.

We saw people had their needs met by sufficient numbers of staff, however prior to our inspection, records showed staff had not always been effectively deployed to meet people’s needs in a timely manner.

People had care plans and risk assessments in place however, these were not always followed or were not up to date.

Emergency evacuation plans were in place for people however there was a lack of planning and equipment in place should an evacuation of the premises be required.

Accidents and incidents were reported; however, these were not always analysed to identify further learning and to mitigate future risks.

People are not always supported to have maximum choice and control of their lives and staff do not always support them in the least restrictive way possible; the policies and systems in the service do not support this practice because steps to ensure people’s care followed the MCA and DoLS were not always taken. Conditions associated with people’s DoLS were not always implemented.

Not all relatives felt comfortable raising issues or complaining. Not all relatives felt the service consistently responded when they had requested updates about their relative’s care.

The system to manage complaints in line with the provider’s policy required improvement.

Statutory notifications were not submitted to the CQC as required.

A registered manager is required at The Beeches; a registered manager was not in place.

Policies and procedures at The Beeches were not always current and up to date.

Systems and processes to assess, monitor and mitigate risks to people were not always effective.

Records were not always complete, legible or accurate.

Some meetings for people and relatives were held however, these were not held very frequently.

People’s views had been sought, however it was not clear how these had been considered and what improvements they had led to.

The home was clean and tidy and staff understood and followed infection prevention and control practices.

Where people were at risk from areas such as falls, they had care plans, risk assessments and alert mats in place to help prev

We inspected the service on 7 December 2016. The inspection was unannounced. The Beeches is registered to provide care and support for up to 26 older people. On the day of our inspection 13 people were living at the service and one person was at the service for short term respite.

The service had a registered manager in place at the time 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 2008 and associated Regulations about how the service is run.

When we last inspected the service on 18 May 2015, we found a breach of the legal requirement related to good governance. We asked the provider to make improvements in this area and during this inspection we found that although some improvements had been made further improvements were still required.

We found that people’s medicines were not stored, managed or handled safely. People could not always be assured that risks associated with their care and support would be effectively assessed and managed as risk assessments and care plans were not always up to date.

People were supported by staff who knew how to recognise and respond to abuse and systems were in place to minimise the risk of harm. People had access to healthcare and people’s health needs were monitored and responded to. However, people could not be assured that they would be provided with effective support in relation to their nutrition and hydration as records were not always completed as required.

People were supported by staff who received training, supervision and support. Staff had the knowledge and skills to provide safe and appropriate care and support. There were sufficient numbers of staff available to meet people’s needs.

People were enabled to make decisions about their support and were asked for their consent by staff providing care. Where a person lacked capacity to make certain decisions they were protected under the Mental Capacity Act 2005.

Staff were kind and compassionate and treated people with respect. People’s right to privacy was protected. There were processes in place to deal with concerns and complaints if they were raised.

People and their families were involved in planning their care and support, and were enabled to make choices about their care and support. Staff knew people’s individual preferences and tailored support to meet their needs. However, we found that people were at risk of receiving inconsistent support as staff did not always have access to up to date information about the support people required.

People were provided with the opportunity to get involved in activities but at times people lacked meaningful ways to spend their time.

The management team were open and friendly and people who used the service and staff felt supported and able to approach them with concerns. However, people using the service and staff had limited formal opportunity to give their views on how the service was run. There were systems in place to monitor the quality of the service however these were not always effective in bringing about improvement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We performed the unannounced inspection on 18 May 2015. The Beeches provides residential care for up to 26 people. On the day of our inspection 24 people were using the service. The service is provided across two floors with a passenger lift connecting the two floors.

The service had a registered manager in place at the time 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.

When we last inspected the service on 2 December 2013 we found people who used the service could be put at risk of receiving unsafe or inappropriate care and treatment as an accurate record of their individual care was not maintained. The provider sent us an action plan telling us they would make these improvements by 31January 2014. We found at this inspection that whilst some progress had been made further developments were required in this area.

The risk of abuse was minimised as staff training had ensured staff had a good understanding of their roles and responsibilities if they suspected a person was at risk of abuse. We also found people were encouraged to take risks and staff supported and encouraged people to increase their independence.

People were supported by a sufficient amount of staff to meet their needs. Staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and were aware of what to do when a person did not have the capacity to make a decision.

People received a balanced nutritious diet and were protected from the risks of inadequate nutrition and hydration. Referrals were made to health care professionals when needed and people received their medicines as prescribed.

People received their medicines as prescribed and medicines management promoted peoples safety.

Further developments were required to encourage people who used the service, or their representatives, to contribute to the planning of their care.

People were treated in a caring and respectful manner by staff that provided support in a considerate and understanding way.

People who used the service, or their representatives, could be involved in the development and running of the home. People also felt they could report any concerns to the management team and felt they would be taken seriously.

The systems in place to monitor the quality of service provision required further development to ensure an effective auditing process was achieved.

Prior to our inspection we reviewed all the information we had received from the provider. On the day of our inspection we used a number of different methods to help us understand the experiences of people who were using the service because some people were not able to fully tell us of their experiences. Fourteen people were residing at the home, we spoke with four people to establish their views on the quality of service provision. We also spoke with the registered manager and two care staff. We looked at some of the records held in the service including the care files. We also observed the support people who used the service received from the care staff.

We found that staff obtained people's consent before interventions were performed and where people lacked capacity to provide informed consent, the provider had acted in accordance with legal requirements. One person told us, “This is my home and I wouldn’t want to live anywhere else. I am happy here, all the girls are great. They always respect me, and my opinions.”

We found the provider had ensured that people benefited from a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences. One person told us, “The food is great,” another person said, “The food is the best. They (care staff) always ask us what we would like and always offer a choice. I just cannot fault it.”

We found that appropriate arrangements were in place to manage people’s medicines. One person told us, “I am happy for the girls (care staff) to sort out my tablets for me, and I always get them on time.”

We found that staff were only employed once an effective recruitment and selection process had been undertaken. People told us they felt there were enough staff to meet their needs and felt the staff had the right qualifications, skills and knowledge to perform their duties.

We found that systems were in place to enable people to complain or make comments about the quality of the service. People also told us they felt confident in reporting any concerns or complaints and felt safe whilst residing at the home.

We found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

During our visit we spoke with three people who use the service; two care staff; the manager; and with two partners who had operational responsibility for the service. We also spoke with three people who were visiting family members living at the service.

All of the people we spoke with who use the service told us that they were happy with the care and support they received. One person told us, “I like it here”. Another said, “They are great here, as soon as you need anything they are there”.

People told us that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed. They also told us they felt safe, knew how to raise any concerns they might have and that staff treated them with respect.

All of the staff we spoke with said the provider was very good in terms of ensuring that all staff training was up-to-date. Staff also told us the provider had given them a lot of support in their personal and professional development enabling them to undertake further, more advanced, professional training. All of the staff we spoke with told us they really enjoyed working at the service, some of which had worked there for many years.

The people we spoke with who were visiting family members all said they were very happy with the care and support they had witnessed on their visits. One of these visitors told us “I think staff have a difficult job, but they really do go out their way to do their best”.