About the service: The Beeches is a residential care home providing personal care. At the time of the inspection, 13 adults were living at the home.

People’s experience of using this service: People were safe and protected from avoidable harm and relevant risk assessments were in place. The management of people’s medicines were safe. The premises and equipment were clean and maintained.

Recruitment procedures were in place to reduce the risk of employing unsuitable staff. There were enough staff on duty to ensure people’s needs were met. New staff received support to help them learn their role. All staff received regular supervision and on-going training.

People were supported to eat and drink. Where people had specific dietary needs, this was adhered to.

Communication was effective within the staff team and people were supported to access other healthcare professionals as needed.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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. People were able to participate in their hobbies and interests.

Staff were caring and kind. People were treated with dignity and respect, they were involved in making daily decisions and encouraged to retain their independence.

Care plans were personalised and detailed. They included information about people’s preferences and abilities. Staff supported people to participate in a range of activities. At the time of the inspection care records did not include information about people’s preferences in the event their health deteriorated.

Staff felt supported and spoke positively about the registered provider and the registered manager. Systems of governance were in place to continually monitor the quality of the service provided. Regular meetings were held with people who lived at the home and the staff team. There was a system in place to manage complaints.

Rating at last inspection:

At the last inspection the service was rated good (published 11 November 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor the intelligence we receive about this service until we return to visit as part of our re-inspection programme for those services rated requires improvement. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 19 September 2016 and was unannounced. At our last inspection of the service on 1 July 2014 the registered provider was compliant with all the regulations in force at that time.

The Beeches is a care home for young adults with profound complex needs. It is part of the Hollybank Trust which is an organisation specialising in providing education, care and support for young people and adults with profound complex needs. The service is registered to offer up to 13 people with accommodation and care (which does not include nursing care).

The registered provider is required to have a registered manager in post, but the last manager was deregistered in February 2016. At the time of our inspection there was an acting manager in place, but they were not in the service during our inspection. 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 2008 and associated Regulations about how the service is run.

People told us that they felt confident about their safety. We found that the care staff had a good knowledge of how to keep people safe from harm and the staff had been employed following robust recruitment and selection processes. We found that the management of medication was safely carried out.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

People that used the service were cared for and supported by qualified and competent staff that were regularly supervised and received appraisal regarding their performance at work. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. They told us they were satisfied with the meals provided by the service. People had been included in planning menus and their feedback about the meals in the service had been listened to and acted on.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the service. People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

We observed good interactions between people who lived in the service and staff on the day of the inspection. We found that people received compassionate care from staff who were keen and who knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that the manager met with people on a regular basis to discuss their care and any concerns they might have. This meant people were consulted about their care and treatment and were able to make their own choices and decisions.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these wherever possible. This ensured people felt satisfied and were enabled to take control of their lives.

The people who used the service and the staff told us that the service was

We considered all the evidence we had gathered under the outcomes we inspected. We

used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• 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 using the service, the staff supporting 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 were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had been trained to understand when an application should be made, and in how to submit one.

Systems were in place for the ordering, storage, administration, recording and disposal of medication. Medication checked was found to be appropriately stored and medication administration records had been correctly completed to provide a clear audit trail.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, mobility and

equipment needs had been identified in care plans where required. People told us that

they had been involved in writing them and that they reflected their current needs. Action had been taken to involve specialists such as speech and language therapists and dieticians when necessary, to ensure the changing needs of the people using the service were identified and planned for.

We talked with the staff and watched their interactions with people using the service during our visit. We observed staff spending time and engaging with the people living at The Beeches in a respectful and dignified manner.

Is the service responsive?

We looked at the personal files of two people who lived at The Beeches during our visit and found copies of assessments and care planning information. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. Records viewed confirmed care plans had been kept under monthly review.

People using the service had individual activity programmes / timetables to enable them to follow their preferred daily routines and activities. This helped people to develop a range of daily living skills and to pursue social and recreational activities of their choice.

Is the service well- led?

The Beeches had a registered manager in place who provided leadership and direction to the staff team.

The service continued to utilise a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives. This information was used by the provider and manager to ensure the on going development of the service.

We looked at the care records of three people. We saw they contained detailed up to date information about their care needs. We saw evidence through our observation of care and review of care records that people's care and welfare needs were being met.

We spoke with three people who lived at The Beeches and they told us it was a nice place to stay. They gave us examples of how they were supported to be independent such as, doing their own washing and taking part in self advocacy groups.

We looked around the home and saw that it was clean and well maintained. Call bells were available and in working order. The fire safety equipment such as fire extinguishers were available, and had been tested to ensure they met the required health and safety standards. We spoke with the cleaning manager who told us about the various cleaning and infection control audits conducted.They also told us about the five year maintenance plan which was being developed.

We spoke with six adults who live at The Beeches. They all told us that they were happy an received good care. They told us that they were involved in making decisions about how the home is run. We spoke with two relatives over the telephone and they were both happy with the quality of care their relative received. One person told us, “I’m very very happy, I couldn’t’ ask for anything better.” Both relatives told us that they knew how to make a complaint.

Staff working at The Beeches told us that they got regular training and supervision. They also told us that they felt well supported by the registered manager.