About the service:

The Beeches is a care home providing personal care and accommodation for up to 56 people. At the time of our inspection there were 54 people using the service.

People’s experience of using this service:

Staff knew how to keep people safe from harm and they received their medicines as prescribed. The provider had a robust recruitment process in place and there were enough staff on duty to meet people’s needs. Staff followed infection control guidance and had access to personal protective equipment. Accidents and incidents were recorded, and appropriate action taken.

Staff had the skills and knowledge to meet people’s needs and referred to healthcare professionals when required. People had a choice of food and their nutritional needs were met. The provider was working in line with the principles of the Mental Capacity Act 2005 and people’s consent was obtained before care and support was delivered.

Staff were caring. The registered manager and staff had a strong ethos of person-centred care and placed people’s wellbeing at the heart of their work. All the people we spoke to were very complimentary about the service. There was a positive caring culture and staff were patient, kind and empathetic. People’s privacy, dignity and independence were respected by staff.

Support was individualised, and regular feedback was encouraged from people and their relatives. People were supported to take part in many different activities and their interests, likes and dislikes were known to staff. The service ensured people received dignified and respectful end of life care which met their personal needs and preferences. The provider had a complaint process which people and their relatives were aware of to share any concerns.

People and staff were happy with the way the service was led and the registered manager made themselves available to people. Spot checks and audits were carried out to ensure the quality of the service was maintained but some improvements were required. The environment was friendly, warm, and clean.

Rating at last inspection:

Rated good (Report published 18-07-2016)

Why we inspected:

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

Enforcement

No enforcement action was required.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. 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

We inspected this home on 24 and 25 May 2016. The home was last inspected in June 2014 and was meeting all the regulations. The home is registered to provide personal care and accommodation for up to 56 older people. At the time of our inspection 53 people were living at the home. We observed how care was provided to people and whether people were happy living at the home.

There was a registered manager in post who was present throughout the 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.

People told us that they felt safe living in this home. Staff knew what constituted abuse and how to protect people from harm. The registered manager had effective systems in place to review accidents and incidents which would reduce the possibility of future harm to people. People and staff told us there were enough staff available to meet people’s needs in a timely manner. The arrangements in place for the management of medicines were good so that people could be sure they would receive their medicines safely.

People told us that they felt confident that staff could meet their specific care and support needs. The registered manager and staff we spoke with understood the principles of protecting the legal rights of people living in the home. Staff sought people’s consent and respected their choices. People were supported to eat and drink well to stay healthy.

Staff were attentive and caring towards people. People’s dignity and privacy was respected and the staff responded to people’s individual preferences and supported them to follow their own interests. People told us that they were able to make decisions about their care and that they were involved in how their care and support was planned and delivered.

Opportunities had been provided for people to express their views about their care plans and contribute to reviews of their needs. Staff understood the needs of the people they supported and the importance of providing personalised care. Staff supported people to follow their interests, hobbies and to maintain contact with people that mattered to them. People knew how to make a complaint and were confident this would be listened to and acted upon.

People and their families were complimentary about the management of the home. People told us they were encouraged to express their views and experiences about living at the home. The registered manager had used their audits and quality monitoring systems to develop and make improvements within the service.

We spent a day at the home, talking to and observing people who lived in the home and staff. We sampled the records. After the visit we spoke to several relatives and professional visitors to the home on the telephone to find out their views.

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 caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke to several people who lived at The Beeches. People told us they felt safe. One person told us, “We have no worries on that count; they look after us well.”

People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We found that the home’s safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards, (DoLS), which applies to care homes. We found that the manager and staff understood their responsibilities in relation to the law.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We found that care was provided in an environment that was safe, accessible, clean and adequately maintained.

Is the service effective?

People told us that they were happy with the care they received and the care staff who supported them. We found that care staff knew the people they supported very well.

Staff training records showed that staff had received appropriate training in a number of relevant topics including: food hygiene, dealing with dementia, moving and handling and infection control. This meant that staff had the appropriate skills and knowledge to ensure that people received safe, appropriate and effective care.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. We saw that people had regular access to a range of health professionals which included general practitioners, dentists, chiropodists and opticians.

People had a good quality of life, with plenty of activities inside the home and in the community. One person told us, “We have fun here.”

Is the service caring?

People were supported by kind and attentive staff. Staff demonstrated that they treated people with respect and they sought consent before providing care and support. We saw that care staff were patient with the people they were supporting.

People told us that the staff were helpful and provided examples of this. Relatives told us, “Everyone’s got time – nothing is too much trouble” and another said “The staff are all nice and they are so passionate about what they do.”

We concluded that people had a good experience of care and support which was delivered with compassion and respected their dignity and human rights.

Is the service responsive?

Records showed that meetings were held between staff, people using the service and their relatives to discuss on-going concerns and improvements at the home including meals, activities and laundry.

We found that care staff had regular one to one supervision meetings. This meant that care staff had the opportunity to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

People living at the care home and their relatives told us that they would have no hesitation in telling the manager and staff if they were unhappy or had any complaints about the service they received. We were told that the manager and staff were approachable and helpful and where they had made requests or raised minor concerns, these matters had been responded to promptly and to their satisfaction.

Is the service well-led?

The manager whose name appears on this report no longer works at the home. Her name appears because it has not yet been removed from our register. The present manager, Bryan O'Connor, has applied to the CQC for registration.

We found that the manager was enthusiastic about providing a good quality of life for the people who lived there and had implemented changes which enhanced people’s quality of life. These included increased activities for people.

We saw that the manager was well known to the people who lived there and the relatives to whom we spoke.

People who lived at the home and their relatives were very complimentary about the manager. Comments included, “He cares for each resident” and “Nothing is too much trouble for him.”

Care staff employed at the home told us that the manager was approachable.

We concluded that there was effective leadership at The Beeches, which ensured that safe, effective and responsive care and support was provided.

People whose care we specifically focussed on were not able to tell us their experience of the service because of their complex needs and conditions. We spent six hours in the communal areas of two dementia care units observing how people experienced the service. We saw some positive practice that showed risk management balanced safety with independence and dignity. However most of the interactions between staff and people who used the service were task based and although staff were kind they did not have time to talk to people. This meant that opportunities to address the diversity of people's needs, engage them in activity and avoid distress reactions were routinely missed. People’s needs were assessed and care was planned but not always delivered in line with their individual care plan for consistency.

Relatives were generally positive about the care that people received but told us that there were not enough staff on duty. We found insufficient numbers of staff on duty to meet people's complex needs; some staff did not know people well and most had neither care qualifications nor training in dementia care.

The provider did have a system to monitor and assess the quality of the service provided but we found that some significant shortfalls, such as the impact of the staffing levels on people's experience of the service had not been identified or addressed by this monitoring system. The system was not always effective in reducing risks within the service.