What life is like for people using this service:

• People who live at The Beeches Residential Home are supported by sufficient staff who are well trained and know how best to support people living with dementia. We observed residents’ requests for assistance being answered promptly. The quality of interaction between staff and people was excellent. We noted staff bent down to talk with people at eye level, and helped them reminisce appropriately e.g. distracted one person who was showing distress by getting them to talk about the terrible storm of 1988. The environment is comfortable and safe. There was good dementia friendly signage on the ground floor making it easier for people to find toilets, dining room and lounges. There was suitable equipment to support people’s needs.

• People were enabled to keep active through regular visits to the high street where the home is situated and several community groups visited. There were events and interesting activities each day both within groups and for one to one support for people who needed this.

• People enjoyed good home cooked food and had a choice to meet their needs. One person told us that staff had cooked them a special birthday breakfast of egg, bacon and fried bread.

• People had good access to healthcare and other professionals. One person told us because their relative was not available staff had taken them for a regular blood test. Incidents and accidents were minimal and if they occurred than staff were able to support and took appropriate actions.

• People and their families were consulted and involved with every aspect of people’s life’s. A relative told us they felt involved in their relative’s care, and saw their care plan regularly. People had a fulfilling life at The Beeches Residential Home.

See more information in Detailed Findings below.

Rating at last inspection: GOOD (report published 07 May 2016)

About the service: The Beeches Residential Care Home provides accommodation and personal care for up to 35 people who require 24 hour support and care. Some people live with dementia and a physical impairment. At the time of our visit 30 people were resident.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

The inspection took place on the 30 March 2016 and was unannounced. The Beeches provides care and accommodation for up to 32 older people. There were 30 people living at the service on the day of our inspection.

The service has a registered manager. 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 liked living in the service and they and their relatives spoke highly of staff and the quality of care.

Risks to individuals were not always managed in a consistent way and it was agreed that further professional advice should be obtained regarding the safety of the environment and action taken to minimise risks. People were generally supported to take their medicines but practice did not always follow the recommended guidance.

Staff were attentive but were not always available in the communal areas to respond to individuals who may not be able to use the call bells to summon assistance. The manager told us that they had already identified issues regarding the availability of staff and their ability to meet people’s needs and had a plan in place to address this shortfall. Recruitment was underway and it was agreed that the deployment of staff would be explored as part of this process. The systems in place to recruit staff were thorough and the uptake of previous employment references and other checks were undertaken before staff started work at the service. Staff had a good understanding of abuse and the steps that they should take to protect people.

The majority of staff had worked at the service for some years were clear about their role and knowledgeable about the needs of older people. A training programme was in place and staff told us that they received regular updates to ensure that they were kept up to date with practice. Newer staff told us that they were well supported when they started working at the service and that they received regular supervision support from management.

People had access to health care support when they needed it and were provided with a balanced diet. People were enabled to make choices and were involved in making decisions about how they were supported.

Care plans documented people’s needs and were regularly reviewed. Staff knew the people they supported well and had a good understanding of people’s needs. We saw that people were supported to maintain relationships which were important to them. Group or personalised activities were regularly provided although there were plans to expand this provision further.

The manager was approachable and promoted an open culture. Staff knew what was expected of them. People’s views were sought in a variety of ways including resident meetings and questionnaires. Audits were undertaken and there were systems in place to drive improvement.

When we inspected this service on 30 November 2012 we found concerns because people had not been consulted about or consented to their plan of care. There was inadequate care planning in place and this compromised people’s care and welfare. We made a compliance action with regard to these concerns and asked the provider to make improvements.

At this follow up inspection we found improvements had been made.

During our inspection on 5 April 2013 we saw that people using the service or their representatives had consented to the care plans in place. People’s individual risk assessments had all been reviewed and updated within the past three months. We found that people’s personal care needs were being met. There were suitable arrangements in place to ensure that people's dignity was maintained. We saw people’s rights to independence and personal choice were being maintained and people were supported by caring and well trained staff.

One person told us, “I love living here as there is always someone to talk to and before I was very lonely at home.” Another person told us, “Staff always come when I call them and I never have to ask for anything twice.”

We spoke with four people using the service and one relative. They told us that they were happy with the support they received and that they felt safe.

Questionnaires completed by relatives in May 2012 provided positive feedback about the service. Relatives considered The Beeches to be a homely and caring environment. One person stated “We feel very lucky that my relative has such a wonderful place to live.” Another person considered that The Beeches provided excellent care.”

We found that the environment was safely maintained and odour free and that all health and safety checks were up to date.

Four people told us that they found the standard of meals was good. People told us that they had been able to bring in personal items from their own homes in order to make their bedrooms more familiar and homely.

We found that the service had effective recruitment and selection processes in place that protected the welfare of the people who used the service.

We found that the service was not meeting the personal, emotional and healthcare needs of some people using the service. This was because we found inadequate care planning and risk assessments in place. These were not being reviewed and updated on a regular basis. People had not always been consulted or given their consent with regard to the care, treatment and support they received.

The people living in The Beeches told us that they liked living there, that the care staff showed them respect and worked hard to look after them. They also told us that they were comfortable in the home. One person told us that they particularly enjoyed watching the animals that the home keeps as pets.