This inspection was unannounced and took place on 6 and 8 March 2018. At the previous inspection in September 2016, the service was rated ‘Good.’ At this inspection we found the provider was in breach of the regulations. The overall rating for this service is ‘Requires Improvement.’

The Beeches is a residential care home that provides a service to older people and people living with dementia. People in care homes receive accommodation and nursing or personal care as 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 is registered to provide a service for up to 40 people. On the days of our inspection there were 31 people living in the home.

The home had a registered manager who was present on the days of 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.

At our previous inspection we found that the management of medicines needed to be improved. At this inspection we found that the provider had not taken sufficient action to make improvements. The storage of medicines in the fridge was not monitored. The medication electronic tablet did not provide staff with information about how certain medicines needed to be administered safely.

We found where people had sustained a fall their risk assessment and care plan had not been reviewed in a timely manner to avoid a reoccurrence.

Hygiene standards within the home placed people at risk of cross infection. The environment was unsuitable for people living with dementia and this could add to their confusion.

The provider’s governance was ineffective in identifying the shortfalls we found. The registered manager did not undertake regular training to ensure they had the skills promote good practices.

Staff’s lack of understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards placed people at risk of their human rights being compromised. People’s right to privacy and dignity was not always respected by staff. However, people confirmed staff were kind and friendly. People’s involvement in their care planning ensured they received a service the way they liked.

People were cared for by staff who had received training and were supported in their role by the management team. People had access to a choice of meals and drinks and were supported by staff to eat and drink sufficient amounts. People were assisted to obtain the necessary healthcare services needed to promote their physical and mental health. People were provided with the necessary aids and adaptation to promote their independence safely.

The involvement of other professionals in people’s care assessment helped in ensuring their care and support needs were met. People could be confident their concerns would be listened to and acted on.

People told us they felt safe living in the home and staff were aware of their responsibility of safeguarding them from the risk of potential abuse. People were cared for by sufficient numbers of staff who had been recruited safely.

People were supported to maintain links with their local community. Staff were involved in meetings and they felt listened to.

The Beeches provides accommodation and personal care for up to 40 older people. A number of people were living with dementia. There were 36 people living at the home at the time of our inspection.

The inspection took place on 20 October 2016 and was unannounced. The service was last inspected on 7 May 2014 when we found the provider was meeting the regulations.

The registered manager had been in post for the past three years. 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 felt safe living at The Beeches. There were sufficient numbers of suitably trained staff available to keep people safe and meet their needs.

Staff had received training in keeping people safe and understood their responsibility to report any observed or suspected abuse. Staff were knowledgeable about the risks associated with peoples care and support. Risk assessments and management plans were in place to manage the identified risks. We found most risks were managed well.

People told us they received their medicines when they needed them. However, medicines were not always managed safely and we could not be sure creams were applied to people’s skin as directed.

New staff received an induction and recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment.

The home had a friendly and relaxed atmosphere and the registered manager supported staff well to provide good quality care to people. People were encouraged to maintain relationships with people important to them and visitors were welcomed at the home.

We saw staff were caring and responsive to people’s needs. They demonstrated good knowledge of how people preferred their support to be provided. They were patient, attentive and treated people with kindness.

People's records contained information to ensure staff had the guidance they needed to meet people's needs. People had been involved in planning their care to ensure they received care and support that met their preferences, likes and dislikes.

The managers and staff understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom.

People made everyday decisions for themselves, which helped to maintain their independence. Staff respected the decisions people made and gained their consent before they provided care. People told us staff respected their right to privacy and told us how staff supported them to remain independent.

People had access to a range of varied activities which they enjoyed. People enjoyed the food and were encouraged to eat a varied diet that took account of their preferences and dietary needs. People were referred to external healthcare professionals to ensure their health and well-being was maintained.

There were systems in place to gather people’s feedback through annual surveys. The information had been analysed and action had been taken in response to this feedback. People knew how to make a complaint and there were systems in place to manage complaints about the service provided.

People and staff thought the registered manager and the management team were open and approachable. Staff enjoyed working at The Beeches and they spoke positively about their managers. They received training and felt supported by their managers through regular meetings.

The provider ensured the quality of care and services was maintained and continually improved through a range of quality monitoring processes.

This was an unannounced inspection. This meant the provider did not know we were coming. At this inspection we also followed up on concerns we identified at the last inspection visit in December 2013 in relation to the management of medicines and the quality of records.

We spoke with four people who used the service and looked at their records. We also spoke with four relatives of people, five members of staff, a visiting professional and the provider to help us to understand the outcomes and experiences of people who used the service.

Is the service safe?

People who used the service told us they felt safe and had no concerns regarding the staff that supported them. People told us that the manager was approachable and they would speak with her if they had any concerns.

Staff spoken with had a good understanding regarding the level of support each person required to maintain their safety and well-being. Information within care plans and risk assessments demonstrated that people were supported to maintain their safety and welfare.

We saw that all care staff carried a radio whilst on duty and we observed these being used regularly. One member of staff we spoke with told us, “We all carry radios to contact one another in the building especially when we are assisting someone”.

Appropriate policies were in place regarding safeguarding vulnerable adults and staff demonstrated a good knowledge of what procedures to follow if they identified any safeguarding concerns or if any information of concern was disclosed to them.

Is the service effective?

Discussions with people using the service and information in care records showed that people’s needs and preferences were met. We saw a log that ensured that people’s preferences were respected with regards to their bedtime, waking and personal hygiene routines. The provider said, “It also makes staff accountable in case a service user doesn’t look well dressed; then we know who dressed them up that day”.

Relatives of people who used the service were generally complimentary of the care their relatives received. One relative said, “X receives very good care here. This place is ideal for her needs”.

During the visit, we saw that other healthcare professionals were involved in the care and treatment of people who used the service. One visiting professional told us that they came regularly to carry out health reviews of people who used the service. They said, “If they’ve [the staff] got any concerns or queries about medications, they’ll ring the clinic for advice. I’ve never gone back and felt concerned about anybody I have seen”.

People who used the service and their relatives told us that structured activities took place regularly and external providers were often invited to engage in activities with people. On the day of the visit, we observed a volunteer activities person engaging people in a sing-along group and exercises. People we spoke with told us that they enjoyed the activities that took place at the home.

Although the provider had made improvements to ensure that people were protected from the risks of unsafe medicine administration, they needed to ensure that their system for recording medication stored at the premises was effective.

Is the service caring?

We observed a positive working relationship between the staff and the people they supported. We observed that staff were caring and sensitive when they supported people with their personal care needs.

People using the service said that they liked the staff and confirmed they were helpful. A person who used the service told us, “The staff are polite and nice”. One relative said, “Staff are pleasant and friendly. I’m perfectly happy he’s [relative] here. I wouldn’t mind being in care here myself”. Another relative told us, “The staff are very caring. They’ve just thought of things that are very good for people”.

We observed that people were treated with dignity and respect by staff. Some people required support during meals and we observed that staff were professional and demonstrated care when they supported these people.

Is the service responsive?

People we spoke with told us that if they had any concerns or worries they would tell a member of staff or a family member. One person said, “You’ve only got to talk to X [the manager] and you’ll be alright”.

From our observations we saw that people using the service appeared relaxed and comfortable with the staff on duty and were able to openly express their opinions and preferences.

We saw that staff responded promptly to ensure people’s needs were met, for example when people requested support to use the toilet staff responded in a timely manner. We observed staff treating people respectfully, ensuring their dignity was maintained.

We saw that staff responded to the changing needs of people. A visiting professional said, “I’ve seen a gentleman who was quite breathless and they told me he was waiting to be seen by the GP”.

At the previous inspection, we told the provider that they needed to make improvements because they did not have appropriate arrangements in place to manage medicines safely and accurate and appropriate records were not being maintained to protect people from the risks of unsafe or appropriate care. We saw that the provider had made improvements to ensure that medicines were managed, stored and audited appropriately. People’s personal records were stored securely and care plans had been updated to reflect the care people received.

Is the service well-led?

People told us that the provider was always around to respond to any concerns. One relative said, “The provider is very good and the staff are very good. I go to X [the Registered Manager] or X [the provider] if I have any problems”.

The provider was present on the day of the visit and we saw that relatives approached him to obtain information about their relatives. We spoke with the provider and he demonstrated a good knowledge of the people who used the service. He said, “We have an open door policy and I love to meet and greet the relatives and get feedback from them”.

People who used the service told us that the registered manger was always available, approachable and friendly. The registered manager told us, “I go round and ask them [people who use the service] how they are. It’s something I’ve always done. Families just come to us if they’ve got a problem and we solve it there and then if possible”.

We saw that the provider carried out audits of the service to ensure that people received safe and appropriate care. We saw that the views of people who used the service, their relatives, staff and other professionals were obtained, recorded, analysed and actions taken to address any concerns raised.

Staff were clear about their roles and responsibilities and spoke positively about the management support they received. Staff told us that they were being provided with regular team meetings. A member of staff told us, “X [the provider] is constantly drilling into all of us about the paper work, that if it’s not written up, then it hasn’t been done”.

During our inspection we spoke with eight people who used the service and three people’s relatives. We also spoke with six members of staff and the registered manager. People and their relatives told us they were happy with the care. One person told us, “I like being here. I have no gripes”. Another person told us, “It’s wonderful here, there is a nice atmosphere”. One person’s relative told us, “The staff are lovely and they bend over backwards to make sure everything is right. The manager and the owners are brilliant”.

We saw that people were treated with dignity and respect. People were given choices about their care, and the choices they made were respected by the staff.

People were treated with care and compassion and people received assistance with their personal care needs in a timely manner.

Effective systems were in place to ensure that people could access health and social care advice and support when they needed to. We also saw that important information about people’s needs was shared with other professionals when required.

We identified that improvements needed to be made to ensure that people were protected from the risks associated with medicines. Effective systems were not in place to ensure medicines were stored safely and given when people required them.

We saw that information about people’s needs and their finances was not stored securely. Improvements need to be made so that people can be assured that information about them is kept safe.

During the inspection we spoke with nine people who lived at the Beeches, regular visitors to the home; seven people who worked at the home and examined four plans of care and several risk assessments. We found that people told us that they had felt happy at the home. One person told us that "They had no complaints at the moment", another person said "It’s very good here, care is fine and I've lived here for two years".

We observed a lunch time meal service, staff offered choices and encouraged and enabled people to eat a balanced diet. People told us that they liked the foods and choices they were given.

Staff told us that they were enabled to develop their skills by completing NVQ (national vocational qualifications). We were told that the manager of the home was helpful and supportive. We saw records that showed staff had been trained in safeguarding and staff when asked knew how to raise concerns about poor care.

We were told by a regular visitor to the home that they were happy with the care that their mother received. The staff had always been kind and caring. They told us that they had a positive relationship with the home staff and they had been able to raise any care issues with them when ever they wanted to. They felt that the care delivered to their relative was good.

The Beeches had systems in place to monitor and improve things when required these Included relative and user feedback, audit schedules and staff meetings

People who use the service told us during our visit on the 8th December 2011 that they were comfortable and have no complaints about the service. One person we spoke to commented that it’s “a nice place”. People told us that that staff are nice and they can approach them if they had a concern.

People we spoke to said there are a lot of activities they can be involved in such as exercise, quiz and bingo. People commented that they have choice and do not have to participate in activities. One person told us if “you don’t want to you don’t have to" another said they “get up when they want”.

People told us that the food was good and they had a varied menu that included fresh fruit and vegetables. People said they were offered hot drinks during the day, one person told us the “food and drink is good”.

Relatives we spoke to on the day said they were happy with the care and that staff kept them informed of changes; one relative told us the service was “excellent”. Relatives told us they were given the opportunity to give feedback on the service by completing questionnaires and as a result improvements were made.

We saw good interactions between staff and people living at the home, people were treated kindly and in a respectful manner. We observed staff spending time with people showing them pictures, talking to them and painting their nails. Staff demonstrated knowledge about people living at the care home and were able to show how they engaged with people suffering with dementia using different approaches.

We observed the environment to be clean, tidy and safe, people appeared to be dressed appropriately and presented well with there personal care needs addressed.

We saw evidence of good quality assurance systems that ensured monitoring of general health and safety as well as attempts to engage with people who use the service their relatives and frontline staff.

We found senior management active in service delivery and there was a positive drive to improve standards and support the training and development of staff, this was reflected in what staff told us.

We saw records that reflected the care that people needed and found to be consistent in what people experienced. During our visit on the 8th December we found overall that people living at The Beeches experienced a good standard of care that ensured their needs were met.