The inspection took place on 09 and 10 July 2018 and was unannounced. Beacon House 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, and both were looked at during this inspection. Beacon House accommodates up to 23 people in one adapted building. At the time of the inspection 13 people were accommodated. The service also has seven bungalows on site but at the time of our inspection, no one living in the bungalows either required or was being provided with the regulated activity of personal care.

Since the last inspection a new manager had been appointed who had registered for the regulated activity of personal care and accommodation. Following this inspection, the registered manager has also applied to register for the regulated activity of personal care so they could provide this care to people living in the bungalows if required. 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 the last inspection in December 2017 we identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two new breaches. The service remained in special measures and we met with the provider to confirm what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At this inspection we found the requirements of these regulations had been met, four of the key questions have now been rated as good and safe has been rated as requires improvement with no breaches of regulations. Safe recruitment practices had been followed and relevant action was taken during the inspection to ensure long-standing staff updated their Disclosure and Barring Service checks. The premises and equipment had been regularly maintained and checked to ensure they were safe for people’s use. Audits and surveys were now effective and where issues had been identified action had been taken to address them for people and to drive service improvements. The registered manager understood what they were required to report and had ensured relevant notifications were submitted.

This service has been in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall. Therefore, this service is now out of special measures. The provider has continued to work with CQC within the terms of their existing voluntary agreement to ensure that all new admissions have first been reviewed and agreed by CQC.

Risks to people had been identified and managed safely. The registered manager acted during the inspection to introduce a falls risk assessment to enable them to be able to demonstrate consistency in how they assessed falls risks to people. They were acting to ensure people’s risk assessments were reviewed monthly as described in their care plans. These actions still need to be embedded in staff’s practice.

Staff had undertaken relevant training to enable them to safeguard people from the risk of abuse. There were adequate numbers of staff to provide people’s care. People received their medicines safely from trained and competent staff who followed the medicines guidance provided. The service was visibly clean and staff followed the infection control guidance provided. Processes were in place to ensure learning took place following incidents.

The registered manager has ensured that staff have access to re

The inspection took place on 11 and 12 December 2017 and was unannounced. Beacon House provides accommodation and care without nursing for up to 23 people some of whom are living with dementia. There were 10 people living at the service during our inspection. Accommodation was provided over three floors of a converted residential dwelling, with a passenger lift that provided access to the second floor and a stair lift to the top floor, the stair lift was out of use at the time of the inspection. The service also has six bungalows on site but at the time of our inspection, no one living in the bungalows was being provided with the regulated activity of personal care.

Beacon House did not have a registered manager in place as required on the day of the inspection; the interim manager had left their post on 30 November 2017. There was an assistant manager and a head of care in post, whilst the provider recruited to the role of 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.

When we previously inspected this service in May 2017, we found four continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and identified one new breach. We again rated the service as 'Inadequate' overall. The service remained in special measures and the provider was required to continue to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these audits and any actions taken or to be taken as a result, which they have provided.

This service remains in Special Measures as although the key question of safe is no longer inadequate the key question of well-led remains inadequate. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

The provider had ensured that the required pre-employment information was available for new staff recruited. However, they had not ensured that all of this information was available for each of the longer-term staff in post as required to demonstrate their suitability for their role with people.

Measures had been taken in relation to the safety of the environment. However, the light fittings in the bathrooms did not all conform to legal requirements to ensure people’s safety nor did all of the windows. Although the provider has started the process to rectify these issues since the inspection, they have yet to complete the works to ensure people’s safety.

Not all notifications of reportable incidents had been submitted to CQC as required. We had not been informed of four medicine errors, which staff had correctly reported to the local authority under safeguarding procedures.

At this inspection, we found improvements had been made to the processes used to assess, monitor and mitigate risks to people's health and safety and to identify issues that required improvement. However, not all audits were fully effective; data gathered on the service was not always consistently used to monitor trends over time and to identify areas for improvement. Where actions were identified, there was not always written evidence to demonstrate the required actions had actually been completed to improve the service for people.

Safeguarding systems, processes and staff training were in place to safeguard people from the risk of abuse. The provider had made the relevant alerts to the local authority as required when they suspected a person might have been experienced abuse. Legal requirements in relation to safeguarding p

We inspected Beacon House on 18, 19 and 24 May 2017. The visit was unannounced on 18 May 2017 and we informed the assistant manager we would return on 19 May 2017. We gave feedback about the concerns we had identified to the director of the provider organisation on 24 May 2017.

Beacon House provides care for up to 23 people living with differing stages of dementia. There were 15 people living at the service on the days of our inspection. Accommodation was provided over three floors of a converted residential dwelling, with a passenger lift that provided access to the second floor and a stair lift to the top floor. The service also has six bungalows on site but at the time of our inspection no one living in the bungalows required personal care.

Beacon House did not have a registered manager in place on the day of the 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. The home manager’s application to be registered was being considered at the time of the inspection.

When we previously inspected the service in September 2016 we found six of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘Inadequate’ overall and the service was placed in special measures. To support the provider to make the necessary improvements we imposed three conditions on their registration in respect of the regulated activity, accommodation for persons who require nursing or personal care they carry on at Beacon House. The provider was required to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these and any actions taken or to be taken as a result.

At this inspection we found planned improvements had not been made or sustained. We found four ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one new breach. We found whilst the service had been in ‘Special measures’ not enough improvement was made within this timeframe and at this inspection there was still a rating of inadequate in the key questions; Is the service Safe? and Is the service Well-led? with an overall rating of ‘Inadequate’. We will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found although the provider had taken some action and engaged an external consultant to drive improvements in the service this had not resulted in people always receiving safe care and the service still lacked the leadership to improve the quality of care provided to people.

We found an effective governance system to monitor the quality of the service and identify the

We inspected Beacon House on 7, 9 and 15 September 2016. This was an unannounced inspection. We brought this inspection forward following concerns received about the safety and welfare of people.

Beacon House provides care for up to 23 people living with differing stages of dementia. There were 18 people living at the service on the days of our inspection. Accommodation was provided over three floors of a converted residential dwelling, with a passenger lift that provided access to the second floor and a stair lift to the top floor.

Beacon House did not have a registered manager in place on the day of the inspection for both their registered activities. 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. The manager had started their application to be registered with the Care Quality Commission to ensure the provider would meet their registration requirement to have a registered manager in place.

The manager had been absent from the service for two months and returned to work on 12 September 2016. During their absence the deputy manager, senior care workers and the provider were responsible for the day to day running of the service. We found at the time of our inspection a comprehensive and effective governance system to monitor the quality of the service and identify the risks to the health and safety of people was not in place. A regular programme of audits had not been completed in relation to the management of people’s medicines, infection control practices, and quality of care records and the manager, deputy manager and provider had not identified all the areas of concern we had found. As a result limited action had been taken to improve the quality of care and ensure the safety of people. The manager, deputy manager and provider were unclear about their overall responsibility to meet and sustain all the legal requirements of a registered person to ensure the safety and welfare of people.

We found people's safety was being compromised in a number of areas. People had not received the support they needed in accordance with national best practice guidelines to mitigate their risk of choking. People were at risk of injury when receiving moving and handling support and when people had developed pressure ulcers they had not always received the support and treatment they needed to prevent their health from deteriorating.

People’s care records did not include all the information staff would need to know about how to provide people’s care and when people received care this was not always recorded. Staff and the managers could therefore not judge from people’s records whether people had received their care as planned and their medicines as prescribed. The managers' and provider’s knowledge of the service was not up to date and communication in the service was not sufficient to ensure people would receive the care they required when their needs changed.

The provider’s philosophy at Beacon House was that each resident should live as full and independent a life as possible. However, people living with dementia did not always receive the support they needed to remain independent, express their wishes and make sense of their environment. We made a recommendation to support the provider to improve the communication between staff and people living with dementia.

People’s privacy and dignity were not always respected. From observing staff interactions with people it was clear the values of the service were not yet fully embedded into practice as care was at times task based rather than person centred, for example when moving and handling tasks were undertaken. We saw poor practices which were undertaken by some staff but not challenged by oth

At our previous inspection on 11 April 2014 we identified concerns that the provider was not operating safe and effective recruitment processes. The provider told us in their action plan of 14 June 2014 that they would have addressed our concerns by 30 June 2014.

During this inspection, we found that the provider had taken positive action and ensured that recruitment of new carer workers were safe and robust.

We looked at the recruitment file of a newly recruited care worker. The records showed that the provider had taken action to carry out the required checks. These checks were to ensure that people employed for the purposes of carrying on the regulated activity were of good character. Checks included verifying applicants’ identity, obtaining a full employment history and evidence of previous training.

Beacon house was the provider’s only care home. At the time of our visit it provided care to 22 people in the main house and 10 people who lived on site in independent bungalows. Not all the people who used the service were able to tell us their experiences. We used a number of different methods, including observation to help us understand the experiences of the people that used the service. If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer 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?

This is a summary of what we found.

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. The provider operated effective systems to identify, assess and manage risks to the safety and welfare of people. We looked at four people’s care records and saw that detailed instructions were available to staff to ensure they knew how to meet people’s needs and keep them safe.

Incidents and accidents had been appropriately reported and recorded. Where trends had been identified, for example, one person had increased falls, we saw that the provider had taken action to prevent these incidents from reoccurring.

The provider did not operate an effective recruitment and selection process. Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who lived in the home. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

We spoke with six people, one relative and one friend of people who lived at the home. They were complimentary about the care received. Comments made by people included ‘‘the staff here are wonderful’’ and ‘’when I ring my call bell they came as quick as they can’’. The manager attended regular Clinical Commissioning Group (CCG) meetings and utilised external resources to ensure that care workers’ practice was in line with current guidance. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. All four staff we spoke with could describe in detail the care required by one person who was at risk of developing pressure sores. This was in line with their care plan and guidance from the district nurse.

Is the service caring?

People were treated with consideration and kindness. All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed. Staff had a good understanding of how to communicate and present information to people with dementia to enhance their involvement in activities and decisions. People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw that care plans had been reviewed monthly to ensure that the home could respond to people’s changing needs swiftly. Records showed that health professionals like the GP and district nurses were contacted in a timely manner when staff had identified that this support was required. People’s views were taken into account when activities and menus were planned. We also saw that a new snack menu and walled garden had been developed following people’s feedback.

Is he service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. An annual quality survey was undertaken and included feedback from professionals, people and their relatives. This year’s survey had been sent out in March 2014 and the provider was waiting for questionnaires to be returned. Records seen by us showed people were complementary about the service and any identified shortfalls were addressed promptly. The relative we spoke with confirmed that they had been listened to. The manager undertook several audits to assess the quality of care being delivered. We saw the action taken following a night spot check and the audit of falls.

Staff and people we spoke with were complementary about the manager. One care worker told us ‘‘She has a lot of knowledge and experience. She is always about and gives good advice if you are not sure how to support someone’’.

We inspected this service on 30 August 2012 and found the service had failed to meet the essential standards of quality and safety in the following areas; care and welfare, safeguarding, management of medicines, staffing and assessing and monitoring the quality of the service. This inspection was carried out to check whether compliance had been achieved and sustained. We found the provider and the registered manager had taken appropriate action to achieve compliance for the benefit of people who used the service.

We spoke with four people who used the service, three members of staff, the registered manager and a visiting community nurse.

People told us they liked living at this home and the staff always helped them. We found through observation that staff treated people with kindness and assisted them with the care they required. We found people and/or their relatives had been consulted and had been involved in making decisions regarding their care.

People told us they felt safe at this home. We found staff had been trained to respond appropriately to protect people from the risk of abuse.

People told us there were enough staff to help them. We found the registered manager had improved the staff levels which had enabled staff to provide more activities and allowed staff to provide the care people required.

People had been asked their opinions regarding the service and these had been acted upon.

We spoke with seven people who used this service. They told us the staff were very kind and caring.Our observations confirmed that staff were generally responsive to peoples’ needs and demonstrated a kind attitude.

People told us they usually really liked the food and that they could choose according to their preferences including wine with their meals. We observed that staff assisted people with their meals, however sometimes this was task based rather than positive interactions. An example of this was that staff stood up whilst assisting people and they did not spend time talking to people to ensure they were ready for more food.

People told us that sometimes they felt there were not enough staff, however, they did say they did not have to wait a long time for assistance.People all said they enjoyed the range of activities they could participate in and especially going for walks in the well kept gardens.We observed people taking part in a music and movement session and staff spent time with people chatting and listening to music.

Two relatives told us their family member had settled in well recently and they felt the staff kept them informed. They commented that the home was clean and there were never any unpleasant odours.

We found that the home had not adequately assessed or planned peoples' needs and medication was not always given safely. People were not adequately safeguarded and the quality assurance system was not effectively used to make improvements.

The people who live at Beacon House told us they liked the staff, who they said were very kind and caring. They told us the staff helped them with all their needs and they were comfortable in the home.

One visiting relative told us they thought the care was good and the staff met their family member’s needs. They told us they were concerned that the staff did not always support their family member to use their hearing aids.

The residents told us they liked living at this home and they appreciated the kind care the staff gave to them.

The residents said they enjoyed the home cooking and they got the food and the drink they needed. We found that people were being offered adequate food and drink but this was not always recorded for the residents with the most care needs.

The relatives told us the home generally met their family members’ needs, but occasionally the home did not have enough staff. The residents told us there were enough staff and they did not have to wait a long time for help.

The quality and improvement officer from the local authority shared their action plan for improvement at this home. This informed us that the providers were taking steps to improve the care planning system, staff training, actions to safeguard the residents and the medication procedures, but some of these improvements were still in progress in March 2011.

The specialist community nurse told us the home had improved by March 2011 and the home had started to use more detail about the residents’ needs in the care plans. We found improvements were still needed to guide all of the staff to meet each person’s needs.

The residents said they were comfortable in the home and the staff treated them with kindness and respect.