What life is like for people using this service:

• People did not receive a service that provided them with safe, effective, compassionate and high-quality care.

• Risks to people’s safety and well-being were not managed effectively and this placed people at risk of harm.

• People were not always safeguarded from abuse and incidents and accidents were not managed safely to prevent a reoccurrence.

• People’s needs and preferences were not always assessed or person-centred plans developed to guide staff on how to meet people’s needs.

• Staff did not complete training in meeting people’s needs and this meant people were at risk of inappropriate care and treatment.

• The principles of the Mental Capacity Act 2005 were not understood and applied. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• People were not always treated respectfully or in a way that promoted their privacy and dignity. The service was not well-led and the governance system was ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

• There is more information about this in the full report.

Rating at last inspection:

The service was last rated as Requires Improvement the report was published on 22 February 2017. Following the inspection, we asked the provider to tell us the actions they would take in response to the breaches of Regulations found during this inspection

About the service:

Beaconsfield Residential Care Home is a residential care home providing personal care for up to 22 people living with a mental health condition and/or a learning disability. At the time of our inspection 21 people were living in the home who met these criteria. One person had been admitted with physical health needs.

Why we inspected:

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

Enforcement:

We have told the provider to take immediate action to address some of the concerns we found. We received an action plan from the provider telling us about the actions they have taken. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, 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 within six months 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 i

This was an unannounced inspection carried out on 10 November 2016.

Beaconsfield residential care home provides accommodation and support for up to 22 people with mental health needs. The Home is a four storey Victorian building; It has a dining room, three lounges and a paved area at the rear of the building. It is situated only a short distance from Southsea beach and a few minutes’ walk from a shopping precinct. The home is registered with the care quality commission (CQC) to accommodate 22 people and the home was at full occupancy at the time of the inspection.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to person centred care, staffing, good governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of this report.

At the time of the inspection the home had 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.

The people living at the home told us that they felt safe. The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns.

We saw appropriate arrangements were in place for the management of medicines. Systems were in place to manage and reduce risks to people. In people's care files we saw comprehensive risk assessments and care plans to mitigate risks.

Recruitment practices required strengthening. Staff had been appointed and commenced working at the home prior to the Disclosure and Barring service (DBS) check having been received. This exposed people to the risk of being supported by unsuitable staff.

We found there was not enough suitably trained and experienced staff on duty to meet people’s social and emotional needs. Staffing levels were not determined using a formal calculation based on the needs of people using the service. We observed interactions were task led and people were sat around with little stimulation offered.

We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

People's nutritional needs were met depending on their individual assessed needs and people were positive about the quality and quantity of food provided. People told us they were offered choice at mealtimes and were able to request additional snacks if they were hungry in between meals.

People told us they were supported by staff that were kind and caring. Staff maintained people’s privacy and dignity and promoted their independence.

People were not supported to live full and active lives. There was no stimulation or attempts made to engage people in meaningful activity. People had expressed the wish to attend an activity but this had not been addressed by the management.

We were told that there had been no complaints received. People told us they felt confident to raise complaint with staff but currently did not have any issues of concern.

We found there was no system in place to asses and monitor the quality of the service provided to ensure improvements were implement to the service provided.

We saw meetings had been conducted regularly with people and staff. Surveys had been sent and an analysis undertaken of the results. Improvements to be implemented had been identified but not consistently actioned.

Staff and people spoke of a positive culture and a management that were approachable and supportive

There were 21 people who used the service at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We observed the care provided and looked at supporting documentation. We talked with 11 people who used the service, care staff and the registered manager

One inspector carried out this inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People had individual risk assessments. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. We saw people had access to medical support as necessary and their medicines had been administered safely. The building had been maintained to ensure people's safety. One person said, " It is clean and comfortable. It's not posh, but meets my needs".

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes in order to ensure people's rights and freedoms are not restricted without proper authorisation. We found staff had been trained to understand when an application should be made to the local authority, and how to submit one. There were proper policies and procedures in place and these had been followed.

Is the service effective?

We observed people were happy with the care they received and they told us they were happy. It was clear from what we saw and from speaking with staff they understood people's care and support needs and they knew them well.

Is the service caring?

We observed that staff had a good understanding of people's support needs. They were supportive and were available when people needed them. People described the staff as, "Real good people” and “They are very good, this is why I have lived here for many years”

Is the service responsive?

Records showed people's preferences and interests had been recorded and care and support had been provided to meet their needs and wishes.

Is the service well-led?

People were asked their views and these were listened to. There were systems to record, monitor, evaluate and improve the service, care and support that people received.

We spent time with people in communal areas, in their private rooms and during a mealtime. They told us that they were happy living in the home and comments included. “I think you will like it here, it’s good; the staff are nice and caring and the food is the best.”

People had their needs and wishes assessed and recorded before coming to live in the home and the home’s manager worked with other professionals to ensure that the home met individual needs.

The staff team were trained in protecting people from risk of abuse and those that spoke with us were aware of their responsibilities.

Staff were only employed following a structured recruitment process and relevant checks were undertaken before they commenced work.

There was a complaints policy and procedure in place and complaints and concerns were investigated by the manager.

A family member told us. “My son can be very difficult but the staff are kind and patient. He is looked after well in every way. The food is excellent and they support him well.”

We spoke with 12 people; the majority of these people were coming in and out or the home throughout the day. Some of the people spoken with had lived in the home for over twenty years. Everyone spoken with told us they were happy with the service they received. People told us if they were unhappy with any aspect of their care they would soon let the manager know. People told us they have choices on how they spend their time. They told us they could leave the home to access the community as they wish. They told us staff were supportative and assisted them in the areas they required help with. People told us the home was clean and decorated to a standard they approved of. We were told the meals in the home were enjoyable and people confirmed they had a choice of meals at all meal times.