The inspection took place on 11 May 2018 and was announced. We last inspected Beanlands Nursing Home on 7 and 8 February 2017. At that inspection we identified three breaches of the regulations and rated the service as Requires Improvement. These were; Regulation 12 Safe care and treatment, Regulation 11 Need for consent and Regulation 17 Good governance. We also made a recommendation that the provider review activities for people living with dementia to ensure they provide appropriate support and stimulation.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection, we found the provider had made all the required improvements and addressed the regulatory breaches identified last time we visited the service.

Beanlands Nursing Home is a 'care home'. 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 provider is registered to accommodate up to 45 older people who may have physical disabilities, terminal illness and those requiring respite care or a period of convalescence. People were supported with both personal care and nursing needs. At the time of the inspection 36 people were using the service.

There was a registered manager in post. 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.

Not all agency staff who worked at the home received an induction. We have made a recommendation about this.

Care records showed people's plan of care were written in a way that reflected their wishes, preferences, needs and choices in areas such as people's routine, preferred foods and social activities. Social activities had improved and took place on a regular, planned basis. These included musical events, exercise and crafts. We found the plan of activities did not include all activities available to people. We have made a recommendation about this.

The environment and equipment was well maintained and subject to service contracts and safety checks. All areas seen were clean and kept hygienic.

Staff sought advice from external health and social care professionals at the appropriate time. We saw evidence in care records of appointments with GP's, opticians and dieticians. This ensured people's health was monitored effectively.

A four-week menu was in place and we saw people were offered a choice of well balanced meals and snacks. People told us the food was good. People's nutritional needs were assessed and recorded.

We saw good standards of privacy and dignity for people receiving care. Staff were kind and friendly in their approach to people. When supporting people to move from one place to another staff took time and were gentle and reassuring.

People were supported to express themselves and communicate through a range of different methods. They had individual communication support plans in place, which were followed by staff. People's needs were reviewed and monitored on a regular basis.

People were provided with information on how to make a complaint.

There were systems and processes in place to monitor and evaluate the service provided. People's views about the service were sought and considered through resident's meetings and satisfaction surveys.

Arrangements were in place to ensure people received their medicines safely.

People who used the service told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

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This inspection took place on 7 and 8 February 2017 and was unannounced. A previous inspection, undertaken in October 2014 found no breaches of legal requirements.

Beanlands Nursing Home is registered to provide nursing care for up to 45 people who may have a physical disability, terminal illness and require respite care or a period of convalescence. Some people at the home are also living with dementia. Facilities are spread over two floors and include accommodation in single or potentially twin rooms. The home is set in private gardens in a residential area on the outskirts of Cross Hills, Yorkshire.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since December 2015. A registered manager is a person who has registered with the 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.

People told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. We found a range of safety issues at the home including issues regarding window restrictors, open sharps boxes, laundry facilities that were not secure from the public and open store rooms. Some people had bedrails without covers in place, meaning there was a risk of entrapment.

Maintenance of the premises had been undertaken, although records were not always signed to confirm they had been completed appropriately, and checks had failed to identify the safety issues highlighted at the inspection. We have made a recommendation about this. People had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed to identify any issues or concerns.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff at the home, although said it could be busy at times. We have made a recommendation to the provider about how they assess staffing numbers and care needs. We found issues with the management of medicines at the home, particularly around the use and recording of topical medicines, such as creams, and variable dose medicines.

Staff told us they had access to a range of training and updating, and records confirmed this. They told us they also received annual appraisals and regular supervision. People told us, and our observations confirmed the home was maintained in a clean and tidy manner.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager confirmed applications for DoLS had been made or granted. It was not always clear appropriate action had been taken, in line with the MCA, to obtain consent or determine action in people’s best interests, where they did not have capacity. People were asked their consent on a day to day basis.

People were happy with the quality and range of meals and drinks provided at the home. They told us they could request alternative items. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements.

The environment was not always suited to supporting people living with dementia or a cognitive impairment. We have made a recommendation about this.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding

We undertook this unannounced inspection on the 7 October 2014. When we inspected Beanlands Nursing Home in September 2013 we asked for improvements to be made regarding the recording of medication. We carried out a further inspection in December 2013, where we found improvements had been made regarding the recording of medication.

Beanlands Nursing Home is registered to provide nursing care for up to forty five people who may have a physical disabilitie, terminal illness and those requiring respite care or a period of convalescence. Beanlands Nursing Home has been established since 1974. The current owner bought the home in 2003, as part of the Czajka Care Group. Facilities include accommodation in single or twin rooms. The home is set in private gardens and parking is available.

Currently there is no registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’ However, we were informed that the new manager had submitted an application which is currently being processed by the Commission.

The new manager has worked at the home for 30 years as she had previously been the deputy manager until being appointed as the manager.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

We found that this service was safe. The staff working at the home knew the people they cared for well and had developed positive relationships with them. Relatives and health care professionals we spoke with all told us that people were safe.

The home had safe systems in place to ensure people living at the home received their medication as prescribed; this included regular auditing by the home.

There were good systems in place to minimise the risk of infection which were followed by staff working at the home.

People living at the home received care and support from well trained staff who were supported by the organisations management . The recruitment processes followed by the organisation when employing staff were robust, which meant that people were kept safe.

People who were unable to make their own decisions were protected because staff followed the principles of the Mental Capacity Act 2005 and associated deprivation of liberty safeguards.

Staff understood how to apply for an authorisation to deprive someone of their liberty if this was necessary.

People told us they were supported with all of their dietary requirements and everyone living at the home we spoke with spoke highly about the provision of meals and drinks at the home.

People lived in a safe environment. Staff knew how to protect people from harm as they ensured that equipment used in the service was checked and maintained and was safe to be used.

Staff were kind and caring and we observed this throughout our visit. Staff we spoke with knew people they were caring for well. People’s care needs were recorded in detail in their individual care records.

The home had received two complaints since the last inspection. Records showed that both complaints had been dealt with and responded to appropriately by the service. Notifications had been reported to the Care Quality Commission as required.

The home was well led as the culture at the home was open and transparent with staff working together as one large team. The manager was pro-active and was committed to improving the service. The manager also received good support from the senior management team within the organisation.

We contacted, other agencies such as the local authority commissioners, the DoLS officer from the Local Authority and Healthwatch to ask for their views and to ask if they had any concerns about the home. Feedback from all of the agencies we contacted were positive with no concerns being raised.

When we visited the service in September we found medication processes at Beanlands Nursing Home were not robust. People we spoke with then did not raise any concerns about medication. However, we found the way medicines were managed, needed to improve, in order to show that the service was managing medicines in a safe and robust manner.

We re-visited the service to check that these improvements had been made. We did not speak with people about the way they received their medicines on this occasion as we had not identified any concerns in this area at our previous visit. We did however observe a medication round during lunchtime and noted that people were offered their medication in an appropriate and professional way. Staff allowed people time to take their medication and explained the purpose of the medication when asked.

Some people were not able to tell us about their experiences. We therefore used a number of different methods to help us to understand the experiences of people, including observing the delivery of care. Twelve people who used the service were able to share their experience and we also spoke with two visitors. Everyone we spoke with told us they were satisfied with the care they or their relative received. We saw records that showed people were involved in developing their care plans and that relatives or their representatives had been involved where appropriate.

We saw how staff supported people, at their own pace, to make sure they knew how best to meet a person's need.

Before people received any care or treatment they were routinely asked for their consent. However, people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage the administration of medicines safely.

There were effective recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were described as ‘very kind’ and ‘pleasant.’ People told us they felt well looked after. Without exception, people gave us the impression that their experiences at the service were positive and that they received a good standard of care.

There was an effective complaints system available. At the time of our visit there were no on-going complaints.

Some of the people we met during our inspection were able to tell us what they thought about the service. We engaged in conversation with ten people and four visitors. Everyone said they were satisfied and happy at Beanlands Nursing Home. One person said they 'felt it was a good nursing home.’ Other comments included; "It is brilliant here, we are very well looked after." and "The staff make sure I am covered when I am being dressed or undressed. They ask me if I mind a male carer helping." Three people said they were involved in their care, with their preferences being sought and taken into consideration. This included being enabled and supported to live their lives as independently as they wished.

People who were able to comment told us that they were happy with the care and treatment they received. One person said; "I use my buzzer to call the staff if I need them. They come quickly, in two or three minutes.” Another person said; “The care is very good.” One person said; “I want for nothing, I have everything I need.” Three visitors told us, we are 'quite satisfied with the care' my relative receives. They said that the buzzer was responded to within ‘an acceptable time frame.’