This unannounced inspection took place on 24 and 29 August 2017. We last inspected Beaufort Care Home on 10 July 2015. At the inspection in July 2015 we rated the home as ‘Good’ overall and for the domains of ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-led’. We rated the home as ‘Requires Improvement’ for the ‘Safe’ domain as we made a recommendation about staffing levels and how these potentially affected people’s social needs.

Beaufort Care Home is on a main road position in Burscough. Accommodation is provided for 32 adults requiring personal or nursing care. At the time of our inspection there were 26 people living at the home. The majority of rooms are of single occupancy, with en-suite facilities. The environment is spacious, well maintained and tastefully decorated with good quality furnishings. All amenities are easily accessible within the nearby village of Burscough and public transport links are close by.

There was no registered manager in place at the time of our 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. There was a manager at the home who had been in post for approximately four months at the time of our inspection. The manager had begun the process of registering with the CQC at the time of our inspection.

People told us they felt safe living at the home and that staff were kind and compassionate to their needs. Appropriate safeguarding practices were in place and staff knew how to recognise and report potential safeguarding issues.

We looked at the way the service supported people with their medicines. During the inspection we observed people being sensitively and safely supported with their medicines. We found medicines were being stored safely and securely. Room and fridge temperatures were monitored in order to maintain the appropriate storage conditions. Processes were in place to manage the appropriate disposal of medicines, including returns to the pharmacists. Controlled drugs were administered and stored appropriately.

We found some examples of ‘as needed’ medicines protocols which included pre-printed ‘generic’ instructions, they were lacking in person centred detail to ensure the medicine was administered safely and effectively in response to the person’s specific needs. We have made a recommendation about this.

During the course of our inspection we found there were sufficient numbers of staff to meet people’s assessed needs. We asked people and relatives about staffing levels and we received mainly positive responses.

We found the home to be clean, free from clutter and devoid of any malodours. There was an efficient cleaning and infection control regime within the home.

Staff received the appropriate training to undertake their specific role effectively. We reviewed the homes training matrix, discussed training with staff and spoke with the external training advisor for the home. People we spoke with had no concerns regarding the ability or competence of staff.

The home was working within the principles of the Mental Capacity Act and any conditions or authorisations to deprive a person of their liberty were being met.

The home supported people with their nutritional needs including catering for people with specific needs such as those needing a diabetic or soft diet. Feedback regarding the quality of food was positive and the dining experience was seen to be a positive one.

We spoke with staff about the needs of the people who lived at the home. It was evident that staff knew people well and were able to describe people’s preferred routines, likes and dislikes. There was evidence within people’s care plans to show that this was documented.

The service had policies and procedures

This inspection took place on 10 July 2015 and was unannounced. We last inspected Beaufort Care Home on 30 October 2014 to follow up issues found during a scheduled inspection on 3 July 2014. During the follow up inspection we found the home had not made the necessary improvements to how they assessed and monitored the quality of the service provision or how they ensured that people’s personal records were accurate and fit for purpose. We judged both areas to have a moderate impact on people living at the home. We issued enforcement action via two written warning notices to the home. During this inspection we reviewed actions taken by the provider to gain compliance. We found that the necessary improvements had been made.

Beaufort Care Home is on a main road position in Burscough. Accommodation is provided for 32 adults requiring personal or nursing care. At the time of our inspection there were 25 people living at the home. The majority of rooms are of single occupancy, with en-suite facilities. The environment is spacious, well maintained and tastefully decorated with good quality furnishings. There is ample car parking available. All amenities are easily accessible within the nearby village of Burscough and public transport links are close by.

There was a registered manager in place at the time of our 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.

People told us they felt safe at the home and with the staff who supported them although five of the twelve people we spoke with who lived at the home, stated that they felt there were not always enough staff on duty. We have made a recommendation about this.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. They told us they would ensure people who used the service were protected from potential harm or abuse.

We looked at how medicines were ordered, stored, administered and recorded. We spoke with the nurses who had responsibility for administering medication and observed medication being given to people over the dinner time period. We also observed the nurse on duty giving one resident a controlled drug. All the medicines given were done so in a discreet manner. The nurse was able to explain what people took their medication for and what support they needed.

We saw there were detailed policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA), which provided staff with clear, up to date guidance about current legislation and good practice guidelines. We spoke with staff to check their understanding of the MCA. Care staff’s knowledge of MCA and Deprivation of Liberty Safeguards (DoLS) was limited. However, nobody living at the home at the time of our inspection was subject to a DoLS authorisation. We have made a recommendation about this.

We received a mixed response from staff when we asked if they received regular supervision. Some of the staff were new but it looked as though supervisions had been held on an ad hoc basis prior to the new manager being in post. We discussed supervisions and appraisals with the registered manager who told us that a staff meeting was planned and supervisions would be discussed within this forum.

People we spoke with told us they were happy with the care they received at the home and that they had positive relationships with staff. Both people and relatives we spoke with all rated the staff very highly and considered them to be kind and caring. All agreed that the staff treated them with respect and also ensured their privacy.

We viewed a number of bedrooms during our inspection. We found rooms to be personalised with objects and pictures displayed that were clearly personal and important to those who lived in these rooms. This promoted individuality and maintained people’s interests.

People we spoke with and their relatives told us they knew how to raise issues or make complaints and felt comfortable doing so. We saw that the home had a complaints procedure and that it was on display and made available to people, this was confirmed when speaking with people and their relatives.

There were a number of systems in place to enable the provider and registered manager to monitor quality and safety across the service. These included regular audits and quality checks in all aspects of the service such as, medication, care plans and infection control. We spoke with the organisation’s care and compliance manager who arrived at the home on the morning of the inspection. As well as individual audits for specific areas, there was also a monthly quality audit that she undertook. We saw copies of these audits during our inspection.

We inspected Beaufort Care Home to review action taken in relation to two areas we had found the provider to be non compliant in when we last visited in July 2014.

During our inspection we looked around the home. We spoke with two relatives and one person who lived at the home. They all told us they were happy with the care and had no concerns. None of them had ever had to complain but they all told us they would be comfortable to approach the manager or staff and felt confident they would be listened to.

We looked at three care plans (two in detail) and were concerned that there were sections that were blank or incomplete. We were also concerned that there were insufficient processes in place to ensure that records such as policies, accident files, medication records, were reviewed regularly. There were few systems in place to monitor the quality of care provided such as satisfaction surveys or residents/relatives meetings.

we were also concerned that staff records showed us that systems were not robust in relation to recruitment and could not be confident that people would be kept safe.

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?

We undertook a tour of the premises at the beginning of our inspection and viewed a number of people's private rooms, toilets, both sluice rooms as well as all communal areas of the home. The environment was very clean and hygienic and there were no unpleasant odours. We undertook another tour of the home with a member of the domestic team later in the day who showed us were cleaning equipment was stored. They also talked us through the daily cleaning schedules that the home had in place.

Records showed care assessments had been carried out and we saw that care plans were written in a person centred way. However we did find examples of missing information and contradictory information within some of the care plans we looked at. One example being that one person we spoke to told us that they felt they had lost weight over the past few months. We checked their care plan and saw that during a six month period they had lost a substantial amount of weight. However monthly weight checks had not been carried out regularly and we could not find any record of weight checks being carried out for the previous two month period.

Is the service effective?

We spoke to the activities co-ordinator who visited the home once per week as well as several other homes within the Dovehaven group. They told us, "The recent change in management has meant there is a more proactive approach to activities. I've spoken to Sue (Acting Manager) and we have worked out who would benefit from 1-1 time and I spend time with people who are unable to leave their room if they want to see me".

Is the service caring?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, Incontinence service and GP's.

We spoke with four members of staff as well as the acting and deputy manager. All the staff we spoke with were clear what to do in the event of an emergency at the home such as fire or if a person living at the home had fallen.

Is the service responsive?

The homes complaints procedure was on display within the reception area and the people living at the home and visiting relative we spoke with all told us that they would feel comfortable raising issues or complaints of they felt they needed to. Staff we spoke with knew how to assist people if they had any concerns or wanted to make a formal complaint.

Is the service well-led?

We saw that a number of audits took place such as medication, hand hygiene and care plans. We saw that issues had been identified and actions put in place as a result. However some of the issues highlighted within the care plan audits were still apparent during our inspection, e.g. weight charts not completed or relevant risk assessments completed.

During our inspection we were able to speak with six people living at the home, who in general, provided us with positive comments. They told us that they felt safe living at Beaufort Care, with their privacy and dignity always being respected and their needs being met by a kind and caring staff team. They said independence was promoted and they were able to make decisions and choices about what they wanted to do, whilst living at the home.

We found recruitment practices to be robust and those living at Beaufort Care looked comfortable in the presence of staff. We also spoke with some relatives who were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

"The staff are wonderful."

"The girls are exceptionally nice. They are very friendly and extremely helpful."

"It is beautiful here. We couldn't wish for any more."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We spoke with seven people living at the home and two relatives during our visit to this location. Those we chatted with were very complimentary about the staff team, saying they were kind and caring, whilst respecting people's privacy and dignity.

Comments we received included:

"I am better off here than at home. I am really well looked after. They (the staff) are very kind and caring to me. I have no complaints at all."

"The variety of food is very good and we are able to choose what we want to eat."

"The staff are marvelous. Very gentle and pleasant and they have a lovely approach."

People spoken to made positive comments about the service provided. They told us that staff were kind, approachable and listened to their opinions.

We used SOFI (Short Observational Framework Inspection) methodology to capture what people experienced during a set period of time. This means that we discreetly observed a number of people during a selcted period of the day, from which we recorded a variety of observations and interactions for specific time frames. On this occasion we observed three people living at the home for one hour over the lunch time period using five minute time frames. All our recordings were positive with some good interactions by staff observed.

During our visit we saw staff talking to people with respect and always in a polite manner. It was evident that individuals were being supported to maintain their independence, although assistance was consistently provided when required.

We saw that people living at the home were being supported to make informed choices, such as what to eat and what to do, as part of day to day life at Beaufort Care Home. One person living at the home told us, “It is great living here. We are well looked after and the staff are very caring” and a relative commented, “Beaufort Care Home is like one big happy family. Everyone is so friendly and the managers are very approachable”.

There was a lot of evidence available to show that support and advice was being sought from external professionals when needed and that people’s wishes were taken into consideration when making decisions about any health care issues.