This inspection of Beaufort Hall Nursing Home took place on 22 October 2018 and was unannounced. Beaufort Hall Nursing Home provides, accommodation, nursing and personal care for up to 33 people; some of whom are living with dementia. It is also registered to provide the regulated activity; treatment, disease, disorder and injury. At the time of this inspection there were 26 people living in the service.

At the last inspection in October 2017, the service was rated 'requires improvement' in the areas of safe and well led. At this inspection, we found the service had made improvements under the questions is the service safe and well-led? The service is now rated as good. Beaufort Hall 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.

People's medication was now well managed by staff that had received training and have been assessed as competent. People were given their medicines in a safe manner.

Quality monitoring procedures were now in place and action was taken where improvements were identified.

There was not a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. However, there was an interim manager in post and a new permanent manager was due to start. 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.

Care plans did not all provide detailed guidance to staff to ensure that people were receiving the appropriate care at all times. People felt safe and staff knew how to respond to possible harm and how to reduce risks to people.

People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practices and to reduce further occurrences. People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

People's privacy and dignity was promoted and maintained by staff. People received a caring service as their needs were met in a considerate manner and staff knew the people they cared for well. People were involved in their care and staff encouraged people's independence as far as practicable. Activities were offered to support people's interests and well-being. Equipment and technology was used to assist people to receive care and support which included the use of call bells.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People's confidential records were held securely. Systems were in place to promote and maintain good infection prevention and control.

People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed and staff followed their advice. The registered manager and staff team worked with other health and social care organisations to make sure that people's care was coordinated and person centred.

Compliments were received about the service and complaints investigated, responded to and resolved where possible to the complainants' satisfaction. Staff worked well with other external health professionals to make sure that peoples end-of-life care w

This inspection took place on 12 October 2017 and was unannounced. Beaufort Hall Nursing Home is registered to provide accommodation for up to 33 people who require nursing or personal care. At the time of our inspection there were 30 people living at the service.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Medicines management were not consistently managed safely.

The provider did not have consistent effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. The registered manager took immediate actions to address the identified shortfalls in the inspection.

Recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely.

Environmental checks had been undertaken regularly to help ensure the premises and equipment were safe.

The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm.

People received effective support from staff that had the skills and knowledge to meet their needs. Staff said they felt well supported and all had regular supervision sessions. Supervision is where staff meet one to one with their line manager.

People told us that staff were kind and caring. We observed that people's privacy and dignity was respected at all times. The service had received a number of compliments from relatives and visitors.

Care plans contained details of people’s preferences and choices regarding the care and support they needed. Plans in relation to people’s health needs were detailed. Care plans had been regularly reviewed. People and relatives felt that the service was responsive to people’s needs. People had access to a range of activities and held the activities coordinator in high regard.

Staff felt well supported by the registered manager and the provider. People were encouraged to provide their views through surveys and regular meetings. Actions were taken in response to people’s feedback.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection on 24 June 2015. The inspection was unannounced. Beaufort Hall nursing home provides accommodation for up to 33 people who require nursing care. There were 26 people using the service at the time of the inspection.

There was a registered manager at the service. 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.

There were systems in place to support staff in providing safe care for people who used the service.

People’s needs were assessed and risk assessments when required were put in place to tell staff how they should provide care to people in a safe manner. Staff received training to help them fulfil their role including how to recognise report concerns if they suspected a person to be at risk of harm or actual abuse. This helped to keep people safe and people told us they felt safe.

There was sufficient skilled staff on duty to meet people’s assessed needs. There were suitable arrangements for the safe storage, management and disposal of medicines which meant people received their medicines safely and according to their needs.

We found that, where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005. The CQC is required by law to monitor the operation of the MCA 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in pace to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection no applications had been made to the local authority in relation to people who lived at Beaufort Hall nursing home.

The manager ensured staff were supported to develop their skills and knowledge to provide effective care and support for the people who used the service. People told us that the staff were caring and were complimentary about the care and support they received. People were supported to maintain good health and there was a varied menu so people could choose what to eat and drink and have enough for their needs.

People’s privacy was respected and people were able to express their views and these were taking into account when providing them a service. This meant the service was responsive to people’s needs. The care provided was needs led and individually focussed.

There was a complaints policy which enabled people and others to raise concerns and they knew what to expect once a concern was raised. The home was led by an effective management team who were committed to providing a good service which was responsive to people’s individual needs and had quality assurance systems in place.

There were 18 people living at the home at the time of our inspection.

People told us they were happy with the care and support they received. One person said "I am very happy here and the staff are wonderful". Another person said "You are always asked what you want to do and I really enjoy the art classes". A relative told us they had taken great care in choosing a nursing home for their family member. The person said "I am very pleased with the care and support that my relative receives at Beaufort Hall".

We reviewed ten care plans and saw they contained risk assessments that were regularly reviewed and updated. This ensured that the care that was delivered, was safe. We noted that care was planned and delivered in line with people's individual care and support needs and met their personal choices.

We observed throughout the day that staff sought consent from people in a kind and gentle manner and used a variety of communication styles when seeking consent.

We observed the home was clean and tidy, well maintained and free from noxious odours.

People told us they enjoyed their meals and there was plenty of choice. We observed throughout the day that people were supported to eat and drink well. People had up to date food and fluid charts. We noted that food and fluid intakes were not calculated daily. This meant there was no system in place to monitor whether the food and fluid intake was adequate for each person's needs.

We spoke with seven of the people who lived in the home and the relatives of one person. Everyone we spoke with said that the staff were respectful and treated them properly. People told us, “I think the staff are really wonderful” and “Staff are perfectly kind and respectful”. We observed people in the dining room at lunchtime. Staff treated people respectfully and introduced themselves whenever they engaged with people or offered to assist them with their meals. People told us, “They come around and ask you what you would like”.

Everyone we spoke with said they were happy over all with the care provided. We were told “We are all looked after properly” and “Staff come quickly when I need them”. One person said, “The staff are very pleasant people. I feel perfectly safe here”. A relative told us, “I’ve seen nothing but kindness here, I can’t speak highly enough about the staff” and “The staff have bent over backwards to make sure my relative is comfortable”. One person told us that in their opinion staff at night were very busy. We observed that staff in the dining room were also busy over the lunchtime period

People told us they were able to express their views and get involved in making decisions about their care and daily living. We were told, “I’ve got no grumbles, if I ask for anything it will be sorted”

People told us that the manager was very visible and continually checked that people were receiving an appropriate standard of service. We observed this. We were told,”The manager is always around and into everything. You name it and she is there” and “I’m happy I’ve come to this home. I’ve had no second thoughts”. People’s relatives were able to visit at any time and could stay for as long as they wished. Relatives told us that they were made to feel very welcome. We were told, “Staff are good at communicating and will let us know about any issues” and “I would recommend this home to everyone”.

We observed that the care plans detailed the care needs of the people at the home. We saw that not all assessments had been completed. This included assessment about people’s mental capacity. This is needed to ensure that people who are no longer able to make decisions and choices for themselves are supported appropriately including decisions for end of life care.

We saw that people who were nursed in bed had appropriate care. We saw that charts were completed to show a regular change of position. We looked at records that were kept of how much food and fluid people cared for in bed, had eaten and drunk. We saw that the records were up to date and showed staff supported people to eat and drink properly. The charts did not show that the amounts taken on a daily basis were not added up. This meant that there was no system to monitor whether fluids and food taken were adequate for the individual’s needs.

Staff told us that they felt well supported and that they had received all necessary training. We looked at the training records and saw that some people had not attended all necessary training.

The people we met were very enthusiastic in their praise of the home, the care and the life they are able to lead there. One person told us “I like it because it is a homely place, you can do what you want and the staff are very hardworking”. Another person said, “I find the service very good”, another comment made was, “the staff listen to you and do what you want”. This demonstrates real satisfaction from the people who use the service with the care and support they receive.

We met a number of visitors during the inspection who were positive in their views of the home. Two people told us that they had looked at twenty one care homes before choosing this one for their relative. This suggests that the people concerned saw something very positive about the home when they made their choice.

People who use the service benefit from the inclusive attitude of the manager. One good example of this is the involvement of people who live at the home in the staff recruitment process. On the day of our visit we noticed two people who use the service were helping the manager to interview potential new staff. We were told this was part of the usual recruitment practice in the home, which shows people living there are involved in the running of the home and helping to choose the people employed to look after them.

We saw people who use the service sitting together in the home looking relaxed and comfortable in their surroundings.

We observed warm relationships between the people who use the service and the staff caring for them.

There has been investment in upgrading and renovating the fixtures, fittings and fabric of the home both internally and externally. The people who use the service and the visitors we met told us how improvements to the environment had enhanced the place and made it a suitable place for people to live in.

The people who use the service receive a caring service meeting their nursing and personal needs. People who use the service are happy living at the home.