We carried out an unannounced inspection of Beaumont Court on 22 October 2018. Beaumont Court is a care home which provides care and support for up to 40 predominantly older people. People living at Beaumont Court had physical health needs and mental frailty due to a diagnosis of dementia. At the time of this inspection there were 38 people living at the service.

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 services registration and regulated activities had changed since the previous comprehensive inspection in July 2016. The service was no longer registered to provide the regulated activity nursing care.

Beaumont Court is an extended historic building in its own extensive grounds close to the town of Launceston. The service is divided into three separate households. The main house is on two floors with the upper floor accessed by a stair lift. The other two households are single storey with patio doors leading onto the landscaped gardens. All rooms had en-suite facilities and there were shared bathrooms, shower facilities and toilets. Each household had its own lounge and dining areas. Hawthorne Avenue was waiting for the construction of a conservatory to extend and improve the living area of this facility.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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 and associated Regulations about how the service is run.

The service had registered onto the Butterfly Project. A model of care specifically designed to promote quality of life outcomes for people living with dementia by educating staff in delivering person centred and relationship focused dementia care. The butterfly system aims to improve people’s safety and wellbeing by teaching staff to offer a positive and appropriate response to people with memory impairment. A staff member said, “It’s all very new but I am loving the changes and the difference its making for residents and staff.” It was anticipated the service would receive accreditation for this project by the end of the year. A family member told us the type of care their relative received meant, “[Relative name] is safe and content here. I feel I have got my dad back.”

Risks to people were assessed and actions were identified and implemented to keep people safe. Staff understood people's psychological and emotional needs and appropriate support was provided to meet them. People had regular access to healthcare professionals and staff worked collaboratively with them.

People's medicines were managed and administered in line with best practice and staff had received medicines training and their competency had been assessed.

Where people had capacity they and their relatives told us they were happy with the care they received and believed it was a safe environment.

The design of the service meant people living with dementia conditions lived in the various households depending on the level and effect of dementia they were experiencing. For example, Cherry Tree Lane was designed for people with lower physical and mental dependency levels, Hawthorn Avenue was designed and staffed to accommodate and support people going through mid-stage dementia. Willow Walk supported people with a higher level of needs for their physical and mental health.

In general, the atmosphere was generally calm and relaxed. People were not restricted in respect of their movement around their area of the home were living in. People were observed to be spending their time in communal areas, their own rooms o

We previously carried out a comprehensive inspection on 5 July 2016. A breach of the legal requirements was found. During that inspection we found that the service required improvement in relation our question; Is the service effective? because staff did not understand the requirements of the Mental Capacity Act 2004 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

The Mental Capacity Act 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS ).

During our inspection in July 2016 we found people’s care records did not clearly record if there had been any capacity assessments carried out to check if people could make specific decisions for themselves.There were people living at the service who had been recognised as not having capacity to make specific decisions for themselves, were not free to leave and were under close supervision. These people had not been identified and judged as potentially being deprived of their liberty. DoLS authorisations are specific to the environment the person is in and cannot be transferred without a new authorisation. The registered manager had not identified that this person should have had an application made for a DoLS authorisation now they had moved to the service.

The DoLS policy held by the service did not reflect current practice at the time of the last inspection. This meant staff were not provided with accurate guidance. Not all staff had attended training on the Mental Capacity Act 2005. Staff were not clear on this legislation when we spoke with them. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Following this inspection the service sent us an action plan stating how they would address the breach of regulation. We carried out this focused inspection to check that the service now met the requirements of the regulation.

This report only covers our findings in relation to these topics. We checked to see if the service was Effective. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaumont Court on our website at www.cqc.org.uk

Beaumont Court is a care home for up to 40 predominantly older people. At the time of the focused inspection there were 39 people living at the service. The service had recently changed the service provided from nursing to residential care. This meant that some of the more dependent people had left the service to be cared for elsewhere. Whilst the clinical lead and one other nurse remain working at the service to oversee this change in service provision, the nursing needs of people living at Beaumont Court were now met by the district nursing service.

At this focused inspection we found the service held a comprehensive and accurate DoLS policy. Staff training in MCA and DoLS had been planned for June 2017. The service had one person for whom an authorisation for a restrictive care plan had been agreed. There were conditions applied to this which the service were supporting. The service had made other appropriate applications for other people to be assessed for DoLS, these were awaiting assessment by the local authority. People had been asked for their consent, where they were able, to receiving care. This record was held in their bedrooms. The service had records to show whi

This unannounced comprehensive inspection took place on 5 July 2016. The last inspection took place on 30 April 2014. The service was meeting the requirements of the regulations at that time.

Beaumont Court is a care home which offers care and support for up to 40 predominantly older people. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service occupies a two storey detached former vicarage which has been extended.

The service had 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.

There were people living at the service who had been recognised as not having capacity to make specific decisions for themselves, were not free to leave and were under close supervision. These people had not been identified as needing to have applications made for Deprivation of Liberty Safeguards (DoLS) authorisations. The DoLS is part of the Mental Capacity Act 2005. The service held a policy for DoLS which had been reviewed in June 2016 by the registered manager. However, this policy review had not taken account of the 2014 Supreme Court judgement which changed how services should judge whether a person might be deprived of their liberty. The policy did not reflect current practice. Staff were not clear on this legislation and guidance. This meant people’s human rights were not adequately protected and staff were not provided with accurate information to guide their practice.

Staff were supported by a system of induction training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff had received most training relevant for their role. Not all staff had received training on the Mental Capacity Act 2005. More specialised training specific to the needs of people using the service was planned. For example, dementia care.

Some people had been assessed as being at risk from developing pressure damage to their skin. These people were provided with pressure relieving mattresses. Such mattresses should be specifically set to relate to the individual’s current weight. Two out of five mattresses checked were incorrectly set. Mattresses settings were not being checked regularly by staff. This meant people’s risk of developing pressure damage was not always effectively managed.

We looked at how medicines were managed and administered. People had received their medicines as prescribed. Regular medicines audits were carried out. However, prescribed creams and liquids were not always dated upon opening. This meant staff were not always aware when the item was no longer safe to use. Medicines kept in the medicine refrigerator were not regularly checked to ensure they remained safe to use.

We walked around the service which was comfortable and in good condition. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. People, relatives, staff and healthcare professionals felt there were sufficient staff to meet people’s needs.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were held on a computer system called the Care Management System. Records were well organised and contained accurate and up to date information. Care planning was reviewed regularly and p

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Beaumont Court alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Beaumont Court had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, although people were not involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a good standard enabling care staff to use the information correctly.

Is the service caring?

We spoke with two people and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful”, “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and some life histories were evident.

Beaumont Court had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

The care records showed evidence of the lifestyle of the people who lived at Beaumont Court and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

We met with the new manager who is not yet registered with the Care Quality Commission. We were told that her application for registered status had been submitted and is in the final stages of the process. We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We carried out an inspection on the 30 August 2013 due to concerns that had been raised with us. We visited the home and looked at how the home was keeping its various records that are required. We found there were concerns about how the home was maintaining its records and judged this to be having a moderate impact on people.

We wrote to the provider and requested they produce an action plan in order to address the concerns raised. They did this and told us they would have completed their plan by the 25 November 2013.

We carried out a follow up inspection on the 03 December 2013 to ensure that the concerns had been addressed as planned. During our visit we looked at the records again and but we also reviewed that people’s consent was being sought and their care and welfare needs were being met.

We were advised there were 34 people living at the home when we visited. We read seven care plans, spoke to five people and observed how staff interacted with people living within the home. We did not speak to any of the care staff but spoke in detail with the registered and deputy manager. We also spoke with the GP with responsibility for the home.

We found people’s right to consent to their care and treatment was being respected.

We also found that people’s care and welfare needs were being met.

We found that progress had been made in respect of the keeping of records but their remained a number of concerns. We have judged this has being of a minor impact

We visited the home due to concerns raised by the ambulance service in respect of the records made available to them when they were required to transfer a person to hospital in an emergency.

We did not speak to people who used the service but spoke at lengths with the deputy manager who was in charge as the registered manager was on holiday.

We looked at a range of documentation such as care plans, daily records, drug records and the archiving. We found the records held by the home about people living there for both short and long term stays were not sufficient to ensure that the delivery of care was being recorded and detailed in a consistent and robust manner. This meant that people's care needs were not being fully assessed and met.

During our inspection we spoke with the deputy manager and three staff about the care and support they provided. We observed staff helping people in a discreet manner and speaking to people with respect. We saw call bells were answered very promptly.

We saw care plans were detailed and directed staff as to the care and support people needed. They had been regularly reviewed.

We saw a range of activities were available and well attended. Some people who used the service also enjoyed trips out in the homes minibus.

We saw meals were well presented and care workers were available to assist people as required. We were told there was always a choice of meals and we saw daily menus displayed around the home.

Appropriate arrangements were in place in relation to the recording of medicine.

Medicines were handled appropriately, kept safely, safely administered and were disposed of appropriately.

The home was arranged over two floors, with access to the first floor via a staircase or a stair lift. The home had 40 en-suite bedrooms, some of which had direct access to the gardens by way of patio doors. We saw the home was undergoing redecoration and refurbishment in some areas. The home was welcoming and homely. Appropriate arrangements were in place for servicing utilities and equipment to ensure the home was safe to live in and the equipment safe to use.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We carried out an unannounced inspection on 29 August 2012. On the day of our visit we were told that there were 35 people living at Beaumont Court. We spoke with eight people living at the home, six staff members which included three members of the management team and looked at four people’s care files.

We saw that staff treated people with consideration and respect. For example, we saw that staff quickly responded to people’s care needs to ensure that they were kept comfortable and informed about what was happening, such as when lunch would be and what activities were available.

Staff had knowledge of privacy, dignity, independence and human rights. For example, how to maintain privacy and dignity when assisting with personal care. They showed an understanding of the need to encourage people to be involved in their care. For example, staff recognised the need to promote positive experiences for people to aid their wellbeing through offering a range of activities to choose to partake in or spending one-to-one time with them.

Care plans that we saw reflected people’s health and social care needs and demonstrated that other health and social care professionals were involved.

We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.

Staff told us they received health and social care needs specific training which they believed helped to equip them to do their job. Staff said they received supervision and appraisals and that the management team provided close supervision, advice and support.

The home conducted regular audits to ensure the health and safety of the people living there. These included checks on, medication, infection control and accidents.