We carried out this unannounced comprehensive inspection of Beaumont Park Nursing Home on 29 and 30 August 2018. During our last comprehensive inspection in August 2017 we rated the service as ‘Good’. During this inspection the rating changed to ‘Requires Improvement’. This is because we identified that some improvements were required to ensure the service provided a good quality service to people who lived there. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to the deployment of staff and the management oversight of the service. You can see what action we told the provider to take at the back of the full version of the report.

Beaumont Park is a ‘care home with nursing’. 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.

Beaumont Park accommodates up to 46 people in one purpose built building across two floors. The ground floor predominantly accommodates people who have residential care needs and the first floor, people with nursing needs. Some people living on both floors were living with dementia. At the time of the inspection there were 30 people living at the home.

The registered manager left the service in March 2018 and an interim manager who was also an operations manager for the provider, was in post. A new manager had been appointed but had not taken up post yet or registered with the Care Quality Commission. 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 were not supported in a timely manner and staff were not always visible in the home. The provider had not taken sufficient steps to analyse and address the reasons for this. The provider had robust recruitment processes in place.

Staff had good understanding of their responsibilities in relation to safeguarding people from potential harm. However, there had been an increased number of safeguarding concerns at the service in the last six months. This indicated that staff may have not always acted to ensure people’s needs were met safely to the degree where neglect by acts of omission had occurred. The interim manager was taking action to improve staff practice and reduce the risk of people receiving poor or unsafe care.

Staff spoke kindly and were respectful to people but were very busy and did not have very much time to chat with them.

Risk assessments were in place that gave guidance to staff on how risks to people could be minimised without compromising people’s independence. Medicines were administered safely and people were supported to access health and social care services when required.

Staff understanding of their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) was sufficient and we saw that they gained people’s consent before they provided any care or support to them as far as possible.

Staff supervision had not been provided regularly over the past two years, although the interim manager had recently taken steps to address this. Training to enable staff to support people well had not been kept up to date over the last year. Again, steps had been taken to make improvements to this and staff had attended more training in recent months.

People were supported to pursue their interests through a wide programme of activities and one to one sessions for people who were at risk of social isolation.

Care plans took account of people’s individual needs, preferences, and choices. However, some areas of need had not been fully considere

We carried out an unannounced inspection on 09 August 2017.

At the last inspection in June 2016 we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing levels and supervision, safe care and treatment, consent to care and good governance. We also had concerns about the impact on people of sharing a bedroom, particularly when the person had not been asked for their consent, or they lacked the capacity to give their informed consent. At this inspection we found the service was meeting the expected standards and was no longer in breach of the Regulations. The provider had reduced the number of shared bedrooms from nine to two, and these were occupied by people who had consented or stated a preference to share.

The service provides accommodation and nursing or personal care for up to 46 adults, some of whom may be living with dementia and/or with life limiting conditions. At the time of the inspection, 38 people were being supported by the service.

The service 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.

There were systems in place to safeguard people from harm and staff understood when and how to report any concerns they had to the appropriate authorities. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised.

The numbers of staff on duty were sufficient to maintain people’s safety, although staff reported being rushed at times. The manager was regularly reviewing this so that enough staff were available should the numbers of people using the service increase or their needs changed significantly. The provider had effective recruitment processes in place.

Staff received regular supervision and appraisal. They had been trained to meet people’s individual needs and understood their roles and responsibilities to seek people’s consent prior to care being provided. The requirements of the Mental Capacity Act 2005 were met.

People were supported to have enough to eat and drink, and to maintain a diet that was suited to their needs. The manager was taking appropriate action to deal with comments that some people would have preferred more choice of meals and some told us the quality of the food was not always good. People were also supported to access other health and social care services when required.

Staff were kind and caring and most people were happy living at the service. People’s dignity and privacy were protected and they were supported to make choices and maintain their independence.

People’s needs had been assessed, and care plans took account of people’s individual needs. There was a range of events and activities provided and people were supported to maintain links with the local community. However a few people felt that the activities provided did not satisfy their interests, although they had not been receptive to the manager’s attempts to improve their experience.

The provider had a formal process for handling complaints and concerns.

The service sought feedback from people and acted on the comments received to improve the quality of the service. The provider had systems in place to monitor the quality of the service and the manager had an effective system for auditing each aspect of the service to ensure that management oversight was effective. However, further work was necessary to ensure that people’s experiences were consistently positive about staffing levels, food and opportunities for them to pursue their hobbies and interests.

Staff felt supported by the manager and had a good understanding of their roles and responsibilities.

We carried out an unannounced inspection on 20 June 2016.

The service provides accommodation and nursing or personal care for up to 46 adults, some of whom may be living with dementia and/or with life limiting conditions. At the time of the inspection, 46 people were being supported by the service, some of whom were accommodated in shared bedrooms.

The service had a new manager who was in the process of registering with the Care Quality Commission. 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 safeguard people from harm and staff understood when and how to report any concerns they had to the appropriate authorities. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised.

The provider had effective recruitment processes in place but staffing numbers were not always sufficient to ensure that people’s needs were met safely.

Staff had not received regular supervision or appraisal. Staff had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. However, the requirements of the Mental Capacity Act 2005 were not always met.

People were supported to have enough to eat and drink and to maintain a diet that was suited to their needs, although some people would have preferred more choice of meals. They were also supported to access other health and social care services when required.

Staff were kind and caring and most people were happy living at the service. The high number of shared bedrooms did not promote people’s dignity or protect their privacy.

People’s needs had been assessed, and care plans took account of people’s individual needs but were not person centred and contained little information about people’s lives and their preferences. There was a range of events and activities provided which was based on people’s interests and hobbies and people were supported to maintain links with the local community.

The provider had a formal process for handling complaints and concerns, but did not always respond to people’s complaints.

The service sought feedback from people and acted on the comments received to improve the quality of the service although a formal survey had not been recently completed. The provider had systems in place to monitor the quality of the service although some aspects of this system had not been fully utilised in recent months. The lack of input from the provider in relation to quality monitoring had resulted in shortfalls to the service being overlooked.

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

During our last inspection of Beaumont Park Nursing and Residential Home on 7 November 2013, we identified concerns in respect of cleanliness and infection control. This was because there was an offensive odour in a number of areas within the home.

We also found that records relating to people living in the home were easily accessible to anyone who had access to the building, meaning that people could not be confident that their personal information was secure and confidential.

This was a follow up inspection to check on these specific areas, and as such we did not speak to people using the service on this occasion.

We found significant improvements in relation to cleanliness and infection control. Apart from one room, we found no offensive odours. Odours that we had previously identified in other areas of the home had gone, either through cleaning or total refurbishment. Action was taken immediately after this inspection to address the one remaining odour.

We also found that improvements had taken place in respect of records, which were now being stored in a more secure way.

During our inspection on 7 November 2013, most of the people we spoke with told us that they were happy with the care provided to them or their relative. One person living in the home said: “Staff are very caring and they treat me with respect.”

Staff we spoke with were clear about the needs of the people they were caring for, and accurately reflected the care described in their care plans.

Arrangements were in place to ensure people had adequate food and drink.

We were concerned about the cleanliness of the home because there was an offensive odour in a number of areas in the building. This meant that people living in the home were not living in a clean and pleasant environment.

Our findings also showed that the existing building was not adequately fit for purpose. However, the provider had already started an extensive refurbishment programme to address this.

Overall, there were enough staff on duty with the right knowledge and skills to meet people’s needs. There were also plans to provide further training to staff; to ensure they were properly supported to meet everyone’s assessed needs.

Suitable arrangements were in place to address people’s comments and complaints, and ensure they were listened to.

However, some records relating to people living in the home were not being kept securely. This meant that people could not be confident that their personal information was being kept secure and confidential.

People we spoke with told us that staff members were wonderful and very good although they were very busy. We were told they were ‘always smiling and would have a laugh and a joke with us’. People felt their privacy and dignity was respected at all times. They told us that they were asked about the care and support that was provided. Although people said that they hadn’t seen their care plans, they confirmed they knew they had one and could ask to see it at any time.

One person told us that staff answer their call bells and nothing seems too much trouble.

People confirmed that they felt safe living at the home. They were able to talk to staff members or the manager if they had any concerns.

All of the people we spoke with told us that they felt that the staff treated them with dignity. People we spoke with said that they were happy living in the home and that the staff were kind, patient and caring. One person told us, “I am very happy here as my family are able to visit as they live close by”. Another person said, “I have no complaints, every thing is great”.

People told us that they were regularly asked for their views about issues within the home that affect them and that they are able to make different choices in relation to the meals they have.