We inspected this service on 28 February 2017. Beech Haven provides accommodation, personal and nursing care for up to 29 older people. At the time of our visit 23 people were using the service.

There was a registered manager in post. 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.

At our last inspection in January 2016 we identified that where risks to people’s well-being were identified, management plans were not always in place to minimise the risk. That was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw the registered provider had made sufficient improvements and the regulation in question was not breached any longer. People’s care records contained risk assessments where risks had been identified. The risk assessments gave staff guidance on how to reduce the likelihood of people coming to harm and manage these risks.

People told us they felt safe. Staff knew what to do in an event of suspecting abuse. Staff received safeguarding training and they were confident the management would take appropriate action if needed. The registered manager ensured there were sufficient numbers of staff on duty to keep people safe. The registered provider followed safe recruitment procedures to ensure only suitable staff were caring for people.

People received their medicine as prescribed and the medicines were kept securely and as per manufacturers’ guidance. People were supported to access health care services when required. People’s nutritional needs were assessed and people were supported to maintain appropriate nutrition and hydration.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the registered manager understood the MCA and DoLS and the provider followed the legal requirements. People told us staff respected their decisions and wishes.

Staff were supported through regular supervision process. Staff had access to training and development opportunities that enabled them to carry out their roles effectively.

People received compassionate care from staff. People were cared for in a way that met their needs. People were involved as much as possible in their care and were asked for consent before staff began to support them. People’s dignity, privacy and confidentiality were respected.

People’s needs were assessed prior to their admission. People’s care plans were up–to-date and reflected the support people required to meet their needs. Where people’s needs had changed care plans were updated accordingly. People received care that met their needs and we observed staff knew people’s needs well.

People were encouraged to engage in activity opportunities and benefitted from a secure environment. The registered manager planned to make improvements to the external environment so people were able to enjoy their time in the garden.

The provider had a complaints procedure in place and people told us they would not hesitate to speak to staff if they had any concerns. The registered manager ensured people’s views were sought and acted on when needed.

The registered manager ensured the quality assurance systems were effective and worked to continuously enhance the quality of the care provided. They had a good overview of all actions identified through a number of audits and ensured any actions that required a follow up were completed.

We inspected this service on 13 January 2016. This inspection was unannounced. Beech Haven is a care home with nursing providing care and accommodation to 29 older people older people requiring personal care. Some people at the home are living with dementia. On the day of our inspection there were 19 people who were permanently living at the service. Four people were on a short term, respite placements.

There was a registered manager in post. 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 felt safe living at Beech Haven. People’s relatives told us they felt the service was safe. Staff were aware of their responsibilities in keeping people safe from harm.

People’s risks such as risks of falls, mobility, malnutrition, moving and handling or skin damage were identified. However, we identified instances where there was no evidence available that the provider was doing all that is reasonably practicable to prevent avoidable harm or risk of harm to people who used the service. People received their medicine as prescribed and were protected against the risks associated with the management of medicines.

There were enough staff to meet people’s needs. People were assisted promptly and with no unnecessary delay, we noted that the call bells were answered promptly.

The service had robust recruitment systems in place that helped the management make safer recruitment decisions when employing new staff. People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff told us they were well supported by the management. However, we found their formal supervision was not always recorded.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA is the legal framework that protects people’s right to make their own choices. DoLS were in place to ensure people’s liberty is not unlawfully restricted and where it is, that it is the least restrictive practice. We noted that whilst care plans provided information about people’s capacity the documentation was lacking decision specific capacity assessments. As a result of this inspection the provider has now implemented decision specific capacity assessments.

People were complimentary about the service and staff. Throughout the inspection there was a pleasant atmosphere and we saw people being supported in a professional, kind and caring manner. Staff were knowledgeable about people’s needs and we saw many interactions which reflected staff understood and respected people’s preferences.

People’s care plans were detailed and personalised. Care plans were up to date, legible and we noted these were regularly reviewed. People commented positively about living in the home and they enjoyed a variety of activities.

People spoke positively about the register manager. The registered manager was aware of the further improvements required to the service. They undertook quality assurance audits to measure and monitor the standard of the service and drive improvement.

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

We inspected Beech Haven on 30 April 2015. Beech Haven provides nursing care for people over the age of 65. Some people at the home were living with dementia. The home offers a service for up to 29 people. At the time of our visit 20 people were using the service. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 11 November 2014. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and the suitability and safety of the environment.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beech Haven on our website at www.cqc.org.uk

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.

The home had a clinical lead who was planning to apply to become the registered manager of Beech Haven and replace the current registered manager who was planning to work as a training lead for the provider.

There were enough staff deployed to meet people's needs. People, their relatives and staff told us the staffing levels within the home had improved and this had had a positive impact on people.

The provider and registered manager had systems in place to ensure the environment was safe and secure. People were protected from the risk of harm as safety systems implemented by the provider were followed.

We visited Beech Haven on 11 November 2014. Beech Haven provides nursing care for people over the age of 65. Some people living at the home had a diagnosis of dementia. The home offers a service for up to 29 people. At the time of our visit 19 people were using the service. This was an unannounced inspection.

We last inspected in June and July 2014. At this inspection we identified a range of concerns. Following this inspection we issued a warning notice because we found the provider and the registered manager did not have effective systems to ensure the quality of the service people received. We required the provider take action by 31 August 2014.

We also found that people could not always be sure that medicines were administered safely, or that staff had knowledge of safeguarding reporting processes. People did not receive appropriate care and treatment and their welfare was not always protected. The provider gave us an action plan and told us they would take action by 31 October 2014. We found the provider had taken appropriate action regarding these previous breaches.

There was a registered manager in post 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.

The registered manager had identified the needs of people had changed, but there was not always enough staff on duty to meet people’s needs. People went for long periods of time without support or reassurance from staff, as they were not always available.

People were not always safe from the risk of injury, as staff did not always use safety measures which protected people from using stairs unsupervised. The provider and registered manager had acted on concerns raised by the local fire safety authorities to ensure people were protected from harm in the event of a fire.

Staff had knowledge of safeguarding processes, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where people were deprived of their liberty, this was done in accordance with best interest assessments and legal processes. People told us staff respected them and that they felt safe in the home.

People received their medicines when they needed them. Staff had taken responsibility for the management of medicines and could ensure people received their medicines as prescribed. The home had audits in place to identify any concerns and take action.

People were cared for by competent, skilled care and nursing staff. People told us they were treated with dignity and respect. Staff supported people with kindness, patience and dignity. Staff had developed relationships with people and knew their needs and preferences.

Staff supported people to maintain their independence and where appropriate supported people to make decisions around their care even if there was an assessed risk. People’s needs were documented and these were reviewed and updated monthly or more frequently if needed.

The management acted upon feedback and complaints from people and their relatives. Feedback was used to inform changes to the service people received. Following a recent survey the registered manager had implemented an action plan around activities, entertainment and people’s religious needs. The registered manager had an overview of the quality of service provided and had developed systems to identify concerns and develop the service.

The provider had a clear goal for Beech Haven. This had been communicated with staff at recent meetings. The provider was looking to develop a caring culture and staff told us this could be achieved by caring for people in a personalised way, involving people in their care and good communication. The provider and registered manager were looking at dementia training courses to improve activities and engagement for people with dementia.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

There were 20 people living at Beech Haven at the time of the inspection. Many people were unable or declined to speak to us but we were able to speak with two people living in the home during the course of the inspection and two visitors.

People were encouraged to give their consent to care wherever possible. Staff delivered care to people based on their assessed needs which were reviewed regularly. People we spoke with told us that staff were courteous and treated them with respect. Visitors said that the staff were friendly, kind and caring. Staff said they felt supported and enjoyed working there because the place had a “homely feel.” A relative had written in a letter of thanks “I knew X could be difficult at times but he felt safe with you and it was his home and you looked after him very well.”

Some aspects of the administration and recording of medicines was not sufficiently robust and may put some people at risk by not having the medicines they need when they need them.

There was an effective complaints procedure in place.

People we spoke with told us that although they had not all chosen the home they liked the home and were happy there. People told us that you could not wish for better staff. People we spoke with told us that care was given when they wanted it and if it was urgent they would ring the call bell.

People liked the food and told us there was always plenty to eat and they had a choice. People we spoke with told us that they liked to entertain themselves but said there are things to do if you wanted to join in. Relatives, friends and guests were made to feel welcome and could visit when they wanted as there were no set visiting times.

On the day of our visit 22 people were using the service. They were supported by a senior care worker, three care workers and a nurse in the morning; and a senior care worker, two care workers and a nurse in the afternoon. We spoke with six people who used the service and three relatives. We also spoke with two nurses, four care workers, the chef and the registered manager. One inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was not safe because staff were unaware of the multiagency safeguarding procedures for the home. A nurse was not aware of the procedure to follow when an allegation of abuse was made.

The service did not have systems in place to ensure people’s medicines were administered safely or recorded appropriately. The service maintained no records of the stock of people’s prescribed medicines.

People were not always protected from risks associated with their care. For example we saw that people who were at the risk of dehydration and skin damage were not always receiving appropriate support as care workers did not follow the person’s care plan.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit we found that the registered manager and senior staff had awareness of DoLS. We found that one person was potentially being deprived of their liberty, but a request for DoLS had not been made. The manager made an application for this during our visits. We spoke with the manager about the recent high court judgement around DoLS. They told us that they had awareness of this decision and had attended a recent conference.

Is the service effective?

The service was not effective because people’s care plans were not always being followed by care staff. For example we saw that people’s needs were recorded but there was not always effective guidance in place for staff to follow in relation to people’s needs.

Care workers and nurses were appropriately trained and received frequent supervisions.

Is the service caring?

The service was caring. People we spoke with were complementary about the home. We found that people benefitted from kind and caring care workers. We conducted a short observational framework for inspection (SOFI) observation in the one of the homes dining room at lunch. We saw during this observation that people were treated with respect.

During our inspection we received a concern about the end of life care of people at Beech Haven. Due to these concerns we returned to the home. No one was receiving end of life care at the time of our visit. Staff we spoke with had good awareness of people’s end of life needs. We will continue to monitor this in future inspections.

Staff demonstrated good awareness of people’s dignity and how they should respect this.

Is the service responsive?

We found that the service was not responsive. Staff did not always report incidents and accidents to the home’s management.

We found that the management sought the views of people who use the service, their representatives and staff; however these were not always acted upon. For example, people raised concerns about the lack of activity and engagement. We saw that the management were aware of these concerns but no changes had been made.

Is the service well led?

We found that the service was not well led. The service did not audit accidents and incidents to identify any trends to inform service delivery.

The service had audits regarding medicines and care plans; however these audits were not always identifying risks and were not always being effectively used to take appropriate actions to address risks.

The management was unaware that fire doors were being obstructed from closing within the home. We raised these concerns with the manager on the first day of our inspection. On the second visit we noticed that staff were still obstructing fire doors from closing. This meant people were not always protected from risk in the event of a fire as staff did not follow correct practice.