This inspection took place on 20 and 21 November 2018 and was unannounced. At this inspection, we found improvements had been made and the service is now rated as ‘Good’.

Beech Hill Grange Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. A maximum of 74 people can live at Beech Hill Grange and at the time of our visit 73 people were living there.

We last inspected Beech Hill Grange Nursing Home on 20 June 2017 when we rated the service as 'Requires Improvement' in all the key questions. This meant the overall rating of the service was 'Requires Improvement'. We found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and were rated as Requires Improvement. The provider was failing to meet regulation 17 of the HSCA which related to the governance systems had not all been effective, and had not ensured that people would receive a consistently safe service that met their needs. After our inspection in June 2017 the provider provided us with an action plan outlining what they would do to meet legal requirements in relation to the breach. At this inspection we found improvements had been made and the service is now rated as ‘Good’ overall.

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.

The provider had systems in place to check and improve the quality of the service provided. We saw that where areas required improvement action had been taken in response.

The home was well-led by an experienced management team who were enthusiastic about the service and committed to providing good standards. Staff received appropriate training and support, understood their roles and responsibilities and had confidence in the management team.

People felt safe living at the home and were protected from the risk of abuse. The provider had systems in place to minimise the risk of abuse and staff had a good knowledge and understanding of the signs of abuse and who to report concerns to.

Staff were available to meet people’s individual needs and demonstrated good knowledge about people living at the home.

People were protected from environmental risks within the home. People received good healthcare and were referred to external healthcare professionals when a need was identified to maintain their health.

Staff were caring and treated people with respect. People were relaxed around staff. Staff showed us that they knew people’s likes, dislikes and interests.

Staff who gave people their prescribed medicines demonstrated a good knowledge and understanding of how to do this safely.

The registered manager was aware of their responsibilities in line with the Mental Capacity Act 2005. Staff offered people choice and respected the decisions they made. Where restrictions on people had been identified, Deprivation of Liberty Safeguards authorisations were in place to lawfully deprive people of their liberty for their own safety.

People were encouraged and supported to eat and drink enough and were positive about the quality of their meals. People were supported to take part in a range of activities in and outside of the home.

People knew how to raise concerns and felt confident they could raise any issues should the need arise and that action would be taken as a result.

The design and decoration of the premises promoted people's wellbeing and supported staff to use

equipment safely. The home was clean

This unannounced comprehensive inspection took place on 20 June 2017. We last inspected this service in October 2014 when we found the service was rated ‘Good’ in all of the five key questions.

Beech Hill Grange Nursing Home is registered to provide nursing care to up to 62 older people who may also be living with dementia. At the time of our inspection there were 58 people living at the home. The home has a registered manager and they were present throughout 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.

Feedback from people living at Beech Hill Grange and their relatives was that they felt safe. While we observed many practices and systems that promoted safety we found that people were not always supported to move safely. Staff did not always follow good practice regards their nails and jewellery and this had possibly caused some people to be injured. The fire safety risk assessment had not been fully responded to, or updated and we could not be certain the fire safety arrangements were adequate. People did not always experience timely support from the staff team, and people and their relatives shared examples of the impact this had on them.

Medicines were well managed, and people could be confident their medicines would be stored and administered safely and as the doctor had prescribed.

Risks people lived with, that were related to their health conditions or age had been assessed, and plans developed to minimise the impact of the risk on people.

People did not always have a pleasant mealtime experience. People gave us mixed feedback about their enjoyment of the food. The food we saw looked and smelt appetising. Adjustments people needed to their food and drinks to ensure they could eat and drink safely had been made. Systems were in place to ensure people ate and drank enough to maintain good health.

Most staff had received training in the specific needs of the people they were supporting, as well as safe working practices. Some of this knowledge needed to be updated and some staff required this training.

People were offered the opportunity to make a wide range of every day choices. We saw and heard people being asked about what they would like to wear, to do, to eat and drink for example. Processes to help people make bigger decisions were established. However the lack of knowledge demonstrated by some direct care staff may mean people’s human and civil rights would not be protected.

People could be confident their healthcare needs would be well met. There were good relationships between the staff working at the home and local health care professionals. Changes in people’s healthcare were noted and the relevant support was sought for people.

People were not consistently treated with kindness or compassion. Staff did not always knock before entering people’s bedroom. People were not always referred to respectfully. People were not always offered comfort or reassurance when they were distressed.

People and their relatives told us that they could share concerns or complaints at any time. However people told us they were largely happy with the service provided and that this had not been necessary.

Activities were provided for people throughout the day and at weekends. Some people really enjoyed and benefitted from these activities. The activities were not well suited to people living with complex dementia or people who needed to stay in bed. These people were at a greater risk of social isolation.

Most people, staff and relatives we spoke with described the home manager as being approachable and involved in the day to day running of the home. We found that the governance systems (Processes to ensur

At the time of our inspection 58 people lived at Beech Hill Grange. We spoke with ten people who lived in the home, two visitors, seven care staff a nurse and the registered manager.

Some people had dementia and were not able to tell us about the care they received. To get a view of the service they received we observed staff interactions with people. We saw that generally interactions were friendly and polite.

We found that people’s needs were assessed and planned to ensure the care people received was safe and appropriate. One person who lived there told us, “This is a good home”. A relative told us, “I am pleased with the home and have no concerns”.

People received a good choice of well-presented and nutritious food and hydration and were protected against the risks associated with poor nutrition and dehydration.

We saw that the environment was clean safe and well-presented and offered people a pleasant place to live.

Satisfactory recruitment procedures ensured that people were protected from the risk of unsuitable staff being employed.

There were systems in place to monitor the quality of the service. The service was well led.

There were 47 people living at the home on the day of our inspection. No one knew we would be visiting. We spoke with ten people who lived at the home, three relatives, five staff and the manager.

The home had recently been extended so the number of people who could live there had increased from 36 to 55. We saw that the homes environment had been improved for people and further work was taking place.

We saw good interactions between people lining there and the staff team. The atmosphere was friendly and relaxed. We saw relatives visiting people and different activities taking place for people to join in with, if they wished to.

People we spoke with told us positive things about the home and the care and support they received. One person said “I am settled and happy here” and another person told us “The staff are nice”.

Staff had been trained so they would understand the procedures to follow if they needed to report any concerns.

Recruitment procedures in place ensured the risk of unsuitable staff working at the home was reduced.

There was information for people about how to make a complaint. People we spoke with told us they knew who to if they were unhappy about anything.

People who live at Beech Hill Grange were able to tell us they enjoyed the food they received. Some of their relatives told us that the care provided was very good and that people had everything they needed.

Beech Hill Grange provides accommodation, nursing and personal care for up to 60 adults.

The inspection was unannounced and was carried out over two days on 23 and 24 October 2014.

A manager was registered with us as required by law. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected Beech Hill Grange in December 2013. At that inspection we found the provider was meeting all the essential standards we assessed.

The manager had followed the requirements of the Deprivation of Liberty Safeguards (DoLS). This is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interest to protect them from harm or injury.

People told us that they felt safe living at the home. There were systems in place to minimise the risk of abuse. Staff we spoke with understood that they had responsibility to take action to protect people from harm.

People told us that staff were caring and kind and they told us that they felt safe with staff.

During our inspection we saw many positive interactions between staff and people that lived at the home.

People told us that they received their medication on time and in a way that they wanted. Arrangements in place ensured that medication was stored safely. 

Staff knew about people’s needs. Staff received the appropriate training to enable them to deliver care safely and effectively.

People told us they liked the food. We saw that drinks and food was available throughout the day. If people needed staff support to help them eat, this was provided.

We saw that people were supported to take part in individual hobbies and interests at the service and in the local community.

People told us that staff listened to them and they knew how to raise concerns. The manager responded to people’s complaints and took action to improve the service as a result of complaints.

There were systems in place for monitoring the service. These had been timely and effective to identify where the improvements were needed.