About the service: Beech House Nursing Home is a residential care home registered to accommodate up to 54 people. At the time of this inspection the service was providing personal and nursing care to 28 older people.

People’s experience of using this service:

• People were positive about the care and support they received. One person said, “The staff are very good and I feel safe and well looked after here.” Another person told us, “The staff never make me do anything. They tell me to tell them what to do.” Another person said, “All the staff are really nice and very kind. [Name of a nurse] is on today; I really like them as we have a laugh and that’s really important to me.”

• The provider had made improvements to the service since our last inspection.

• Governance of the service had improved. Effective checks and audits were carried out to determine the quality of the care. The provider had acted promptly to address areas identified for improvement.

• Risks to people were monitored and procedures were in place to help keep people safe.

• People received their medicines when they needed them.

• People were supported by adequate numbers of staff who were safe and competent to work with them.

• People were protected from the risks associated with the control and spread of infection.

• Staff understood the importance of ensuring people’s rights were understood and protected.

• People’s health care and nutritional needs were monitored and understood by staff.

• People told us staff understood their needs and were kind, caring and compassionate.

• People had opportunities for social stimulation and were able to maintain links with the local community.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in November and December 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

More information is in Detailed Findings below.

This inspection took place on 29 November and 7 December 2017 and was unannounced.

Beech House Nursing Home provides nursing and personal care for up to 54 people. At the time of this inspection 31 people were living there, some of whom were living with dementia.

A registered manager was in post and present throughout this 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.

When we completed our previous inspection on 09/12/2016 we found concerns relating to staffing, care planning, staff training and quality assurance. At this time these topic areas were included under the key question of safe, responsive and well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key questions safe, effective, responsive and well-led. Therefore, for this inspection, we have inspected these key questions and also the previous key question to make sure all areas are inspected to validate the ratings.

This is the second time the service has been rated Requires Improvement.

At the last inspection completed on 09/12/2017, we asked the provider to take action to make improvements (for example to staffing levels). At this inspection we saw improvements were still required overall.

The provider had systems in place to monitor the quality of support given and to make changes when needed. However, these systems were ineffective and did not identify the concerns or improvements required that we found at this inspection. This was a breach of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.

People were not always safely supported with their medicines. People were at risk of receiving inconsistent support regarding how they received their medicines as the guidance was not always clear. People did not always have care and support plans that reflected their current needs.

The provider had infection prevention and control systems in place including staff link persons and cleaning schedules. However, these systems were not fully embedded into staff member’s practice and individual pieces of equipment needed cleaning and in some instances replacement.

People’s rights were not always protected by those supporting them and staff members did not always follow recognised procedures when supporting people.

People did not have sufficient opportunity to engage in activities that they found interesting and stimulating.

People were not always treated in a kind, caring and considerate manner by those supporting them.

People received care from staff that had the skills and knowledge to meet their needs. New staff member’s received an introduction to their role and were equipped with the skills they needed to work with people. However, new staff members were not always supported by existing staff to support people effectively.

Although people generally thought there were enough staff to meet their needs they received an inconsistent response to requests for assistance. This included waiting for longer than expected periods of time for help.

People had access to healthcare to maintain wellbeing. People were supported to eat and drink enough to maintain their health

Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s needs was provided.

People were kept safe from the potential harm of abuse or ill-treatment as staff knew how to recognise and respond to such concerns. The provider followed safe recruitment procedures when employing new staff members. Any incidents and accidents w

This inspection was unannounced and took place on 1 and 2 September 2016.

Beech House Nursing Home provides accommodation and personal care for up to 54 people who require nursing and personal care. On the day of our inspection 37 people were living there.

The home had a registered manager who was present for the 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.

People’s care and support needs were not always met in a timely manner because there was not enough staff on duty. However, people could be assured they would be protected from the risk of harm as staff knew how to protect them from potential abuse. They were protected from the risk of accidents because the provider had systems in place to monitor this and to prevent them from happening again. People were supported by staff to take their prescribed medicines to promote their health.

People were supported by staff who may not have received training about how to care for them. People were able to make their own choices and staff supported them to do so. Some of the staff were unaware of what the Deprivation of Liberty Safeguards (DoLS) meant or the impact this may have on people. People were supported to eat enough and had access to drinks at all times. People were supported to attend medical appointments and had access to relevant healthcare services when needed.

People were not always involved in planning their care but they were happy with the care they received. The provider had taken action to ensure people were treated with dignity and that their right to privacy was respected. The majority of staff treated people with kindness.

Staff did not always involve people in their assessment and there was a lack of ‘person centred' approach. People were not supported to pursue their hobbies and interest but staff assisted them to maintain contact with people important to them. People could be confident that their concerns would be listened to and acted on.

People told us that the registered manager was nice and staff said they were approachable. The provider carried out routine checks to monitor the quality of the service provided to people but these were not entirely robust to make sure people received an effective service.

You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and 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?

During the inspection we spoke with four people who used the service, a relative, three care staff and a nurse. The people who used the service that we spoke with said they felt safe and comfortable within their home. One person said, “I am happy living here.”

We saw that mental capacity assessments were in place. The registered manager confirmed that these assessments had recently been reviewed and an application for Deprivation of Liberty Safeguards (DoLS) had been submitted where restrictions were necessary to ensure people received the appropriate care and treatment.

On the day of the inspection engineers were in the process of installing a new passenger lift. This caused some disruption to the service people received. The registered manager confirmed that risk assessments were in place to ensure people’s safety whilst works were carried out.

The care records we looked at contained risk assessments to promote people’s independence and ensured their safety whilst doing so. For example, falls risk assessments were in place. These assessments provided staff with information about the level of support the person required and the equipment needed to ensure their safety.

Prior to our inspection we had received concerns that fire doors were wedged open with furnishings and wooden wedges. On the day of the inspection were saw that a number of fire doors were wedged open. This could compromise the safety of people in the event of a fire.

Discussions with a nurse who was responsible for the management of medicines on the day of our inspection, confirmed that people who used the service required support to take their prescribed medicines. We found that the management of medicines was not entirely robust and the registered manager acknowledged this. The registered manager said that immediate action would be taken to improve systems and practices.

Is the service effective?

Discussions with the registered manager and the care records we looked at confirmed that a needs assessment was carried out before people were offered a placement at the home. This assessment enabled the registered manager to find out whether they could meet the person’s needs before they were admitted to the home.

We spoke with one visiting relative who confirmed that their relative did have access to relevant healthcare professionals when needed and this was confirmed by the people we spoke with. We spoke with a visiting general practitioner who said, “The staff are skilled and competent and contact me when necessary.” Access to relevant healthcare professionals ensured that people’s physical and mental healthcare needs were met.

The people we spoke with confirmed that they had a choice of meals. One person said, “The food on the whole is good, it’s got better over the past six months.” The care records we looked at contained a nutritional assessment. This assessment ensured that staff were aware of the support the individual required to meet their nutritional needs.

Is the service caring?

The people we spoke with were happy with the care they had received. We looked at three care plans that provided detailed information about people’s care needs and how to meet them. We spoke with two care staff who demonstrated a sound understanding about how to care for people. This meant that people could be confident that their care needs would be met.

We observed that people were well looked after and staff were attentive to people’s needs. One person told us that they didn’t have to wait long for support when needed.

Is the service responsive?

Prior to our inspection we had received concerns about the care and support provided to one person who used the service. The registered manager was able to confirm and evidence that this person’s care and prescribed medicines had been reviewed. The registered manager had also made a referral to a community psychiatric nurse to provide the person with support with their mental health needs. This meant that the registered manager had listened to the concerns raised and took appropriate measures to ensure the person’s wellbeing.

Is the service well-led?

The home was managed by a registered manager. A clinical lead had recently been appointed. We found that both the registered manager and clinical lead had a good understanding of people’s care needs.

The people we spoke with who used the service were very complimentary about the care and support provided to them. One person told us about their previous role has representative for the home. They told us, “My role involved greeting new people and telling them about the home and staff.”

The registered manager said that regular meetings with people who used the service took place and this was confirmed by the people we spoke with. These meetings gave people the opportunity to be involved in the running of the home.

We saw that there was a quality assurance system in place to ensure that people received a safe and effective service.

The name of the recently resigned manager appears in this report as they were still the registered manager for the service at the time of our inspection. Any comments made about the manager in this report refer to the manager who started working at Beech House in January 2013.

There were thirty one people living at the home. We met and spoke with over ten people, four relatives, and seven staff including the manager. Some people had complex needs and could not share their experiences. We spent time in the lounge areas to observe their care and support. We also visited some people in their bedrooms.

People and visitors had good things to say about the home. They were positive about recently upgraded communal areas, their rooms, and activities they took part in. They were very complimentary about the manager and staff. One person said, “We have seen a lot of change and it has all been for the better.”

People told us they were being involved and consulted about how their care and support was given and reviewed. We saw care plans had improved and Maximum characters 1500 with spaces.

There were thirty one people living at the home. We met and spoke with over ten people, four relatives, and seven staff including the manager. Some people had complex needs and could not share their experiences. We spent time in the lounge areas to observe their care and support. We also visited some people in their bedrooms.

People and visitors had good things to say about the home. They were positive about recently upgraded communal areas, their rooms, and activities they took part in. They were very complimentary about the manager and staff. One person said, “We have seen a lot of change and it has all been for the better.”

People told us they were being involved and consulted about how their care and support was given and reviewed. We saw care plans had improved and gave better guidance for staff so they knew the arrangements for people to give consent for care and treatment.

Staff told us they had received all of the necessary support and training they required to help them do their job well. We saw that better organisation of staff and monitoring of their performance had had a positive impact on people's care.

The provider had improved their systems to monitor and review the quality of their service with better monitoring systems in place to maintain them. We saw the actions of the manager had a positive impact to improve the provision of care for people living at Beech House.

We met and spoke with over ten of the 30 people living at the home, seven relatives, and seven staff including the new manager. Some people had complex needs and could not share their experiences. We spent time in the lounge/dining area to observe their care and support as well as visiting them in their bedrooms.

The majority of people and visitors had good things to say about the support and care they received. They were complimentary about activities they took part in, and the staff. Other relatives told us they had attended a meeting where they discussed improvements which were still needed.

People told us they had started to be involved and consulted about their care. Although care plans had started to improve, they still lacked guidance for staff about how all of people’s needs should be met.

People were not always treated with respect and courtesy. Not everyone received appropriate support at meal times to make this a dignified experience.

We saw better organisation of staff teams and monitoring of their performance had improved people's care.

Communication between management and staff had improved which meant people were protected from the risk of abuse. We were told, "Staff are friendly, courteous and go that extra mile".

The management had improved their systems to monitor and review the quality of their service. We saw the actions of the new manager had begun to have a positive impact to improve the provision of care for people living at home.

We met and spoke with over 20 of the 38 people living at the home, eight relatives, seven staff and two visiting health care professionals. Some people with complex needs could not share their experiences so we observed their care in two lounges as well as visiting them in their bedrooms.

The majority of people had mixed feelings about the nursing support and care they received and made negative comments about this. They felt lack of permanent nursing staff meant their needs and wishes were not respected and understood which meant they did not always receive all of their nursing care.

We saw lack of effective staffing had a negative impact on care. People were not involved about how their care and support was given and reviewed. Care plans lacked guidance for staff about how peoples needs should be met.

People were not always treated with respect and courtesy. We saw people did not receive appropriate support at meal times to make this a dignified experience.

People were not protected from the risk of abuse. Staff did not recognise and report concerns about people’s welfare.

When people made complaints they were not fully acted upon. Although Beech House had systems in place to monitor and review the quality of their service, we saw that prompt remedial action was not always taken.

The provider took immediate action following our inspection. The provider confirmed a number of shortfalls through their own audits and started work to make improvements