This inspection was carried out on 24 and 28 September 2018. The inspection was unannounced.

Beechcare provides accommodation and support for up to six people who may have a learning disability, autistic spectrum disorder or physical disabilities. The service is set in a bungalow in a quiet residential area. There were five people living at the home when we inspected.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in post who was available and supported us during 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.

At our last inspection, the service was rated 'Requires Improvement' overall with caring and responsive being rated as Good.

At our previous inspection on 29 June 2017, we found three breaches of Regulations and issued warning notices. The provider had failed to do all that was reasonably practicable to mitigate risks. Risks had not been assessed and mitigated, and medicines had not been managed safely. People did not benefit from an environment which was suitable for the purpose for which it was being used. The provider had not designed care and treatment with a view to achieving people's preferences and ensuring their needs were met. Accurate, complete and contemporaneous records had not been maintained. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made, and the previous breaches found at our last inspection had been met.

At our previous inspection we found risks relating to people and the environment had not always been assessed and minimised. Medicines had not been managed safely. At this inspection we found both areas had improved.

At our last inspection we found systems to monitor the service did not identify issues highlighted during the inspection. At this inspection we found improvements in this area; a new auditing system was in place alongside a schedule for audits which had been effective.

At our previous inspection the service had not been adapted to ensure all areas had wheelchair access, which meant some people were unable to access to kitchen. At this inspection we found improvements in this area, including access to and within the kitchen.

People were protected from the risk of abuse. Staff had received safeguarding training and knew how to recognise and report any concerns. There were enough staff to keep people safe and meet their needs. Staff had received training in infection control and utilised personal protective equipment appropriately. Accidents and incidents were recorded by staff and used as a tool to improve the service.

The service followed safe recruitment practice which included checking staff’s full employment history and obtaining criminal record checks.

The registered manager completed an assessment on people’s needs to ensure the service could meet the needs of the person prior to them receiving a service. Staff had received training and support to enable them to complete their roles. People were supported to eat and drink sufficient amounts to maintain a balanced diet. People were offered choices around meals and drinks, and preferences were recorded so staff could support peopl

This inspection was carried out on 29 June 2017. The inspection was unannounced.

Beechcare provides accommodation and support for up to six people who may have a learning disability, autistic spectrum disorder or physical disabilities. The home is a single storey building in a quiet residential area. There were four people living at the home when we inspected.

The service had a registered manager in post who was available and supported us during 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. The provider of the service is Beech Care limited which is owned by CareTech Holdings PLC.

At our previous inspection on 22 and 23 March 2016, we found breaches of Regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to do all that was reasonably practicable to mitigate risks. Safety checks had been missed to ensure equipment and systems were effective in keeping people safe. People did not benefit from an environment which was suitable for the purpose for which it was being used. The provider had not designed care and treatment with a view to achieving people's preferences and ensuring their needs were met. Accurate, complete and contemporaneous records had not been maintained. We asked the provider to take action to meet the regulations.

The provider sent us an action plan on 22 June 2016 which showed they planned to make the changes and meet regulations by October 2016.

During this inspection we found that the provider and registered manager had not made all of the improvements that they had planned to make.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

Medicines were not always well managed. Medicines had not been recorded appropriately.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments were not in place for all areas of identified risks. People were at increased risk because fire safety advice had not been followed in a timely manner.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known in the form of care plan summaries. The registered manager was still working on reviewing and updating care plans to ensure they reflected the care people received from the service. We made a recommendation about this.

There were enough staff deployed on shift during the day to keep people safe. At night time staffing had been reduced to one waking night staff and one sleep in staff. The sleep in staff member was frequently woken to provide care and support. We made a recommendation about this.

The service had not been adapted to ensure all areas had wheelchair access, which meant some people were unable to access to kitchen.

Systems to monitor the quality of the service were in place. Audits picked up a number of issues and concerns which the management team had completed and were continuing to work through. Audits had not picked up all the issues we found during the inspection. Action to address previous breaches of regulations was not timely.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Staff had received training relevant to their roles. Staff had received regular supervision.

Relatives were encouraged to feedback to the service through surveys.

People were encouraged to take part in activities that they enjoyed.

Staff knew and understood how to protect people from abuse and harm

This inspection took place on the 22 and 23 March 2016 and was unannounced. Beechcare provides accommodation and support for up to six people who may have a learning disability, autistic spectrum disorder or physical disabilities. At the time of the inspection five people were living at the service. Beechcare was last inspected on 5 August 2014 and had been rated as requires improvement at that inspection.

This service requires that a registered manager be 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. The provider had appointed a manager to manage the home. They had not submitted an application to register with the Care Quality Commission (CQC) registration department at the time of our inspection, but confirmed they would start this process. The new manager was present throughout both days of the inspection.

Appropriate action was not always taken to protect people from potential harm and some risk assessments needed to be implemented to keep people safe. People did not have up to date personal emergency evacuation plans that staff could refer to in emergency situations such as fires.

Records of incidents lacked detail. One person’s behaviour could challenge others and staff were frequently harmed by this person. There were no behaviour guidelines available for staff to follow to support this person consistently.

There was insufficient guidance in place to ensure people’s healthcare needs were always met. Follow ups of identified health problems were not documented well.

People did not benefit from an environment designed to meet their physical needs. One person had previously enjoyed to engage in activities in the kitchen but were no longer able to do this because of a change in their mobility.

Documentation was in need of review to reflect the most current needs of people. Documentation was conflicting and repetitive in areas. Staff did not have clear guidelines about people’s current needs or how to support them in the best possible way. Parts of one person’s care plan contained conflicting information.

Some staff training had lapsed. Staff did have a good knowledge of people’s individual needs and how they could support people well.

Medicines were managed safely. However, when people were prescribed creams documentation was not in place to advise staff where creams should be administered. This is an area which needs to improve.

There was enough staff to meet people’s immediate needs. Staff said people’s physical needs had changed over the last 18 months and additional staff would be beneficial so tasks such as personal care would not have to be rushed.

Staff had a good understanding of how to keep people safe and contact names and numbers were available should concerns of peoples safety need to be raised.

The new manager had arranged formal supervision for staff. Staff said they felt well supported by the new manager.

People had choice around their food and drink. Staff involved people in choosing what they would like by showing them pictures and showing them the available options.

Staff were caring and compassionate and spoke to people kindly. People’s choices were respected and staff spent time engaging people in communication and activities suitable for their current needs.

People were protected by a robust complaints procedure. There was a complaints procedure in place for people and their representatives, the service had received several compliments.

Staff felt positive about the future of the service and were positive in the feedback they gave about the new manager who they found supportive and approachable. The new manager had started to implement changes to improve the service people received.

We found

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new process being introduced by the CQC which looks at the overall quality of the service.

This was an unannounced inspection. Beechcare provides care and support to six people with learning disabilities some of whom have lived there for a number of years. There were six people living in the home during the inspection.

This service requires that a registered manager be in post. The provider had appointed a suitably experienced and qualified manager to manage the home and an application to register them had been submitted to the Care Quality Commission (CQC) registration department at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were unable to tell us about their experiences of care because of their communication difficulties, but our observations showed them to be in positive relaxed moods throughout the inspection, and interacting with staff or objects that interested them or were particular favourites.

A management structure was in place and staff benefitted from having a clear understanding of their role and accountability. A comprehensive quality assurance process that included audits of incidents, risks and care plans, helped to ensure that people received a consistent service.

Staff told us that they were happy in their work and showed a commitment to the wellbeing of the people they supported. The provider ensured there were enough suitably trained staff to meet people’s needs. A thorough recruitment process ensured that appropriate checks were made of new staff before they commenced work. Staff told us that there was a low staff turnover because they felt well supported and involved.

Staff understood how to safeguard people from harm and implemented the requirements of the Mental Capacity Act 2005 and DoLS. There were appropriate arrangements in place for the induction, training supervision and appraisal of staff, but staff did not always put what they had learned into practice.

Throughout our inspection we saw that people were treated with respect and dignity. Their care plans were personalised and kept updated to reflect changing care and treatment needs. People’s immediate care and treatment needs were addressed and kept under review, and they were provided with the equipment or adaptations they needed. Staff demonstrated an awareness of advocacy services and ensured that relatives and relevant professionals were kept informed and consulted. Relatives were encouraged to visit.

We identified some areas for minor improvement to enhance existing arrangements. These were centred on better use by staff of their positive interaction training. Our observations of and discussions with staff showed that they understood people’s needs, and provided care with kindness and compassion, but that they sometimes showed anticipation of people’s choices rather than enabling them to make active choices for themselves. Staff were seen engaging with people through activities and when they were sitting quietly. However, they did not make the best use of the communication tools available to aid this, which would help to make people feel included and consulted in daily decisions and planning of their care.

Staff respected peoples choices but did not always explore the reasons for changes in chosen or preferred activities or habitual behaviours. Staff were mindful of the impact of aging on the people in the home and provided activities accordingly, although improvements were needed to make some of these meaningful.

Six people were living at the home at the time of the inspection. We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us their experiences. We observed how people spent their time during the day, how staff met their needs and how people communicated and interacted with staff.

During the inspection people spent time at home doing activities they liked. These included doing puzzles, looking at magazines and spending time with staff. We observed that people were comfortable in the presence of staff and staff understood people’s individual methods of communication.

People’s care records showed that they and their representatives had been asked about how they liked to be supported. Care plans contained information that was designed to be meaningful and accessible to people with the use of plenty of pictures and photographs. We observed that people’s choices and preferences were recorded and respected.

People saw health and social care professionals when they needed to and staff recorded the outcomes of appointments.

The provider had systems in place to monitor the quality of the service provided at the home. These included asking people and their representatives, and other professionals for their views.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. We observed how people interacted with staff and the management of the service. We saw people were supported appropriately and the atmosphere in the home was calm and relaxed.

We spoke with one person who lived in the home during our visit. People who lived in the home were not able to engage with our review process. We observed how people were cared for, spent their time and interacted with each other and with members of staff during our visit.