We inspected the service on 10 October 2018. The inspection was unannounced and was the provider’s first inspection since it was registered.

Beechdale Manor is a ‘care home’. 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. Beechdale Manor provides personal and nursing care for up to 65 people over three floors. At the time of our inspection, there were 28 people living at the service.

A registered manager was in place but they were unavailable on the day of 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.

Staffing levels and deployment of staff were found to not meet people’s needs and safety. People had experienced falls and sustained injuries at times when staffing levels were lower at night. Action to manage and mitigate risks had not always been completed in a timely manner. Risk assessments reviewed and guidance updated to reduce reoccurrence.

The audits and checks in place to assess, monitor and review risks were insufficient to protect people’s safety. There was no analysis of falls, accidents and incidents to review for themes, patterns and lessons learnt. This lack of oversight impacted on people’s safety.

The provider had failed to notify CQC of all reportable incidents they are legally required to do. Where they had completed notifications, these were inaccurate in detail and had not been submitted in a timely manner as required.

The prevention and control measures for infection and cross contamination were not fully met. Equipment was found to be dirty due to a lack of cleaning and there was a lack of oversight of cleaning schedules.

Staff were aware of the action to protect people from abuse and had received safeguarding training. However, safeguarding incidents had not always been reported to the local authority responsible for investigating safeguarding in a timely manner. This was a requirement under the multi-agency safeguarding procedures.

Safe staff recruitment checks were used to assist the provider in making safe recruitment decisions. People received their prescribed medicines and these were stored and managed in line with best practice guidance.

National best practice guidance was used in the form of recognised assessment tools to assess people’s needs. Staff received an induction on commencement of their employment and ongoing training and opportunities to discuss their training and development needs. Processes were being implemented to check staff’s competency.

People received a choice of meals and drinks and their nutritional needs were known, understood and monitored. Staff worked with healthcare professionals in managing people’s healthcare needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the principles of the Mental Capacity Act 2005 and further work was in progress to review how best interest decisions were made.

The environment met people’s needs and ensured people did not experience any discrimination due to their disability. Equipment to support people’s needs was provided and available.

Staff were caring, compassionate and knew people’s needs, preferences and what was important to them. Staff respected people’s privacy and dignity, encouraged people with choice making, and promoted independence. Independent advocacy support was provided. People and or their relative where appropriate, were involved in their care and treatm