This inspection took place on 14 November 2017 and was unannounced. This meant the registered provider did not know we would be visiting.

The Beeches was last inspected by CQC on 3 May 2016 and was rated Requires Improvement overall and in four areas; Safe, Effective, Responsive and Well-led. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments.

Whilst completing this visit we reviewed the action the provider had taken to address the above breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulation.

The Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Beeches provides personal care for up to 64 people. At the time of our inspection there were 59 people living at the home, some of whom were living with dementia.

There was a registered manager in place. 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 the last inspection we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. Stock checks of controlled drugs were not always recorded accurately and room and medicine temperatures were not always recorded. People’s medicines records were not always person centred and lacked detail and audits of medicines did not identify issues. Records for people who took medicines ‘as and when required’ were not detailed enough to give staff enough guidance. At this inspection we observed actions had been taken and sustained improvements were achieved in this area including improved records.

At the last inspection risk assessments for people were not updated regularly and some lacked detail. At this inspection we found people were supported to take risks in everyday living and individualised risk assessments were in place and updated regularly.

Accidents and incidents were monitored by the registered manager to monitor any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

The premises were clean and tidy. However we observed a malodour on the first floor of the building and this was addressed by the registered manager.

Throughout the inspection we saw staff cleaning communal areas, and we noted that people’s rooms were also tidy. Staff had access to personal protective equipment.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

People’s health was monitored and referrals were made to other health care professionals where necessary, for example, their GP, community nurse or dentist.

Staff were supported to maintain and develop their skills through training and development opportunities..

Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further training 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 supported this practice.

This inspection took place on 3 May 2016 and was unannounced. This meant the registered provider did not know we would be visiting. The service was previously inspected in February 2015 and was meeting the regulations we inspected.

The Beeches Care Home can accommodate up to 64 people. The building is on two floors and is located in a residential area of Newtown, Stockton. At the time of our inspection 52 people were using the service, some of whom were living with a dementia.

There was a registered manager in place. 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.

Appropriate arrangements for the safe handling of medicines were not always in place. Controlled drugs were regularly assessed however stocks were not always recorded accurately. Room and fridge temperatures were not recorded on the ground floor and not recorded accurately on the upper floor. Care plans were not person centred for medicines administration as they did not have information about a person’s preference for taking medicines. Medicines audits were completed however they lacked detail. ‘As required’ (PRN) medicine care plans were not always sufficiently detailed. People managing their own medicines did not always have completed risk assessments. The frequency of medicine administration was not always safely managed.

Risks to people were assessed and plans put in place to minimise the chances of them occurring. The service used recognised risk assessment tools to do this. Most risk assessments were specific and detailed how the risk could be minimised and how often it should be reviewed. However, we did see that some risk assessments for one person were lacking in detail and the registered manager said this would be reviewed.

Risks to people arising out of the premises were regularly reviewed, and remedial action taken where needed. Accidents and incidents were monitored by the registered manager to see if any trends were emerging and to ensure appropriate referrals where made if needed. The registered manager described how they used their accident analysis to make referrals to external professionals such as the falls team.

Plans were in place to evacuate people safely in case of emergency. A business continuity plan was in place in to help staff organise a continuity of care in a range of situations where the premises could not be used.

The premises were clean and tidy. Throughout the inspection we saw staff cleaning communal areas, and we noted that people’s rooms were also tidy. Equipment was generally suitably stored, though we did see some continence pads being stored in a communal lounge. The area manager said these would be moved immediately. Throughout the inspection we saw staff using personal protective equipment (PPE) such as gloves and aprons to assist with infection control.

The registered manager and area manager both monitored staffing levels at the service. The registered provider had three other services in the region and these were used to provide staff to cover absences. Housekeeping and kitchen staff completed the same training as care staff, so were able to provide care support in emergency situations.

The registered provider’s recruitment procedures minimised the risks of unsuitable staff being employed. Applicants completed an application form requiring them to detail their employment history and provide details of two referees. Written references were sought and Disclosure and Barring Service (DBS) checks carried out before applicants were employed.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant saf

One inspector carried out this follow-up inspection. At the time of our inspection 49 people lived at Beeches Care Home.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the care and treatment that people received identified on our previous visit on 27 November 2013.

During our inspection on 14 February 2015, we spent time speaking with the registered manager, two senior care staff, four care staff, two relatives, four people who lived there and observing people and care staff. We looked at the records that related to people’s personal information that we had previously found to be limited in detail. We found that improvements had been made and that people's care plans were robust and contained up to date and relevant information for staff and medical professionals.

A dedicated activities coordinator had been recruited and we found evidence that people were protected from the risks of social isolation because they were encouraged to take part in a variety of activities that were stimulating. We found that staff conducted and recorded hourly checks of communal areas in the home. If you want to see the evidence that supports our summary please read the full report.

During the inspection we spoke with 11 people who used the service (from both the residential unit and dementia unit) and three relatives / representatives. We also spoke with the manager and to care staff.

People who used the service told us that they were happy with the care and support that they received. One person said, “It’s lovely, relaxed and I’m not worried about pressing my buzzer. If I need help, I get it.” Another person said, “The staff have a heart of gold they will do anything for you.”

The manager told us that the activity co-ordinator left in October 2013 and since then she had been trying to recruit a new person to plan activities and outings for people who used the service. Seven of the 11 people we spoke with told us that since the activity co-ordinator left, activities carried out on a daily basis have been limited.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. However, we saw that people were let unattended in the residential lounge from 1:40pm until 2:50pm.

People were supported to eat and drink sufficient amounts to meet their needs.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment.

We saw that the service had appropriate equipment and that regular servicing was undertaken to ensure that it was safe.

We found that appropriate recruitment procedures were in place.

When we visited Beeches we found 40 people lived there. We spoke with three people who lived at the home and two visiting relatives. The people who lived at the home were largely complimentary of the quality of care they received. One person said, “It’s very nice here. There’s no rigid rules; you can please yourself – what you do and when you do it.”

People said they were involved in their care, with their preferences being sought and taken into consideration. This included being helped to live their lives independently and joining in with activities if they wished.

Everybody we spoke with told us they felt safe at Beeches and with the care staff employed by the service. People were also clear about how and who to report any concerns about their safety.

Most people told us they were happy with the staff employed by the service and the care they provided. One person said "They look after me smashing; I have no problems with the staff.” People said the staff knew them well and how best to help and support them in their everyday life. A small number of people were less complimentary of the staff and food at Beeches, but felt the new manager was making improvements to the home.

There were arrangements in place to gain additional feedback about services from user satisfaction surveys, relatives and staff questionnaires.

People who use the service and relatives said that they were very happy with all aspects of the service provided at Beeches Care Home. Typical comments included: "The staff are brilliant, the food's good and I'm pretty impressed with the overall quality of care." They liked the homely atmosphere and the friendly, caring practices of staff. They felt they were well respected by staff who acknowledged and understood their individual needs and wishes. They felt safe and found that they could talk easily to staff about any concerns. They described the home as being well run. They liked the range of activities and social events on offer. They enjoyed the meals and felt happy with the quality of the catering and choices available. They were confident that their health and social care needs were being well met, including the arrangements for their medications and access to healthcare professionals/services. They felt they were consulted about all important matters.