This inspection took place on 03 January 2019 and was unannounced.

Beechfields 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.

Beechfields is a registered care home providing accommodation, personal care and support for up to nine older people. It is situated in a rural area approximately two miles from the town of Sittingbourne in Kent. The accommodation was comfortable and home like, was on one level and had been purpose built to meet people's needs. All the rooms had on-suite shower facilities. At the time of the inspection, eight people lived in the service.

There was a registered manager employed at the service. A 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 registered manager was not present during the inspection, this was conducted with Mrs Saffrey, who is joint provider of the service with the registered manager and in day-to-day charge of the care being delivered.

At the last inspection the service had an overall rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed. At this inspection, we found the service remained overall ‘good.’

At our inspection on 03 June 2016 we made two recommendations to assist the provider to further improve the quality of their service. One was in relation to the provider's policy about emergency planning and the other was about the management of risk around the monitoring of potential waterborne viruses. At this inspection, we found that the provider had taken actions on our recommendations.

Risks continued to be appropriately assessed and mitigated to ensure people were safe. Medicines were managed safely and people had received their medicines as prescribed. Staff knew what they should do to identify and raise safeguarding concerns. The provider knew their responsibilities in relation to keeping people safe from harm.

Effective systems continued to be in place to enable the provider to assess, monitor and improve the quality and safety of the service. Accident and incident records were closely monitored, actions were taken in a timely manner to ensure lessons were learnt.

People were happy with their care and support. Staff had built up good relationships with people. The service provided good quality care and support to people enabling them to live as fulfilled and meaningful lives as possible. Staff were caring and kind in their approach and had a good rapport with people. People told us they were treated with dignity and respect. People’s privacy was respected.

People were asked about their needs relating to culture, race, religion and sexual orientation in their assessment. This was recorded in their care plan and staff were aware of this.

There were enough staff deployed to meet people’s needs. The provider continued to operate a safe and robust recruitment and selection procedure to make sure staff were suitable and safe to work with people. Staff received training, which enabled them to meet people’s needs. They also received support and supervision to enable them to carry out their roles safely.

People were encouraged to make their own choices about everyday matters. People’s decisions and choices were respected. People's care plans clearly detailed their care and support needs. People were fully involved with the care planning process. The service had developed care plans which clearly detailed people’s preferences, likes, dislikes, mental health and social needs. Care had been delivered in line with people’s choices. The p

The inspection was carried out on 3 June 2016 and was unannounced.

The service provided accommodation and personal care for up to nine older people. The accommodation was comfortable and home like, was on one level and had been purpose built to meet people’s needs. All of the rooms had on-suite shower facilities. There were eight people living in the service when we inspected who had low to medium needs.

At our inspection on 28 January 2015 we made recommendations about the effectiveness of the provider’s staff supervision systems and about how people were involved in developing the service. At this inspection we found that the provider had taken account of the recommendations. However, at this inspection we have made two recommendations to assist the provider to further improve the quality of their service. One is in relation to the providers policy about emergency planning and the other is about the management of risk around the monitoring of potential waterborne viruses. You can see more about this in the body of the report.

There was a registered manager employed at the service. A 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 registered manager was not present during the inspection, this was conducted with Mrs Saffrey, who is joint provider of the service with the registered manager and in day-to-day charge of the care being delivered.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. No one living at the service was subject to any restrictions that required a DoLS application, but the provider understood when an application should be made. People made their own decisions about their care or day-to-day medical treatment. The provider ensured they followed the principals of the Mental Capacity Act 2005 when assessing people’s needs.

People were kept safe by staff who understood their responsibilities to protect people from harm. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes. The provider’s and a small but stable staff team delivered care to people safely.

The provider and care staff used their experience and knowledge of caring for older people effectively. Staff assessed people as individuals so that they understood how to plan people’s care to maintain their safety, health and wellbeing.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Risks were assessed within the service, both to individual people and the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

The provider involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences.

Systems

The inspection took place on 28 January 2015 and it was unannounced. We carried out this inspection in response to some concerns received. The areas of concerns centred on the delivery of care to people and management of the home.

Beechfields is a registered care home providing accommodation and personal care for up to nine older people. At the time of our inspection, eight people lived at the home. The home is a small family run care home with four members of staff. All the facilities were on the ground floor and every person had a single room with en-suite facilities. There was a large easily accessible garden and views from all the bedrooms.

There was a registered manager at the home. 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.

Staff had not received one to one supervision, which enabled the registered manager to identify future training needs and support them to meet people’s needs. We have made a recommendation about this.

There were no formal processes of involving and for gaining the views of staff, people and relatives, such as staff meetings, resident’s meetings and surveys on aspects of the service. We have made a recommendation about this.

All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the staff or the registered manager.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team, in a timely manner.

All people had risk assessments in place to identify risks that may be involved when meeting people’s needs. These risk assessments were reviewed in December 2014. Accident records were kept and reviewed to look for trends. This enabled the staff to take immediate action to minimise or prevent accidents.

Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Medicines were managed, stored and administered safely. Clear and accurate medicines records were maintained.

Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. Staff understood the importance of obtaining consent from people before care or treatment was provided.

People said the food was good. The menu offered variety and choice on a daily basis. It provided people with a nutritious and well-balanced diet.

People and their relatives were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed when necessary to check they were up to date.

People were always treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. People were able to make choices and their independence was promoted.

Staff had suitable training and experience to meet people’s assessed needs. They were informally supervised and adequately supported by the registered manager and provider. However, this was not formally documented.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People knew how to make a complaint if they were unhappy.

People spoke positively about the way the home was run. The provider had a clear set of vision and values, which were observed being implemented by both the registered manager and staff. The registered manager and staff understood their respective roles and responsibilities.

The home had a system to monitor and review the quality of service they provided. Prompt action was taken to improve the home and put right any shortfalls they had found. Information from the analysis of accidents and incidents was used to identify changes and improvements to minimise the risk of them happening again.

One inspector visited the home, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

People received a consistent and safe level of support.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs. One person said, “They involve me in what is going on here and in my care. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I feel well looked after here and they help me to do things for myself”.

People who used the service, their relatives, friends and other professionals involved with the service were recently sent an annual satisfaction survey by the manager to be completed.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People knew how to make a complaint if they were unhappy. We saw that the provider had a complaint system in place. Family commented. “If I have any concerns I will speak to the management first and if not resolved, will contact CQC or other people. It’s easy to talk to people/staff here”. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People expressed their views and were involved in making decisions about their care and treatment. One person said "We are very involved in our care here. For example, I do not have a shower if I do not want to". Another person said, “I get anything I want and it's lovely to be listened to”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with two people about their experience of living in the home. One person said, "I love it here”. Another person said, “I choose to live here because I like to live in the country and it has been lovely”.

Appropriate arrangements were in place in relation to obtaining medicine and the recording of medicine. Medicines were kept safely.

Appropriate checks were undertaken before staff began work.

Staff were able to obtain further relevant qualifications, from time to time.

All the records we saw were stored securely and were easily accessible for staff when they were required. All the staff we spoke with knew where the records were kept and their responsibilities for maintaining them. One member of staff said, “Keeping records up to date is very important in our job because it allows us to care and support the people very well. It is there for both the people we support and other people to see”.

Eight people were living in the home on the day of our inspection. We spoke with two people living in the home. People told us they were generally happy with the care they received and felt that their needs were being met. People told us that they liked the staff who supported them, and described them as "friendly and helpful" and “very caring people”.

We found that people’s privacy and dignity was respected. People told us they were happy with the care they received, and felt that their needs were being met. One person said “Very good indeed, nothing is too much trouble for them here”.

The registered premises were also the provider's family home. The home was furnished to a high standard and was comfortable and homely. One person said “I will be celebrating Christmas here with the manager and I am looking forward to it”.

The provider had no effective recruitment procedures in place to ensure that people were cared for by suitably qualified, skilled and experienced staff. We could not verify that all required checks had been undertaken before staff began work.

People were made aware of the complaints system. The home had a written policy and procedure on what to do if a person wanted to make a complaint.

We found that the quality and accuracy of people's records was unsatisfactory, because there was insufficient documentary evidence to show that people's care needs were kept under review and consistently met.

The people who used this service told us that they were very happy in the home. They said they enjoyed their meals and that they loved the environment. They said that they had enough to do and that the staff were kind and helpful.

One person said, “I can’t praise the staff enough” Another said, “What can I say? The home is absolutely fantastic – we want for nothing”. Other comments made included, “The food is very good”; “It’s like home from home”; and “The environment and the position here is second to none – they even make sure the bird feeder outside my window is kept filled so I can watch all the wild birds come down to feed. It’s lovely”.