Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people. At the time of our inspection there were 20 people living at the home. Beechill is situated in the Cheetham Hill area of Manchester. Facilities include 23 single bedrooms and four double bedrooms, a large lounge area, dining room, a conservatory and a smoking room. There is a small garden area at the back of the property and car parking at the front and rear of the premises.

The home had a registered manager. 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.

This was an unannounced inspection which took place on 11 and 12 April, 2018. We last carried out a comprehensive inspection of the service in August 2017 and rated the service as inadequate which meant the service was in ‘special measures’. At that inspection we identified breaches of seven of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, including concerns that placed people at serious risk of harm. We identified breaches in relation to: cleanliness, maintenance, fire safety, security of the building, managing risks, servicing of equipment, wound care, medicines, recruitment, supervision and training, Deprivation of Liberty Safeguards (DoLS), activities and governance.

Some of the concerns we found at the August 2017 inspection impacted on the safety and well-being of people living at the home. We asked the registered manager to take immediate action to deal with the most serious concerns, which they did. These concerns were around fire safety, window restrictors, wound care, servicing of the passenger lift, bed rail risk assessments and the monitoring of legionella. We then carried out a focussed inspection in October 2017 to check that these serious problems had been rectified, which largely they had been, and the risks to people were reduced.

At this inspection we found the service had made further improvements and the service is no longer in ‘special measures’. However, we have found one continuing breach of the regulations. This is in relation to training. We have also made two recommendations. These are in relation to the provision of meaningful activities and the monitoring of people’s food intake.

Systems were in place to help safeguard people from abuse and staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people living at the home.

There had been a significant improvement in the cleanliness and maintenance of the home. Much of the home had been redecorated and new furniture and fittings bought.This made the home a more pleasant environment for people to live in. A programme of improvement and investment in the home had been implemented and was on-going. Maintenance checks on services and equipment were up-to-date. Fire safety had improved since our last inspection. Procedures were in place to prevent and control the spread of infection.

Medicines were managed safely.

Staff had undertaken a variety of training. However, there was a lack of training in the care of people with autism. This meant staff did not have a good understanding of this condition, how it affected people and how they would support someone with autism in the appropriate way. Staff received regular supervision which provided them with an opportunity to voice any concerns and plan their professional development.

Staff encouraged people to make choices where they were able. The service was working within the pr

This inspection took place on the 23 October 2017 and was unannounced. When we last inspected Beechill Nursing Home on the 29 and 30 August 2017 we found breaches of seven of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014, including concerns that placed people at serious risk of harm. We identified breaches in relation to: cleanliness, maintenance, fire safety, security of the building, managing risks and servicing of equipment, wound care, medicines, recruitment, supervision and training, Deprivation of Liberty Safeguards, activities and governance.

We rated all domains of our inspection report as ‘inadequate’ and the overall rating for the home was ‘inadequate’. This meant the home was put in 'special measures'. Services in special measures will be kept under review. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this focussed inspection we looked specifically at the areas of concern that posed significant risk to people using the service. These were concerns around fire safety, wound care, bedrail risk assessments, monitoring of legionella, servicing of the passenger lift, and the window restrictors. Following our inspection on 29 and 30 August we asked the provider to send us an action plan stating how they would address our concerns, which they did. We used information contained in their action plan to inform this inspection. Not all the risks and concerns identified at our comprehensive inspection of 29 and 30 August have been reviewed during this inspection. We reviewed the risks which had caused us to take urgent action against the provider. This means that the ratings for individual domains in our inspection report for our 29 and 30 August inspection will remain unchanged. They will be reassessed at our next comprehensive inspection which will look at all aspects of the service again.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs including substance misuse and other complex needs. It is situated in the Cheetham Hill area of Manchester. Facilities include 23 single bedrooms and four double bedrooms, a large lounge area, dining room, a conservatory and a smoke room. There is a small garden area at the back of the property and car parking at the front and rear of the premises.

We found that fire safety had improved and people were no longer exposed to serious risk in this area. The provider had addressed the concerns we raised around fire safety and the majority of those identified by the Greater Manchester Fire and Rescue Service (GMFRS). GMFRS had carried out their own inspection of the service at our request.

There was new wound care documentation in place and we found this was being completed correctly. Wounds were being monitored and evaluated correctly.

Following our last inspection a new, more comprehensive bed rail risk assessment had been identified by the provider. However, this had not been implemented at the time of this inspection. This meant people living at the home who had bed rails in place still did not have the appropriate risk assessment. We asked for this to be rectified immediately and during our inspection risk assessments were carried out on all people using bed rails to check that they were safe to be used.

At our last inspection we found that the provider was not aware of their responsibilities to ensure people living at the home were protected from the risk of exposure to legionella bacteria. Since our last inspection a legionella risk assessment had been carried out and the provider had taken some steps towards ensuring people were protected from the risk of legionella. We identified that some work had not been carried out, such as ensuring the water temperatures were correct and sampling of the water for legione

This inspection was carried out on the 29 and 30 August 2017. Our visit on the 29 August 2017 was unannounced.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs including substance misuse and other complex needs. At the time of our inspection there were 25 people living at the home. Beechill is situated in the Cheetham Hill area of Manchester. Facilities include 23 single bedrooms and four double bedrooms, a large lounge area, dining room, a conservatory and a smoke room. There is a small garden area at the back of the property and car parking at the front and rear of the premises.

We carried out this inspection in response to concerns raised about the service by Manchester City Council in relation to health and safety, staffing levels and environmental living conditions for people at the home.

The previous Care Quality Commission inspection took place in March 2017and the overall rating for the service was 'Requires Improvement’. At that inspection we found breaches of eight of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations.

At this inspection we identified breaches of seven of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, including concerns that placed people at serious risk of harm. We identified breaches in relation to: cleanliness, maintenance, fire safety, security of the building, managing risks and servicing of equipment, wound care, medicines, recruitment, supervision and training, DoLS, activities and governance.

We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

At the time of our inspection there was a registered manager who had been registered with CQC since February 2015. The registered manager was also a director of the company that owns Beechill Nursing 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.

We identified serious concerns around fire safety. Immediately after our inspection we referred the home to Greater Manchester Fire and Rescue Service who carried out an urgent inspection of the premises. They served the provider with an enforcement notice as they found they were failing to comply with fire safety legislation. We will review the action the provider has taken following this enforcement notice at our next comprehensive inspection.

The home was visibly very unclean and poorly maintained. We found two window restrictors broken which put people at risk of injury as they could fall out of the windows. These have since been mended. Paintwork, carpets furnishings and equipment were dirty and stained. Some chairs had ripped cushions.

Safety checks for gas, emergency lighting and hoists had been completed and PAT testing was up-to-date. However, the fire extinguishers had not been serviced. This had been identified at our inspection in March 2017, but no action taken. There was no legionella risk assessment or regular monitoring being undertaken to reduce the risk posed to service users in relation to legionella. Since our inspection a legionella risk assessment has been carried out and the fire extinguishers have been serviced.

Security of the building was poor as we were able to enter the building unchallenged on several occasions during our inspection. This meant there was a risk intruders could enter the building or vulnerable people who lacked capacity could leave without the knowledge of sta

We inspected Beechill Nursing Home on the 15, 16 and 21 March 2017 and the first day of our inspection was unannounced. This meant the provider and staff did not know we were visiting. Beechill Nursing Home (Beechill) provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs including substance misuse and other complex needs. Beechill is situated in the Cheetham Hill area of Manchester, within easy reach of shops and other local facilities. There are 23 single bedrooms and four double bedrooms across two floors, a large lounge area, dining room, a conservatory and a smoke room. There is a small sloped garden area at the back of the property and car parking at the front and rear of the premises. At the time of this inspection there were 28 people living at the care home.

The previous inspection took place in March 2016 and the overall rating for the service was ‘Requires Improvement.’ The service had a registered manager who had been in post since February 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We made a recommendation that the provider should implement a schedule of supervisions and appraisals to ensure all staff had adequate support and chance to raise issues relating to their work.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to safeguarding people from abuse, medicines administration, recruitment practice, activities and good governance. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe living at Beechill and that staff ensured they were safe. We found recruitment processes in place were not robust to help ensure people were supported by suitable to work in the care industry.

We noted the service had made improvements in ensuring protocols were in place for people who needed PRN (as required) medicines. However we found some gaps still existed in this area. This meant staff did not always have the necessary guidance to know when to offer a person a particular medication.

The service undertook various health and safety checks of emergency lighting and fire systems, for example. We noted however that the inspection certificate for fire extinguishers was out of date and that appropriate fire drills were not taking place. This meant that in the event of a fire we did not have any assurances that people would be safe from harm.

Induction and mandatory training provision did not provide strong assurances that staff were suitably skilled to do their job safely and effectively. This meant that people may be at risk of harm.

Some improvements had been made since our last inspection to ensure staff received regular supervision and annual appraisals. We saw that the registered manager and team leader had undertaken supervision of some staff.

People were supported to eat and drink healthily at the care home. We observed that meals were freshly prepared and that people were always offered a choice.

People and relatives told us staff were caring and knew them well. Staff were familiar with people’s personalities and their individual likes and dislikes.

The majority of people we spoke with said they had been involved in decision relating to their care. However, not everyone could remember having seen their care plans.

People told us staff always treated them respect and they gave us examples of how staff demonstrated this.

There was a lack of meaningful actives to help improve people’s good quality of life. Most people told us there was little to do at Beechill.

The service did not do initial assessments of people before they were admitted;

This inspection took place on 22 and 23 March 2016. The first day was unannounced which meant the service did not know we were coming. The second day was by arrangement. At the last inspection in September 2014 we had found the service to be meeting the regulations we looked at.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs, including some with a history of alcohol or substance misuse. There were 28 people living in the home at the time of our inspection. The home is situated in the Cheetham Hill area of Manchester, within easy reach of shops and other local facilities. There are 23 single bedrooms and 4 double bedrooms on two floors, a lounge and dining area, a conservatory and a smoking room.

Beechill Nursing Home has a registered manager, who is also one of the directors of the company that is the provider. 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 considered themselves to be safe in the home. Although there had recently been some violent incidents action was taken to prevent a recurrence.

We found a range of issues relating to medicines. These included a lack of instructions as to how to give medicines prescribed to be given ‘as required’, and incomplete instructions about giving insulin. These issues were a breach of the regulation relating to the proper and safe administration of medicines.

The building was designed to be safe for people living in the home. However, we were concerned about a possible lack of security due to the absence of a proper signing in book and the CCTV not functioning.

Staff were trained in safeguarding and knew their responsibility in this area. People were protected from the risk of fire.

Staffing numbers were calculated in relation to dependency levels and we considered there were enough staff on duty.

Recruitment records showed that steps were taken to ensure only suitable people were employed. There were effective disciplinary procedures. The home was kept clean and action had been taken following an infection control report.

Consent to care and treatment was recorded on care files but in some cases consent was given by a relative which is not in accordance with the Mental Capacity Act 2005. Consent had not been obtained for bedrails and the home did not conduct mental capacity assessments when needed. This was a breach of the regulation relating to consent.

Applications had been made appropriately under the Deprivation of Liberty Safeguards (DoLS).

The majority of staff had received the relevant training for their role, but there were some gaps. Staff at the home were trained to support people at the end of life. Regular supervision took place but sometimes the sessions were used to communicate messages to staff rather than allow staff to raise issues.

The cook was popular with people in the home and the food was well liked. People had access to health professionals. We have recommended that guidance should be followed to make the environment more suitable for people living with dementia.

Staff had a caring attitude towards people in the home but were often busy with paperwork. We saw one example where someone’s needs for assistance were neglected for a long period during breakfast. We found this to be a breach of the regulation relating to meeting people’s needs.

People’s experiences varied but on the whole they found the home was supportive and encouraged their independence. Provision was made for people whose first language was not English. We saw that people were encouraged to reduce their dependence on alcohol.

People’s personal privacy was respected although there were examples of the confide

This inspection was undertaken by two adult social care inspectors. The intention was to focus on the four areas of non-compliance identified in the previous inspection in May 2014, and to see whether actions promised by the provider in the action plan following that inspection had been fulfilled.

The service did not have a registered manager at the time of our inspection. The director was acting in the role of manager, and was intending to apply to become the registered manager. Immediately following our visit such an application was submitted. He is referred to as the director in this report.

This inspection was limited in scope, to look at the specific areas where we had found the service to be in breach of regulations at the last inspection, and to see whether or not the actions taken meant the service was no longer in breach.

In the area of safeguarding, we found that the service had improved its accounting system for recording people's money. There were now always two staff signatures for any transaction. We found that there had not been a clear process for distinguishing between care fees and personal allowances when money arrived, because they went into the same account. A separate bank account was opened immediately after our inspection which remedied this problem.

At the last inspection there had been only one cleaner working, and we found a number of areas that required attention. At this inspection we found that a second cleaner had been employed, and that the standard of cleanliness and infection prevention had improved, although there was room for further improvement.

Some records had gone missing before the last inspection which made it difficult for the director to demonstrate adequate monitoring and quality control. We found that there was insufficient analysis of questionnaires and internal audits. At this inspection we found that these and other issues had been addressed. The director was actively engaged in procedures to drive up the quality of the service.

We found that steps had been taken to ensure that records were kept securely, following our last inspection. Personal care records had been improved in order to reduce uncertainty. We saw that records were kept systematically.

People using the services provided at Beechill told us that they were properly supported and cared for. They said staff treated them respectfully and maintained their privacy and dignity, particularly when personal care was being provided. Concerns or worries were said to be promptly responded to by the manager and his senior staff. The general opinion was that the meals provided were of good quality and that the home was a clean, warm and comfortable place to live. Comments included;

“I am quite satisfied about the way I am looked after at Beechill and so are my family”.

“The staff are all very good and help me do the things I can’t do for myself anymore”.

“The staff know what I like, if there is something on the menu I don’t like I can always have something else”.

People using the services provided at Beechill told us that they were well cared for and supported properly by staff at the home. They said staff treated them with respect and sought to maintain their privacy and dignity – especially when personal care was being provided. Concerns or worries were said to be promptly responded to by the manager and his senior staff. The general view was that the meals provided were of good quality and that the home was a clean, warm and comfortable place to live.

This inspection was carried out by one inspector. We met with 20 people who used the service and observed their experiences of care to support our inspection. Not every person we met was able to talk with us due to their health conditions. We spoke with a director of the service, seven care and nursing staff and three relatives.

The director told us they had applied to become the registered manager of the home.

During the inspection we were told by the director there was an investigation on-going into the disappearance of keys and various records at the home.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There was an assessment completed of the needs of people who were living at the home.

People were cared for in an environment that was not always clean and hygienic.

We asked people if they had any concerns about the care provided by the home and they told us that were happy with the care provided and that the staff were caring. One person said, “I feel safe living here. I am fed, having my clothes washed and staff tidy up for me. What more could you need?”

There were effective recruitment procedures in place and staff had appropriate checks completed on them.

Not all risk assessments were in place and the provider needed to ensure staff complied with fire safety precautions.

We found concerns with financial procedures at the home, although we saw safeguarding procedures were in place and that staff understood how to safeguard the people that they supported.

At the time of the inspection, there was no one at the home subject to an authorisation under the Deprivation of Liberty Safeguards.

There were quality checks and audits completed to make sure the premises and procedures were maintained. However, we found the provider had not always actioned any issues arising from these.

Is the service effective?

Relatives were satisfied with the care and treatment being delivered to their loved ones. One relative told us, “They are very poorly and staff are doing their best.”

We saw daily notes being completed to ensure all staff were aware of the current situation of people who lived at the home.

We had a mixed response from people that we spoke with. Some told us they were happy with the care that was delivered and their needs were met, while others were less positive. We noticed all of the people who lived at the home had a key worker.

We saw evidence of the improvement in one person’s health conditions since they came to live at the home.

We saw people walking around the home freely and making their own decisions about where they wanted to go, including some people going out to smoke or go to the local shops. We saw one person returning from a walk to the park.

One relative told us that they were kept regularly updated by the staff team if any changes occurred, they said, “Staff keep me up to date if anything changes with my relatives health.”

Staff had received appropriate training to meet the needs of the people who lived at the home. Although we did not see all of the certificates to verify this, staff confirmed this information.

We also saw people had a choice of where they ate meals and what they had.

We found people’s care records were not kept securely.

Is the service caring?

Observations during the visit showed staff and people who lived at the home were comfortable in each other’s company. During the day we saw some positive interactions taking place and staff responding in a kind manner to people who lived at the home.

We saw staff using equipment within the home and ensuring that the person who they were supporting kept their dignity, for example, when hoists were used.

Is the service responsive?

Regular reviews were carried out to make sure that people’s care and treatment needs had not changed. This helped ensure staff supplied the correct care and treatment. However, some people told us they were not fully involved with their reviews.

When a person who lived at the home needed other professional input, we saw the staff had ensured this happened. We saw staff supporting one person to attend a GP appointment.

Meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service, although records were missing; staff confirmed these took place.

We were told by staff that people who lived at the home held meetings with staff to discuss their views on living there, however we found no recent minutes and two people we spoke with said they were unaware of meetings taking place.

Completed questionnaires were seen at the home. However, no record of conversations with people who lived there was recorded and not everyone we spoke with could remember completing one of these forms.

Is the service well-led?

There was no registered manager in post at the home, although the director had applied to become the registered manager.

People who used the service had contact with the director and other senior staff to check their wellbeing. We were told a meeting with people who used the service had been arranged to update them with changes that had recently occurred within the home.

People and relatives we spoke with knew who to contact if they wanted to complain.

There were on call systems in place in the event of an emergency.