This inspection took place on 6 and 7 December 2016 and was unannounced.

Beechwood care home is registered to provide accommodation for up to 60 older people some of whom are living with dementia . There were 56 people living at the service when we inspected. The service cared for people with predominantly residential care needs on the ground floor and nursing needs on the upper floor. The service was purpose built and had several communal areas and gardens. It had specialist equipment to assist people with mobility problems and was close to local transport links.

The service 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.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the service. The registered provider had sufficient suitable staff to care for people safely however the registered manager had experienced difficulty recruiting sufficient suitable staff which meant that staffing levels were sometimes not at an optimum level.

Care plans were kept up to date when needs changed, however staff did not always have sufficient information about people preferences and what was important to them to ensure they gave people personalised care. Medicines were safely handled and risks were well assessed to protect people.People’s individual risk management plans were in place. However, these sometimes focused on recording information and did not always give clear instructions to staff on how to translate the information into clear management plans to protect people around risk.

The environment was safe for people and monitoring checks were regularly carried out. People were protected by the infection control procedures in the service.

Staff had received training to ensure that people received care appropriate for their needs. Training was up to date across a range of relevant areas.

Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood that people should be consulted about their care and they understood the principles of the MCA and DoLS authorisations. People who lacked capacity were supported to make decisions and where necessary protected from making unwise choices.

People’s nutrition and hydration needs were met. People enjoyed the meals. Specialist advice around people’s health care was sought and followed.

People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well as a team. Care plans provided detailed information about people’s individual needs and preferences. Records and observations provided evidence that people were treated in a way which encouraged them to feel valued and cared about.

People told us their complaints were responded to and the results of complaint investigations were clearly recorded. Everyone we spoke with told us that if they had concerns they were addressed by the registered manager who responded quickly.

The registered provider had an effective quality assurance system in place and was well supported by the senior management of the organisation.

The service was well managed and staff were well supported in their role. The registered manager had a clear understanding of their role. They consulted appropriately with people who lived at the service, people who were important to them, staff and health care professionals, in order to identify required improvements and put these in place. The registered manager was improving the way in which the quality assurance system informed improve

This inspection took place on 26 January 2016 and was unannounced. We last inspected this service on 26 May 2015 where we identified multiple regulatory breaches and rated the service as inadequate overall. The breaches identified related to person centred care, consent, care and treatment, the premises and equipment, staffing and how the services was managed.

This inspection took place on 26 January 2016 and was unannounced. This inspection was a re-rating inspection carried out to review the rating under the Care Act 2014 and to see if the registered provider and registered manager had made the improvements we required during our last inspection.

During this inspection we found the provider was now meeting the regulations and had made significant improvement to the service and the care people received.

Beechwood Care Home is a purpose built home. It is registered to care for up to 60 people who need nursing or personal care some of whom may also be living with dementia. It is located close to the town of Northallerton and is convenient for the shops and other facilities. The home is over two floors and has a passenger lift. All bedrooms are single with en-suite toilets and wash hand basins. There are secure gardens to the front of the home. At the time of this inspection the service was providing care/nursing care for 50 people.

The home employed a registered manager who had worked at the home for over a year. 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 told us they felt safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

People’s needs were regularly assessed, monitored and reviewed to make sure the care met people’s individual needs. Risk assessments were completed so that risks to people could be minimised whilst still supporting people to remain independent. The service had systems in place for recording and analysing incidents and accidents so that action could be taken to reduce risk to people’s safety. People had good access to health care services and the service was committed to

working in partnership with healthcare professionals. However, people did not always have access to their call bells and people were restrained by safety gates that were fitted to several bedroom doors.

Medication was managed safely and people received their prescribed medication on time. Staff had information about how to support people with their medicines.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. The service recruited staff in a safe way making sure all necessary background checks had been carried out.

The home’s infection control procedures had improved as there were no unpleasant odours in any of the communal areas we saw on the day. The home was clean and the domestic team followed cleaning schedules to maintain a good standard of cleanliness. We saw that new furnishings had been purchased and flooring in some of the communal areas had been replaced.

The principles of the Mental Capacity Act 2005 were consistently followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. There was a record of the person’s views and other relevant people in their life. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards (DoLS).

We saw people had access to regular drinks, snacks and a varied and nutritious diet. If people were at risk of losing weight we saw pl

We undertook this unannounced inspection on the 26 May 2015. We last inspected Beechwood Nursing Home on the 16 July 2014. We found the home was not meeting the regulations regarding meeting people’s nutritional needs and management of medicines. We carried out a further inspection on 2 September 2014 to ensure the regulations were being met. At that inspection we found the home was meeting the regulations that were assessed.

Beechwood is a purpose built home.It is registered to care for up to sixty people who need nursing or personal care or some of whom may also be living with dementia. It is located close to the town of Northallerton and is convenient for the shops and other facilities. The home is over two floors and has a passenger lift. All bedrooms are single with en-suite toilets and wash hand basins. There are secure gardens to the front of the home.

The home employed a registered manager who had worked at the home for over one year. 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 service was not safe. Although some of the people we were able to speak with told us that they felt safe both relatives and staff told us they felt there were insufficient staff at the home. Relatives described staff working non-stop. We saw that on one occasion staff took 5 minutes to respond to someone who had called for assistance. We observed throughout the day that care staff were consistently busy with care tasks. We witnessed poor care practices during our visit. We saw people were left for long periods of time in communal areas without any presence of staff. There was a shortage of staff due to sickness. You can see what action we have asked the provider to take at the back of the full version of this report.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show that staff employed were safe to work with vulnerable people.

Staff we spoke with understood how to make an alert if they suspected anyone at the home was at risk of abuse. Training had been given to staff about safeguarding procedures.

We identified issues with boxed medicines. We found that they were only counted on arrival and not checked again until the next month. Prescribed as necessary (PRN) medicines were not always recorded separately and so there were no details of why the medicine was needed. Eye drops were not dated when they commenced. This meant that there was the potential for errors occurring and not been addressed quickly which may mean that people received out of date medicines.

The home’s infection control procedures were not good as there were unpleasant odours in all of the corridors and several bedrooms. You can see what action we have asked the provider to take at the back of the full version of this report

We found restrictive practices were being used at the home. Staff were not always following the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. You can see what action we have asked the provider to take at the back of the full version of this report.

The home provided nutritious food as we observed this during breakfast and lunch. However, we observed people to have been left without food or drink for long periods of time, especially those people who had risen early. People were not always supported well to eat their meals by staff at the home. You can see what action we have asked the provider to take at the back of the full version of this report.

Staff were described as being ‘A lovely bunch of lasses’ and we saw some good practice where staff were seen as being kind and attentive. However, we did see poor practice such as people living at the home looking unkempt; having had clothes on that were stained and several people had no socks or stockings on.

A lack of robust care planning impacted on people’s health and wellbeing. Care plans lacked information or contained contradictory information for staff to provide care and support in a manner which responded to the person’s needs consistently. You can see what action we have asked the provider to take at the back of the full version of this report

We did not observe any activities taking place during our visit to the home.

People and their relatives completed an annual survey. This enabled the provider to address any shortfalls identified through feedback to improve the service.

We found the home to lack good management and leadership, which had led to potential risk on the everyday management and care delivery of the establishment.

There were auditing and monitoring systems in place to identify where improvements were required. However not all audits we saw were up to date this included infection control and cleanliness of the service, and fire safety. We did not see that the home had an action plan to address these. You can see what action we have asked the provider to take at the back of the full version of this report.

In July 2014 we carried out an inspection of this service. We judged, at that time, that improvements were needed to some areas of the service.This was because people were not always protected from the risks of inadequate nutrition and dehydration.

Improvements were also required to the medication system at the service. This was regarding the storage and recording of medicines.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people and the staff supporting them and from looking at records.

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

Is the service safe?

We inspected the medication system at the service to ensure that improvements had been made in this area following our last inspection. We found that improvements had been made to the storage and recording of medicines.

Staff involved in giving people their medication had received training to ensure they did this in a safe and effective way

Is the service effective?

People's nutritional needs were known by the staff and were being monitored. Effective monitoring systems were in place to make sure that everyone received the support they required to ensure they received the nutrition and hydration they required for their general health and well-being.

Is the service caring?

Not applicable. We did not inspect this area.

Is the service responsive?

Not applicable. We did not inspect this area.

Is the service well-led?

Not applicable. We did not inspect this area.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

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

Is the service safe?

People we spoke with said they felt safe at the home and were respected by the staff. A person we spoke with said “I am taken care of.” Relatives told us they were happy with the care and support their loved ones received at the home.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Senior staff had been trained in this area to help to protect people.

We had received a higher number of safeguarding notifications from this service which prompted us to undertake this scheduled inspection. The issues raised were being looked into by the relevant authorities. The provider had notified us of these issues and were cooperating with the relevant authorities to help to protect people. Safeguarding policies and procedures were in place for staff to follow. Staff we spoke with told us that they knew what action they must take if they suspected abuse was occurring. A member of staff said “If I saw a safeguarding issue I would go to the manager. I have had safeguarding training.”

Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and concerns. This helped to reduce the risk to people and helped the service to look at ways to improve.

Staff involved in giving people their medication had received training to assist them to do this safely. However, we found that there were some minor issues to address. We have asked the provider to address the issues found.

Is the service effective?

People’s health and care needs were assessed with them or with their chosen representative. People were encouraged to live their life even if there were risks attached to this, which promoted their independence.

Help and advice was gained from relevant health care professionals in regard to people currently living at the home. We spoke with two visiting health care professional on our visit, both spoke positively about how staff listened to their advice and acted upon it to enhance people’s health and wellbeing.

People’s nutritional needs were known by the staff and were being monitored. However, effective monitoring systems were not in place to make sure that everyone received the support they required to eat and drink. We have asked the provider to address the issues that we found.

Is the service caring?

People were seen to be supported by staff who appeared to be patient and kind. We saw that people were visited by a range of relevant health care professionals. This helped to maintain people’s health and wellbeing.

We saw staff spent time with people, for example we saw staff undertaking a board game with people in the downstairs lounge. People we spoke during our visit said staff were pleasant and kind. Relatives we spoke with said “Everything is as good as it can be, I have no concerns. I feel X is safe and well looked after. The staff are really friendly they do everything they can for the people in here.” and “The staff are good. They are very skilled. They are very good with X.”

People using the service were asked to complete a satisfaction survey. The manager told us that the results of this survey had not been received yet. However, they said that any shortfalls or concerns raised would be addressed.

Is the service responsive?

We saw the manager had an ‘open door’ policy in place. In her absence the Area Manager was there to listen to and take on board issues raised by people or their relatives.

The management team took action to help to protect people’s wellbeing when safeguarding issues were reported to them.

Is the service well led?

The service worked well with other health care professionals to ensure that people could receive the care they needed. Quality assurance systems were in place. The quality of the service provided was being monitored and was under review to ensure shortfalls found could be addressed. The management team told us they were about to look at how mealtimes could be improved for people.

Staff were clear about their roles and responsibilities. Staff we spoke with said they were happy working at the home. They said they would not want to work anywhere else. The ethos of the home was to continue to improve all areas of the service over time.

The manager of the service told us that there had been a lot of changes undertaken to the quality of the service over the last few months. They were determined to continue to make positive changes to the service to enhance people’s quality of life at the home.

Some people were not able to tell us about their experiences. We therefore used a number of different methods to help us understand the experiences of people. This included observing the delivery of care and speaking to visitors as well as people who lived at Beechwood Nursing home.

We spoke with eight people who used the service and six relatives. Everyone told us they were satisfied with the care they or their relative received. People told us that they were treated with respect and were able to make choices and decisions about their care. One person told us “Wonderful people in here, you get help when you need it, but they encourage you to help yourself to be independent.”

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One relative told us “I can go home and sleep at night knowing she is being well looked after.”

People who use the service were protected from the risk of infection as the provider had good systems in place to prevent the spread of any infection.

Records we looked at also confirmed that staff received appropriate training in areas such as dementia awareness, infection control and safeguarding. Staff we spoke with told us that they received ‘really good support from the manager’ and that they received good training.

There was a range of effective quality management systems in place to assess and monitor the quality of service that people received.

We had received some information of concern about the home. We decided to carry out an unannounced inspection. We looked around the home and observed how people were being looked after. We found that people looked comfortable and cared for. One person said "I am nice and comfy sat here. I have someone to talk to a cup of tea to drink. What else do I need?”.

We were told that people who lived at the home had bruising and skin damage. We asked the manager about this. They told us that currently nobody at the home had any pressure damage to their skin. We looked in someone’s care records who the manager identified had previously had some pressure damage. We read that this had now healed and preventative measures such as pressure relieving equipment were in place to avoid this happening again.

We were told that there had been an issue with the laundry arrangements between Christmas and the New Year because both of the washing machines had broken down. However contingency plans were put in place until the machines were fixed. The laundry was fully functional on the day of inspection.

We observed how staff supported people with their mobility and how they used moving and handling equipment such as hoists to move people safely. Staff confirmed that they had been trained in moving people safely. Staff reported that although the work was hard and tiring staff moral was improving and they felt supported by the home manager to carry out their roles and responsibilities fully.

People who use the service told us that the home was ‘good ‘and that the staff were kind and helpful. One person said “It’s smashing, I forget things some of the time but it doesn’t matter I can ask anyone anything, they are all very patient with me and kind.”

A visitor to the home said “Things have improved in recent weeks the place is a lot cleaner and tidier. The staff seem happier and more settled. That a least must make it a better place for people to live” Another visitor said they were “very happy” with the care and service their relative was receiving at the home.

At an inspection on the 13 February we found that there were concerns about how people were cared for and about the cleanliness of the home. We issued warning notices on the 23 February 2011 for regulation 9 outcome four, care and welfare of people who use the service and regulation 12 outcome eight, infection control. We asked the provider to ensure the home was compliant with the regulations by the 1st March 2012. We carried out this inspection to check whether these improvements had been made

During our inspection we did not ask people their views about this outcome instead we observed how people were cared for and talked with staff. We observed that people’s appearances had improved. All were wearing clean clothes, their hair was brushed and the men had been shaved. We observed that the staff responded quickly when people required help, and they regularly interacted with people asking them if they were “alright”.

We found the first floor had been deep cleaned, damaged furniture and bed linen had been replaced.

When we talked with the staff they told us how they felt their work had improved, they said the moral of the staff had improved, because the concerns they made were now being responded to.

Overall we found improvements had been made and new systems had been put in place to ensure these were maintained. However these systems had not had the opportunity to become embedded, therefore we will be monitoring the home to ensure these improvements are maintained and the home remains compliant.

We carried out an inspection of Beechwood care home on the 24 October 2011 where we made compliance actions which required the provider to ensure the home was compliant with the essential standards of quality and safety. Following this inspection we were provided with an action plan by the area manager of Beechwood Care Home which told us how and when they would be compliant with the essential standards. On the 13 February 2012 two inspectors carried out an inspection of Beechwood Care Home to check whether they the home were now meeting the essential standards.

Our inspection concentrated on the first floor at Beechwood Care Home, which is for people with nursing needs who have dementia. Due to the complex needs of some of the people living at Beechwood Care Home, we were not able to talk to them about their experiences in detail. However, we did observe the interactions between staff and those being looked after.

During our inspection we found concerns about the care and treatment delivered to people, and the maintenance of cleanliness and hygiene on the first floor of Beechwood Care Home. This raised concerns about how the management were assessing and monitoring the quality of the service provided and taking action to improve this.

We spoke with some people who lived at Beechwood Care Home. Generally people told us they were happy living at the home and thought the staff were kind and caring towards them.

We had received some information that raised concerns with us about the care and support people were getting at the home. We decided to carry out this review to ensure that people were safe and being cared for properly.

Due to the complex needs of some of the people living at Beechwood Care Home, they were not able to tell us about their experiences in detail. However, we did observe the interactions between staff and those being looked after. We saw examples of positive engagement and staff were seen to be attentive and caring. Visitors told us they were completely satisfied with all aspects of the care home and that they thought their relative was being well looked after. One visitor spoke highly of the care their relative was receiving and described the staff as 'great'.

Due to the complex needs of people living at the home some were unable to tell us about their experiences. We did however visit and talk to people and asked for their views about the way they were supported and cared for. People told us that they felt well cared for and that the staff were caring and supportive.

We did not consult with people who use the service at this site visit. Instead we spoke with staff and looked and some documentation.