The inspection took place on 29 and 30 August 2018 and was unannounced.

Beechwood House is registered to provide accommodation for persons who require nursing or personal care, for a maximum of 37 people. At the time of the inspection 37 people were living at Beechwood House, many of whom were living with dementia. Accommodation is over three floors, accessed by a lift, and includes shared living areas. There is a large garden to the rear of the home.

Beechwood House 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.

There was a registered manager is post at the time of the 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.

At the last inspection in September 2016 we found that the provider was in breach of Regulation 12 of the Health Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not managed safely. We asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe to at least good. At this inspection we found that improvements had been made. The service was managing medicines safely, and the provider was no longer breaching the regulation.

Staff were person-centred and treated people with kindness, compassion and respect. People’s visitors were welcomed and their privacy and dignity respected. People were supported to remain as independent as possible.

Activities were tailored to the interests and abilities of people. Staff supported people to challenge themselves and celebrated their successes.

End of life care was innovatively supported by the service. The right support for people, their relatives and the staff team had been considered and provided.

People told us they felt safe. Processes in place around safeguarding and the management of falls were followed, and lessons learnt to prevent reoccurrence. Risks to people’s safety had been appropriately assessed, and measures to reduce the risk implemented.

There were sufficient staff available to meet people’s needs, who had been recruited through safe recruitment processes. Staff were supported to ensure they had the right skills and knowledge to support people.

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.

The registered manager led the service well. Staff told us they were well supported and people and their relatives told us they were involved in decisions about their care and the service.

The service worked in partnership with healthcare and other professionals, to ensure the best support for people.

There was a clear governance framework in place to assist the management team to identify areas for further improvement.

The inspection took place on 28 November 2016 and was unannounced.

We undertook this focused inspection in response to concerns received, saying that people were being made to get up early against their wishes. This report only covers our findings in relation to this concern. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beechwood House on our website at www.cqc.org.uk

Beechwood House provides accommodation and nursing care for up to 37 older people. At the time of our visit, there were 33 people in residence. Earlier this year, the service started an agreement with the local NHS Trust for five ‘discharge to assessment’ beds. This meant that the beds were funded by the NHS. To minimise disruption to permanent residents, the bedrooms used for this purpose were located together in one part of the home.

The service has 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 inspection was conducted out of hours in order to check whether people were being treated properly and in accordance with their wishes. We arrived at the service at 4.45am and checked who was up, dressed and awake. We found no evidence to support that people had been made to get up against their will. Those who were awake appeared content and their care plans indicated that they did not always follow a typical night sleeping pattern.

Following our inspection, we provided detail of the concerns received with the management of the home. They plan to make further checks to ensure that all staff are treating people properly and in accordance with their wishes. They have agreed to provide feedback to The Commission on their findings.

The inspection took place on 20 and 21 September 2016 and was an unannounced inspection.

Beechwood House provides accommodation and nursing care for up to 37 older people. At the time of our inspection, there were 34 people in residence. Earlier this year, the service started an agreement with the local NHS Trust for five ‘discharge to assessment’ beds. This meant that the beds were funded by the NHS. To minimise disruption to permanent residents, the bedrooms used for this purpose were located together in one part of the home.

The service has 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.

People and their relatives spoke highly of the care provided. At the time of our visit, the home was undergoing a major programme of refurbishment to both individual rooms and communal areas. This included redecoration, replacing of worn carpets and the levelling of uneven flooring. One relative said, “It’s not looking its best but the care is fantastic, it has a nice atmosphere”.

The registered manager had been in post for less than a year but had made significant changes to the service. This included increasing the number of staff on duty, improving activity provision and updating care plans. People spoke positively about the changes. One person said, “I am happy with this home and I am happy to recommend it to anybody any time. They are kind to us”. A staff member told us, “(Registered manager) is making a lot of changes for the better”.

During our inspection we identified some areas that required improvement. These included how medicines were managed, the monitoring of risk and the safety and cleanliness of parts of the premises. As a result, we found that the service was not consistently safe and that further work was needed. The registered manager was aware of the concerns and had already taken action in many cases to make improvements.

Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

There were enough staff to meet people’s needs. Staff had received training and were supported by the management through regular supervision and appraisal.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified.

People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, district nurses or optician.

There were a variety of activities for people to participate in, both in groups and as individuals. This included games, visiting entertainers and attending a local coffee morning in the village.

The registered manager had a system to monitor and review the quality of care delivered and was supported by the provider. People, their relatives and staff felt confident to raise issues or concerns with the registered manager. Where improvements had been identified action had been taken or was underway.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the p

In this report the name of a registered manager appeared who was not in post and not managing the regulated activities at this location at the time of the inspection. This was because they were still a registered manager on our register at the time of this inspection.

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?

At the time of the inspection 34 people were living at the home, 28 of whom required nursing care. Some of the people using the service had complex needs which meant they were unable to tell us directly about their experience. We spoke with two people using the service, nine relatives, two care staff, the activities coordinator, the administrator, the cook, the kitchen assistant, a visiting training consultant and the registered manager. The summary describes what they told us, what we observed and the documents and records we looked at.

This is a summary of what we found:

Is the service safe?

The two people we spoke with told us they felt safe, and were supported by staff in making their own decisions. This was confirmed by their care plans and through observation and discussion with care staff. Six relatives with whom we spoke said they were confident that their family member was safe and they felt reassured.

The registered manager and care staff had attended training in safeguarding people, the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS become important when a person is found to lack the capacity to make an informed decision related to aspects of their care and treatment. Care and nursing staff demonstrated an understanding of the support required to enable people with dementia to make choices about their daily lives and their care. The registered manager had assessed each person to ensure the MCA was considered in the assessing and planning of people’s care. We saw care records relating to a recent DoLS application which showed that the registered manager understood the procedure to be followed.

Risks to people’s health and safety had been assessed and plans were in place to minimise the risks.

People were protected from the risk of poor nutrition because their needs were assessed and appropriate support was provided.

Is the service effective?

People had their needs assessed. Care plans were regularly reviewed to ensure they remained effective, and were kept up to date to reflect the changing needs of people.

Records of care given and food and fluid records showed that people were receiving the care they needed. People who were cared for in bed and at risk of tissue damage as a consequence were being supported to move regularly and specialised equipment was used to minimise the risk.

Staff had received training to enable them to meet the specific needs of people living at the home. One person told us “If you asked me to rate it out of ten, it would be ten out of ten.”

Is the service caring?

The two people we spoke with told us they were well cared for and their needs were met. One person said “I can’t believe people can be so caring”. From speaking with staff and observing how they supported people it was clear that they knew people well and understood their needs.

A relative told us “On the whole people are pretty well cared for. Staff are friendly and welcoming.” A family group told us “It’s loving care – it couldn’t be better.”

We saw that care staff supported people in way that was unhurried and at their own pace.

Is the service responsive?

A relative said “If you ask for something to be done it is”.

There were quality assurance processes in place to make sure that issues were identified and action was taken to address them. For example, there was an increase in the night staffing level in response to the increased dependency levels of people, which was identified through a staffing needs analysis.

Is the service well-led?

Staff demonstrated a good understanding of the values that underpinned the care provided at the home.

People were cared for by care staff who were trained and well supported. We spoke with the registered manager, two care staff and the nurse on duty, all of whom said they felt supported by their managers.

We used the Short Observational Framework for Inspection (SOFI). The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have a positive experience. This includes looking at the support that is given to them by the staff and the interaction. During the lunch time we used the SOFI tool to help us see what people’s experiences at mealtimes were. We spent time watching at lunchtime and found that people had positive experiences. Members of staff supporting people knew what support they needed and they respected their wishes if they wanted to manage on their own.

We also spoke with three people who lived at Beechwood House during the visit and spoke with the six staff who were on duty. People we spoke with described the home as a comfortable and a nice place in which to live. One person told us: "People here know what I need and they make sure I get what I need.” We spoke with a relative who told us: "I am impressed with the way my mother is taken care off here. They go out of their way to make this place comfortable. She is finally settled.” We also reviewed six care plans and found that the care was person centred and people were listened to by the staff. We saw the care plans had been drawn up with the person so that the home could be sure they were meeting the person's needs and wishes.

A person we spoke with said, "The home is very clean, spotless." We found the rooms, bathrooms, toilets, lounge, dining and to be clean. We checked pressure cushions and found that they were clean. There was a process in place to ensure these were checked regularly.

We found that the provider had effective recruitment policies and procedures in place to ensure staff were both fit and able to meet people's needs.

Beechwood House had systems in place that ensured all aspects of the running of the home, and meeting people's needs had been regularly audited. People had been invited to comment on how the home was meeting their needs.

We spoke with three people who used the service and they told us that members of went out of their way to take care of them. They told us people they were kind and took their time when providing them with care. People told us they were able to make choices in their lives. We spoke with four relatives who told us they were happy with the service provided by the home. They told us that members of staff took their time in providing care to people who used the service. Relatives we spoke told us they were always kept informed about the care given and felt they could speak to members of staff if they had any concerns.

During our inspection, we spent a period of time observing people's experiences of living in the home. We saw people were relaxed and members of staff treated them with care and dignity. We saw care was being delivered in a kind and reassuring manner. We found members of staff were patient and respectful when people found it difficult to communicate their needs.

We spoke with one General Practitioner who told us they were happy with the service provided to people who lived at the home.

We spoke with 2 people who use the service and they told us that they were treated well by the staff and said that staff were kind, They said that the staff ask them if they want any support and that there was always someone around to help. They told us that they were able to make choices in their day to day lives and both stated they felt safe and that if they were not happy or had any concerns that they would speak to the manager.

We were unable to talk to other people who live at the home due to their age related memory loss.

We spoke with staff during the visit to the home and they told us that they receive regular supervision and that training is provided on a regular basis. Staff told us that they staffing levels were adequate but they could always do with an extra pair of hands.

Relatives of people told us that they were happy with the care provided to their relatives and said that their privacy and dignity was respected. They confirmed that they were consulted about the care and support their relative receives and that they were invited to reviews of their relatives care.

Family members told us that they were happy with the home and said that they were able to visit whenever they wished and that they were always made welcome by the manager and staff. They told us that they had no concerns about the staff at the home and said staff were kind and caring.

We spoke with one person who visits the home regularly and he had no concerns about the home and told us that there were always staff around and that he was made very welcome. He told us the home was kept clean and said that he can stay and have a meal with his relative and said he was very happy with the food provided at the home

All of the people we spoke with told us that they knew how to make a complaint if they needed to and were confident that the manager would respond appropriately to any concerns that may be raised.

We spoke with the community nurse service that visit the home and they told us that they visit on a regular basis. They said that felt that the home could improve by earlier reporting of pressure areas for some people. They also said that there was fine line with some people who may require nursing care.

The manager told us that peoples needs are kept under review and that at the first sign of any pressure area developing, then appropriate pressure relieving equipment is sought and the community nurse team contacted to provide advice and support. She said that staffing levels are kept under review to meet people’s changing needs.

The manager confirmed that regular staff meetings take place and that all staff have annual appraisals.