This inspection took place on 6 and 14 February 2017 and was unannounced.

Beechwood Nursing Home is registered to provide nursing care for up to 32 older people. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building spread across three floors. At the time of our inspection 27 older people with nursing needs were using the service.

The service had a registered manager. They had been the registered manager since December 2017. A registered manager is a person who has registered with the 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.

At the last inspection in December 2016, we asked the provider to take action to make improvements to ensure the service was person-centred and to improve governance and quality assurance at the service. At this inspection, improvement had been made in some areas and the service was person-centred. However, we identified new concerns regarding safe care and treatment, staffing and on-going concerns about the governance of the service.

The provider did not have an infection prevention and control lead. The sluice room and laundry were unclean and robust systems were not in place to ensure and evidence all areas of the service were regularly cleaned and deep cleaned.

There were a number of maintenance and health and safety issues. Risks had not been adequately assessed to ensure appropriate control measures were in place to keep people safe. For example, the need for window opening restrictors had not been adequately assessed and regular checks had not been completed to ensure these were in place. Concerns identified at our last inspection about doors being left unlocked and cleaning chemicals left in accessible places had not been addressed.

Staff had not always received appropriate training. Staff had not received regular supervisions; annual appraisals had not been completed. The provider had not ensured competency checks were consistently completed to evidence staff had the necessary skills to safely meet people’s needs.

The concerns identified during our inspection showed us effective systems were not in place to monitor the quality and safety of the service provided and to maintain consistent standards of care. This was the third consecutive inspection where we identified a breach of regulation and the second time the service has been rated Requires Improvement.

We found breaches of regulation relating to safe care and treatment, staffing and the governance of the service. You can see the action we asked the registered provider to take at the back of the full version of this report.

People who used the service told us they felt safe. Staff were safely recruited and sufficient staff were deployed to meet people’s needs.

Care plans and risk assessments were person-centred and generally contained proportionate information about how staff should support people to maintain their safety. Accidents and incidents were recorded and actions taken to reduce risk and prevent reoccurrences.

Staff supported people to ensure they ate and drank enough. Staff worked with healthcare professionals and supported people to see their GP or attend appointments when necessary.

Consent to care was considered and documented in line with relevant legislation and best practice guidance.

Staff were kind and caring. Staff respected people’s privacy, dignity and personal space. People made choices about their care and support and staff respected people’s decisions.

The registered manager had a system in place to gather feedback a

This inspection took place on 20 December 2016 and was unannounced. The home was last inspected on 2 February 2016. This was a comprehensive inspection and we identified a breach of regulation in respect of Regulation 17: Good Governance in respect of record keeping. At this inspection we identified a repeat breach of Regulation 17 in respect of record keeping. We are taking action to ensure the registered provider understands that improvements have to be made to record keeping at the home otherwise enforcement action will be taken by the Care Quality Commission.

The home is registered to provide accommodation and nursing care for up to 32 older people, including people who are living with dementia. On the day of the inspection there were 26 people already living at the home, and one person was due to be admitted. The home is situated in Scarborough, a seaside town in North Yorkshire. The home has three floors and a passenger lift operates between all levels.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 manager was registered with CQC on 28 October 2016 and prior to that had been the registered manager for two other services within the organisation.

Some records were not up to date, some information was missing from care plans and some care plans included contradictory information. In addition to this, food and fluid charts and positional change charts had not been consistently completed. This meant there was a risk that people’s up to date care needs might not be met. This was a repeat breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

Although people had care plans in place, we saw that some information that should have been recorded in these plans was missing and some was contradictory. This could have led to people not receiving person-centred care. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Person-centred care.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Discussion with staff showed they understood their responsibilities in respect of protecting people from the risk of harm or abuse.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the registered manager had informed the Care Quality Commission when DoLS applications had been authorised.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. Staff told us that they were well supported by the registered manager and they were happy with the training provided for them.

We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

People’s family and friends were made welcome at the home. A variety of activities were provided and people we

We inspected Beechwood Nursing Home on 2 February 2016. The visit was unannounced. Our last inspection took place on 11 December 2014 and there were no identified breaches of legal requirements.

Beechwood Nursing Home is registered to provide accommodation to up to 32 people who require nursing or personal care. On the day of the inspection visit the service was caring for twenty five people. The home is situated in a residential area of the seaside town of Scarborough.The home is fully accessible for those with mobility needs. There are several communal areas for residents to use.

At the time of this inspection the home had a registered manager but this person had left their post and was no longer employed by the service. 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 managed by the area manager on the day we carried out the inspection visit.

Overall, medicines were safely handled, though there were a number of areas for improvement which did not impact directly on the safely of people's care. People told us they felt safe in relation to their medicines and their care.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe.

The home was clean and staff understood infection control procedures.

Staff were safely recruited and trained. They had regular supervision and appraisal to support them in their role.

We found the service was meeting the legal requirements relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The home met people’s nutritional needs and people reported they had a good choice of food. People had a good experience at mealtimes.

People had access to health care professionals when they needed this. The service referred to specialists when necessary and advice was incorportated into care plans. People were supported to attend health care appointments when they needed this.

During our visit we saw people being well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated they knew people’s individual characters, likes and dislikes. Staff were aware of and knew how to respect people’s privacy and dignity.

The service had assessed people’s needs around their social, recreational and spiritual lives. However, for some people, staff had insufficient information about them as individuals to support them to offer personalised care.

The registered provider investigated and responded to people’s complaints, according to the provider’s complaints procedure.

The service was not consistently well led, as records and systems did not fully support the area manager to monitor and mitigate the risks around people's care. This was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A new manager was in place, who was planning to submit an application for registration with CQC. We saw the provider had a system in place to assess and monitor the quality of the service and they acted on this to improve people's care. Staff told us they were supported and encouraged in their role.

This was a responsive inspection to follow up on concerns raised at the last scheduled inspection on August 2014. These concerns were as follows:

Care was at times task based and care planning documentation was not always sufficient to ensure staff had the information required to provide personalised care. This was in breach of Regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2010- Care and welfare of people who use services.

Notifications had not been sent to CQC as required or managed appropriately. This was in breach of Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010- Safeguarding people who use services from abuse.

The provider did not always demonstrate learning from incidents to protect people. People’s views and staff views had not regularly been sought or acted upon. This was in breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010- Assessing and monitoring the quality of service provision.

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up on the above concerns and to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three people who used the service, two visitors, a nurse, two care workers and the acting manager. We reviewed four care plans with associated documentation and a range of other documents related to the management of the home. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe, and they told us they felt safe. One person told us “Oh yes, the carers are nice and don’t leave you.” People’s risks were assessed so that freedom and independence were balanced against safety. People were protected by effective whistle blowing procedures. They were cared for by sufficient staff who were well recruited and in sufficient numbers to offer safe care. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People received effective care. Staff had the training and knowledge to offer people the care they needed and were well supervised. Although people’s mental capacity was assessed, there was not always sufficient information for staff to ensure people’s capacity was maximised. People's nutritional needs were met, and they had access to the health care support they needed.

Is the service caring?

Staff were kind and caring. They involved people in their care, taking time where this was needed and explaining things to people in a way they could understand. People’s privacy and dignity were respected.

Is the service responsive?

The service was responsive. People told us that staff understood their care needs and responded to them. The service handled complaints appropriately. Care plans gave information for staff to offer personalised care, however the acting manager was still working on identified improvements.

Is the service well-led?

The service was well led. The registered manager was not managing the home at the time of the inspection. However the home was being managed by an acting manager. Staff reported that they could share their thoughts openly with the acting manager, and raise concerns with confidence. They were clear on the values and ethos of the home. Staff told us the acting manager listened to them, acted on their views and provided a clear lead. Notifications had been sent to CQC as required and incidents were analysed to minimise future risk. Staff were clear about their roles and responsibilities and communication within the staff team had improved with more meetings and informative handovers.

Two inspectors carried out this inspection. During the inspection, the inspectors focussed on answering five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we looked at records for five people who used the service. We spoke with the general manager. We spoke with a relative of a person who used the service, several people who used the service and six care staff. We reviewed records relating to the management of the service.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports our summary please read the full report.

Is the service safe?

We carried out an inspection following information received regarding the failure to report and respond appropriately to a safeguarding incident. During the inspection we found that the systems in place were not effective and required improvement to ensure that safeguarding incidents were responded to appropriately. There was a lack of monitoring and auditing that had resulted in failure to respond to issues within the home. These were being reviewed at the time of our visit.

Staff had a good understanding of how to raise concerns and people who used the service felt safe being supported by staff. We observed that care and support was carried out in a safe way. One staff member told us “I would raise issues with management and I know how to take it higher if I needed to”.

There had been some previous staffing level issues but these were being actively addressed within the home to ensure that staffing levels remained at a safe level.

Is the service effective?

People who used the service reported to us that they were given the support they required. We observed that staff were patient and responded to requests for assistance quickly and appropriately. Care needs were recorded in care plan files although these required reviewing to ensure that people’s most recent needs were known by all staff. One person who used the service told us “I am happy living here and although there have been lots of changes I can tell that things are being looked at and improving”.

There were systems in place for monitoring and auditing all elements of care and management of the home although these were not being used to their full capacity at the time of our visit.

There was an effective complaints system in place and people we spoke with felt able to raise concerns and were confident that these would be dealt with in an appropriate way.

Is the service caring?

We observed throughout our inspection that staff were patient and friendly with people when supporting them. Communication was good and people understood what support was available. People who used the service spoke positively about staff and reported that they felt cared for.

There was a lack of activity and social interaction within the home, but staff responded in a timely way to requests for support with daily living tasks. People were given support where required to eat and drink and this was done in an appropriate way. This ensured that people got enough nutrition and hydration to meet their needs.

Is the service responsive?

Although there were systems in place to gather feedback from staff, residents and relatives in order to lead improvements, these had not been used effectively since the last inspection. Where audits had been carried out these had been responded to appropriately through action planning and allocation of responsibilities to staff to make improvements. However this had not been done consistently across the home and there was a lack of evidence that feedback had been gathered and analysed.

There was a robust complaints system in place and people were aware of how to raise issues. All those we spoke with felt that any complaints would be handled effectively and responses would be appropriate. People felt staff were approachable and keen to make improvements. One relative told us “The staff are very good, they take on a lot”.

When any issues had arisen regarding people’s needs, evidence showed that appropriate referrals had made to services such as physiotherapy and the dietician.

Is the service well-led?

At the time of our visit there was a new general manager in post and an interim manager that was overseeing the running of the service while recruitment was being undertaken. Some issues had been highlighted with the previous management of the home and the new management team were undertaking work to identify and address the issues that were present.

The provider and the new general manager were keen to ensure that the home made improvements in several areas and staff reported that morale in the home was improving due to the directive management style being used at the time of our inspection. Staff reported that they felt the general manager and interim manager were approachable and were motivated to improve all elements of the home.

We visited Beechwood Nursing Home in May 2013 and identified some issues with areas including infection control and cleanliness, suitability of the premises, medication and quality assurance. We had asked the provider to make some improvements. We revisited in September 2013 to make sure that these improvements had been made.

We found during our visit in September 2013 that the manager had implemented systems including extensive cleaning schedules, audits of the environment and cleanliness, medication, care plans, and equipment. Extensive repair and renovation work was underway in the service including redecoration, new flooring and carpets, upgrades to bathrooms and new equipment. This work was on-going.

The manager had arranged for an audit of medication systems from the local authority and had subsequently developed an action plan which was partially completed at the time of our visit. Resident and staff meetings had been held, as well as surveys of satisfaction.

When we visited Beechwood Nursing Home we found that people felt reasonably well cared for. Staff ensured that people had given consent before carrying out any care. We observed that basic care needs were met well. One person told us “Things aren’t always as good as they could be, but the good does outweigh the bad”. Another person told us “It’s alright”. A relative told us “Staff know them well and they always seem happy”. Another relative told us “I am happy with the care received”.

We found that there were deficiencies in the cleanliness of the home and no auditing of this area to ensure that risks were minimised. The environment was not maintained to a high standard and required some further input.

There were issues with the correct and accurate recording of medication administration and storage and no auditing of medication was being done within the home.

There were systems in place for quality assurance of the service but these had not been maintained and opportunities for staff and residents to feedback had not been provided effectively in the last year.

Beechwood Nursing home had a scheduled inspection in June 2012 which highlighted issues around involvement in services, planning and paperwork and quality assurance. We visited again on the 12th of November to check and see whether the service had addressed the issues raised in the last inspection.

When we visited we saw that there were new care plans in place for people, and these were detailed, person centred and being regularly reviewed. There was evidence of people’s involvement in rewriting their plans, and although not all updates were completed, the process was well underway. We spoke with people who used the service and they told us that they had been involved in planning their care. One person told us “Staff and I have been rewriting my plans together. I have talked to them about how I want to be supported”.

We saw that the manager had developed various quality assurance and audit systems, which were being used effectively to gather both residents and relatives views and input. An activity co-ordinator had been employed by the provider, and a focussed plan for that role was being developed with staff and residents.

During our inspection we observed good interactions between people and staff, and there was evidence that staff had received focussed training around dignity and respect. When we spoke with people who used the service they told us that they were always treated with dignity and respect by staff.

People we spoke with told us that they did not have a care plan and that there was not much to do in the home. They told us that staff were pleasant and that they could attend meetings about the home if they wished.