This was an unannounced inspection carried out on 3 May 2017.

Beenstock Home is registered to provide nursing and personal care for up to 26 people. The care home offers residential care on the third floor, nursing care on the second floor and sheltered housing facilities to the ground and third floor. All bedrooms are single occupancy with en-suite facilities. The home offers a culturally specific service for the Orthodox Jewish community.

There was a registered manager at the service at time of 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 comprehensive inspection on the 20 October 2015 the service was found to be in breach of regulation 17 with regards to Good Governance. We then carried out a focused inspection on 15 February 2016 where we found the service had worked towards rectifying their position. We concluded the service was then meeting all the regulations applicable at that time.

During this inspection, we found the service continued to meet current regulations.

We received positive feedback from people using the service, their families and staff members. Everybody we spoke with told us with confidence that the management and staff team were caring, respectful and understood their needs and requirements well. Relatives voiced their confidence in the service and its ability to support their relatives safely and effectively.

The provider had processes in place to maintain a suitable environment for people living at the service and their visitors. Risk assessments were established to identify any environmental risks associated with areas both internal and external areas such as the use of lifts, stairs and substances hazardous to health (COSHH). The service also employed a full time maintenance person to carry out any repairs to the building.

Suitable training was offered to staff to ensure they were competent in recognising the signs of abuse and could appropriately and confidently respond to any safeguarding concerns. Staff were aware of how to notify the relevant authorities when required.

The service had satisfactory staffing levels to support the operation of the service and provide people with safe and personalised care. Comments from people using the service, their relatives and staff supported this. Staff were expected to access a variety of mandatory and additional training which ensured they were skilled and experienced in safely and effectively supporting all people using the service. The registered manager was very supporting of staff development and additional training.

Recruitment procedures were in place to ensure appropriate steps were taken to verify new employee's character and fitness to work. New employee induction processes were robust and staff were required to complete an additional shadowing programme with an experienced member of staff prior to working alone. This process ensured the correct amount of detail was provided to them to ensure they were equipped with the knowledge to carry out their support role effectively. People spoken with and their relatives felt that staff knew their needs well. Staff demonstrated a good understanding of their role and how to support people based on individual need and in a person centred way.

The provider had appropriate processes in place for the safe administration of medicines; this was in line with best practice guidance from the National Institute for Health and Care Excellence. Staff were adequately trained in the administration of medicines and all medicines were stored securely and safely.

Each person had a care file containing documents such as care plans, risk assessments and a personal profile. These records gave clear i

We carried out an unannounced comprehensive inspection of this service on 20 October 2015. During that inspection we found one breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breach of regulation.

Beenstock Home is registered to provide nursing and personal care for up to 18 people. The care home is integrated into a sheltered housing complex that comprises of three floors, with sheltered flats on the ground and second floors and the nursing and residential units on the first floor. All bedrooms are single occupancy with en-suite facilities. The home offers a culturally specific service for the Orthodox Jewish community.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Beenstock Home on our website at www.cqc.org.uk.

During our last inspection we found that the provider had not implemented systems to assess, monitor and improve the quality and safety of the services provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance.

During this inspection we found the service was able to demonstrate that they were meeting the requirements of regulations. We found the service undertook an extensive and comprehensive range of audits and checks to monitor the quality of services provided. These included weekly and monthly medication audits. Other audits introduced included care plans, falls, pressure ulcers, safeguarding incidents, Deprivation of Liberty Safeguards (DoLS), weekly weights monitoring, bedrail and mattress checks and infection control.

The home had introduced a training matrix to monitor the training requirements of all staff and also undertook regular Nursing and Midwifery Council checks to ensure registered nurses were suitably registered to undertake their duties.

We looked at monthly meeting reports, which detailed the home’s response to safeguarding meetings, CQC reports, monthly audits and staffing issues. An action plan was then formulated to address any issues within set time scales.

This was an unannounced inspection carried out on the 20 October 2015.

Beenstock Home is registered to provide nursing and personal care for up to 16 people. The care home is integrated into a sheltered housing complex that comprises of three floors, with sheltered flats on the ground and second floors and with the nursing and residential unit on the first floor. All bedrooms are single occupancy with en-suite facilities. The home offers a culturally specific service for the Orthodox Jewish community.

There was a registered manager in place at the time of our 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.

When we last inspected this service in May 2014, we did not identify any concerns about the service.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found the service undertook checks to monitor the quality service delivery. These included weekly medication record chart audits, however the last audit had been conducted on 26 September 2015. We looked at an Independent Monthly Home Audit, where records indicated the last audit had taken place in May 2015. We also found there were no quality assurance systems to effectively monitor the training requirements of staff and the current training matrix we looked at was not fit for purpose.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service failed to assess and monitor the quality of service provision effectively.

People told us they believed they felt safe living at Beenstock Home.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

People were protected against the risks of abuse, because the service had appropriate recruitment procedures in place. Appropriate checks were carried out before staff began work at the service to ensure they were fit to work with vulnerable adults.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service administered medicines safely.

As part of this inspection we looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. Staff we spoke with confirmed they received training both at induction and then annually through refresher training.

We found that staff had not received any recent training in the Mental Capacity Act. A number of staff had not received recent training in First Aid and Fire Awareness.

We have made a recommendation about training in the Mental Capacity Act.

We looked at how the service supported people with their diet. Care plans detailed guidance on the support each person required in respect of food, drink and nutrition. We spent time observing the lunch period to see how people were supported to receive adequate nutrition and hydration.

People we spoke with told us that the service was excellent and that staff were kind and caring.

Throughout the day we observed staff interacting and engaging with people who used the service. This interaction was kind and gentle and staff took time to support people if they were mobilising or administering medicines and fluids.

Staff we spoke with were also clear about how to promote people’s independence. For instance, at lunch time we saw that whilst assisting one person to eat their meal, a member of staff helped them to cut up their food, but then allowed this person to eat it themselves.

People and relatives told us that they were treated with dignity and respect by staff.

People told us that staff helped them retain their independence. Staff we spoke with were clear about how to promote people’s independence.

The service ensured that staff effectively met the cultural and spiritual wellbeing of people who used the service.

On the whole, most relatives we spoke with said the service was responsive to their loved one's needs.

The service also identified ‘lessons learnt’ from any complaints, safeguarding or incidents, which were then shared with staff either through individual supervision or staff meetings.

We found that the management promoted an open and transparent culture amongst staff. Staff we spoke with were positive about the leadership provided by the service.

We found the provider was unable to demonstrate to us that the installation of the CCTV system had been installed in the best interests of people who used the service and that people, including those who lacked capacity, had been consulted.

We looked at the minutes from the most recent staff meeting, which had taken place in October 2015. This provided staff with the opportunity to discuss concerns or talk about areas, which could be improved within the service.

Providers are required by law to notify CQC of certain events in the service such as serious injuries and deaths. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

Beenstock Home provided residential and nursing care for older people. It was registered to provide nursing and personal for up to 16 people. The home offers a culturally specific service for the Orthodox Jewish community.

At the time of our inspection, a temporary manager had been in post for four weeks following the resignation of the previous manager. We were told the service was in the process of appointing a new manager which they hoped to be able to confirm in the near future.

During our visit we spoke to four people who used the service, four visiting relatives, three health care professionals and four members of staff.

Our inspection team was made up of an inspector who addressed our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

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

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person told us; “I feel safe here and I’m very satisfied with service.” A visiting relative said “We feel X is very safe, we are happy with the care here.”

Safeguarding procedures were robust and staff were able to confidently explain to us when to make a referral if they had any concerns. This demonstrated they understood how to safeguard the people they supported.

We found systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. We saw guidance available and that staff had received training.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly and people were not put at unnecessary risk.

We found there were sufficient numbers of suitably trained staff on duty to effectively meet the needs of people who used the service.

Overall recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing their care plans which reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. One relative told us; “Staff are very welcoming, I can come anytime I want.”

Is the service caring?

People were supported by kind and attentive staff. We observed staff supporting people sensitively and with humour. People commented, “ I have been reassured from the outset, professional values and doing things that give me reassurance and confidence about the care my X is receiving.” “Never had any cause for concern about residents, staff are very caring.” “Very happy with care, everybody are so kind.” “Never made to feel uncomfortable, everything is fine.”

Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities within the home. An organised programme of events was displayed and people were gently encouraged to be involved.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One visiting professional told us; “It is a very caring home.”

The service had quality assurance system in place, records viewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly being improved.

Staff told us they were clear about their roles and responsibilities and were respectful of the religious and cultural values of the people who used the service.

During our inspection we spoke with six people who used the service, five people’s relatives and a visiting professional. In addition we spoke with a number of staff members including care assistants and the manager.

Some people who used the service had limited communication skills due to their dementia. We spoke with care staff and observed care practices. The people who used the service and their relatives spoke positively of the staff and the manager. We asked people about the care they received and they told us: "Staff are excellent, they can't do enough for you." "If you need them they are there willing to help." “They give us choices about everything.”

Staff were seen to support people in an appropriate way, sensitively and maintained their dignity.

We saw that some of the assessment records showed that people who used the service had signed to confirm their care needs had been discussed with them and they had agreed with their planned care.

Staff spoken with told us they thought training was very good and a good standard of care was provided to people. One person told us, "I feel really well cared for here and the staff always involve me in my care”.

We asked about the meals provided and people told us: "The meals are very good." "They bring us drinks and a supper in the evening."

The provider had a system to assess and monitor the quality of service that people received.

When we visited Beenstock Home we spoke with four people who used the service four visiting relatives and four members of staff. We were told that people were happy living at the home. One person said "I am very happy here, I can do anything I want. I go out and have family and friends who come to visit me."

People told us that they were treated with respect and dignity. One comment was, "I

feel like I am very well respected, the staff always call me by my name in a way I like."

People we spoke with said they were offered choice in a number of ways.

For part of this inspection we were supported by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of service. This person talked with a number of people who use the service at Beenstock Home. The Expert by Experience completed a report after the inspection and some of their comments and observations are included in this report.

The relatives and people who used the service we spoke with were positive about the care and support provided by the staff. Staff were described as being patient and kind towards the people they supported. Relatives spoken with felt satisfied their relative was safe and felt confident to raise any issues of concern at any time.

Relatives we spoke with told us that the staff acted in a professional manner and they were kind.