We conducted an unannounced comprehensive inspection at Beulah Lodge on 10 July 2018. Beulah Lodge is a ‘care home’ for older people. 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. Beulah Lodge accommodates up to 21 people in one building. At the day of our inspection 17 people were living at the home.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.’ The registered manager was also a director of the registered organisation and the Nominated Individual (a Nominated Individual must be employed as a director, manager or secretary of the organisation, with authority to speak on behalf of the organisation. They must also be in a position which carries responsibility for supervising the management of the carrying on of the regulated activity). The management team consisted of the registered manager, a manager, a clerical manager and a team leader.

At our last inspection, published in January 2016 the service was rated as good overall and for all five questions we ask. At this inspection we found some areas which need improvement within safe, effective and well led.

There were health and safety policies, audits and monitoring in place; however, the provider had failed to ensure the environment was safe. The provider could not be assured that people could vacate the premises safely if a fire were to break out. Fire drills had not gone as planned and corrective action had not been taken. We have made a recommendation about this. A first-floor bedroom window was not restricted from opening fully, this put people at serious risk. This was a breach of the Health and Social Care Act 2008 regulations. Post the inspection the provider told us they had taken immediate corrective action with regard to the window restrictor.

The provider did not consistently ensure the safe use of people’s prescribed medicines. Medicines errors were not analysed effectively to prevent reoccurrence; there were not always protocols in place for people who needed medication ‘as and when required’ to ensure people received medicines when they needed them. The failure to ensure the proper and safe management of medicines was a breach of the Health and Social Care Act 2008 regulations. Post the inspection, the provider told us they had taken corrective action.

Accidents and incidents were not always analysed effectively so lessons were not always learned when things went wrong. This is an area for improvement. Individual risks relating to people’s care were managed, systems were in place and appropriate action taken. Safeguarding and whistleblowing policies were in place, concerns had been appropriately reported and staff had received training. Systems were in place which ensured information held about people was secure. There were sufficient staff available to meet people’s needs and safe recruitment practices were completed. Infection prevention and control policies, risk assessments and systems were in place.

People were asked to consent to their care. People’s needs were assessed and people’s care plans detailed their individual needs. Although the provider had meet people’s needs around their communication, they were not aware of the Accessible Information Standard (AIS). We have made a recommendation about this.

Feedback on the choice, quality and amount of food was very positive. People were supported to live healthily and access healthcare. The provider worked with partner organisations to ensure people received the care they

The inspection was carried out on 24 November 2015 by two inspectors. It was an unannounced inspection. The home provides personal care and accommodation for a maximum of 20 older people. There were 20 people living there at the time of our inspection. All the people living in the home were able to express themselves verbally.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

There was a system to record and monitor accidents and incidents to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. People told us, “Every need is covered here” and, “The staff and I know each other very well indeed, I bet they can hear my thoughts by now”.

Staff received essential training and had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supporting people to the expected standards.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There was a system to submit appropriate applications to restrict people’s freedom considering least restrictive options as per the Mental Capacity Act 2005 requirements.

Staff sought and obtained people’s consent before they helped them.

The service provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect.

People were satisfied about how their care and treatment was delivered. Relatives told us, “The quality of care here is second to none” and, “The staff are amazing, so kind and patient.”

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to contribute.

Clear information about the service, the facilities, and how to complain was provided to people and visitors. The activities programme was provided for people in a suitable format which made it easy to read.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly with their participation and updated when their needs changed.

People were involved in the planning of activities and told us they were satisfied with the activities provided.

The service took account of people’s feedback, comments and suggestions. People’s views were sought and acted on. The registered manager sent satisfaction questionnaires regularly to people’s relatives or representatives, analysed the results and acted upon them. Staff told us they felt valued under the registered manager’s leadership.

The registered manager notified the Care Quality Commission of any significant events that affected people or the service. The registered manager kept up to date with any changes in legislation that may affect the service and carried out audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

We spoke with seven people using the service or their relatives. They were positive about the service. One person told us they received “good care”, “the staff are great” and that it “couldn’t be better”. Another person using the service said they “couldn’t fault the home” and that the staff were very positive. A relative we spoke with said they had “no criticisms of the home” and that the staff “seem to have a laugh and a joke with people”.

The care records we looked at showed that people had had their needs assessed and care plans developed from this. Where people had healthcare needs appropriate advice and treatment was sought.

There were processes in place for the management of infection control within the service.

The service had processes for managing and administering medication safely and securely.

The service monitored the quality of the service, and responded to any concerns raised.

We spoke with at least six people who used the service or their relatives. They told us that people using the service were treated with respect by staff. We saw that people had personalised their rooms with their own belongings. People said they were involved in their care and told us “it’s my choice” about what they wanted. People using the service, their relatives and the staff were asked for their views about the service, and actions had been taken as a result of this.

People and their relatives were mostly positive about the care they received, and felt safe in the home. They told us they talked to the staff about any problems they had. One person told us they were “really quite happy, no complaints at all really” and another said the service was “fantastic” and had a “lovely atmosphere”. People told us that if they were unwell the home responded to their needs.

The home was clean and tidy and there were no unpleasant smells. One person told us that the environment "could do with improvement." We saw that some areas of the home showed signs of wear and tear, but others had been recently decorated or refurbished. There was outdoor space and a summerhouse that people told us they enjoyed using.

People were positive about the staff and told us they were “all very kind and caring”. The home had had staffing vacancies over the summer, but these were now filled. People using the service told us that staff had been “very busy” but their needs had still been met.

People told us that they were well cared for; staff were caring and friendly and understood their needs. People had good relationships with staff.

People said their needs were well met, they received the care they expected to have and the home accommodated any changes in care or routine that were needed.

They said they were happy with the standard of accommodation and cleanliness, a relative commented that there was never an unpleasant odour in the home.

People complimented the standard of the food; they said it was of very good quality with plenty of choice available.

People told us they were pleased about changes made to the home over recent months and felt it was improving.