The inspection took place on 21 of September 2016 and was unannounced. We last inspected Beverley Park Nursing Home on 23 April 2014 and found the service met the regulations we inspected against at the time.

Beverley Park Nursing Home provides nursing and residential care and support to up to 18 people. This includes care and support for people living with dementia. At the time of our inspection there were 17 people using the service.

The home 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.

People said they were happy with the support they received and felt safe. Staff showed a good understanding of safeguarding adults and were confident in how to keep people safe.

Medicines were managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staffing levels were consistent with people’s needs. Staff were recruited in a safe and consistent manner with all appropriate checks carried out.

General risk assessments were in place in relation to premises and environment. All equipment was maintained and serviced within identified timescales. Each person had a personal emergency evacuation plan (PEEP) in place to ensure staff could support people in the event of a fire.

Staff received regular training and competency assessments were carried out in relation to specific areas, including the management of medicines. Regular observations were carried out as part of supervisions.

Staff told us they felt supported in their roles and they received regular supervisions, as well as annual appraisals. Records we viewed reflected this.

The registered manager and manager had a good understanding of the Mental Capacity Act 2005 and the procedure for Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place where appropriate.

We observed during mealtimes that people enjoyed their meals, some independently and others with support from staff. There were choices available for people and support was provided by staff with patience and at an appropriate pace to each individual.

People and relatives told us the service was “brilliant” and staff were caring.

People had access to advocates where required. During the inspection we found one person was receiving advocacy support.

People and their relatives knew how to complain and felt confident and able to do so. People spoke positively about the service and told us they had nothing to complain about.

A range of regular audits were carried out that related to the service the home provided, as well as the premises and environment.

Two inspectors carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

On the day of our inspection we found the environment was clean and hygienic. We saw infection control policies and procedures were in place. Staff had access to personal protective equipment (PPE) such as; gloves and aprons.

We saw records to show moving and handling equipment was regularly serviced and maintained to ensure people were not placed at risk.

The staff recruitment process was thorough and included taking references and making a check with the Disclosure and Barring Service (DBS). This was to make sure the staff employed at the home had not been barred from working with vulnerable people.

The manager determined staffing levels based on people’s needs and dependency levels. This meant sufficient staff were on duty to make sure peoples care needs were being met.

Staff approached people in a respectful manner maintaining privacy and dignity. We spoke with people who lived at the home who told us: “They are all very good.” They ask what I want.” “I am very happy here.”

The care staff we spoke with were aware of their responsibilities in relation to safeguarding and whistleblowing procedures.

CQC has a statutory duty to monitor the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw there were policies and procedures in place and training had been provided for staff in relation to the Mental Capacity Act and DoLS Codes of Practice.

The staff we spoke with demonstrated an understanding of DoLS and when an application might be needed. The manager told us no applications had been made to deprive people living in the home of their liberty.

Is the service effective?

Care plans were detailed and easy to read. Each care plan contained a summary of the persons care needs. Care plans and risk assessments were reviewed on a regular basis.

We looked at staff training records and saw staff received appropriate support and training to improve their skills and knowledge.

Staff showed a good understanding of people’s care and support needs. We spoke with people who lived at the home and their comments included: “They are lovely.” “I have everything I need.” “They are very kind and gentle.”

We spoke with a visitor who told us: “I would know if (their relative) was unhappy.” “The staff have been responsive and helpful.” “They are very good.”

A monthly newsletter was produced detailing any events or birthdays. On the reverse of the newsletter there was a comments form for people to make suggestions about the service. In addition the people we spoke with told us the manager spoke with them on a daily basis.

Is the service caring?

We spent time observing the interactions between people who lived at the home and staff. We saw staff were patient and supported people in a caring and sensitive manner.

We looked at a sample of people’s care plans and found they were detailed and easy to read. Care plans included information about preferences to make sure care and support was provided in the way the person wanted. One person told us: “The staff always ask me what I like.”

There were jugs of fruit juice and water in the lounges and throughout our inspection we saw staff serving hot and cold drinks.

We spent time observing the lunchtime meal service. Where people needed support to eat their meals we saw staff sat beside the person and the meal was not rushed. The people we spoke with told us: “I am very happy here.” “It is very good.”

The people we spoke with told us there were activities arranged. One person told us: “There is enough to do.” We saw the raised garden beds where people had planted carrots and radishes. The chef told us everything they grow is used.

Is the service responsive?

We spoke with the relatives of one person who lived at the home who told us the staff at the home were responsive and helpful.

There was a complaint procedure in place and people were given a copy on admission to the home. There had been no complaints but the manager told us they would keep a record of the complaint any investigations and the outcome.

We saw the minutes of a staff meeting that was held following a recent television programme about care homes. This gave staff the opportunity to discuss the content of the programme. The staff we spoke with were aware of the homes whistleblowing policy and procedure and the action they should take if they witnessed poor care practice.

Is the service well led?

The manager was registered with the Care Quality Commission (CQC).

There were systems in place to monitor the quality of the service they provided. These included a newsletter with a comments form, audits and staff meetings.

Discussions with people who lived at the home and or their relatives were used to improve the service. This meant the provider took people’s views into account.

We saw supervision records and the minutes of staff meetings. The staff we spoke with told us they felt well supported by the manager and deputy manager. Comments included: “The training is good and we can ask for more training if we need it.” “We have regular supervision and the manager is always available to talk to.” “We have a staff meeting every couple of months.”

At a previous inspection in September 2013 we had found that appropriate arrangements for safely handling medicines were not in place. At this inspection we found significant improvements had been made and overall we found medicines were now being safely and appropriately managed.

We checked the medicines records and stocks of five people who used the service.

None of the people we spoke with expressed any concerns about how their medicines were handled.

We reviewed policies and procedures, records and asked the manager what systems they had in place to regularly assess and monitor the quality of service that people received.

We saw a new audit system was in place which enabled the manager to systematically monitor quality.

We reviewed the policies and procedures in place, and noted all had been reviewed and updated between December 2013 and February 2014. The policies reflected current good practice guidelines and legal requirements.

During this inspection we followed up on three areas of concern identified at our last inspection. As part of our inspection we reviewed records, observed care, spoke with people living in the home, relatives and health professionals who visited the home.

Friends and relatives who visited the home told us: “I have been coming every week since X has been here; I have never seen anything that has concerned me.” Another person told us: “I like the atmosphere here, X is happy, we wouldn’t dream of moving them, it is their home”

We looked at four records. All the new care records included a summary of people’s social history, family, preferences and current care needs. We noted personal preferences had been noted throughout care plans including likes and dislikes.

We carried out a tour of the home and found all communal rooms, bedrooms and toilets were clean, with no malodours.

We saw a new checklist had been implemented by the manager to check cleaning and infection control practise had been carried out, this had been completed and signed by the manager. These checklists were not robust audits and did not give detail of the checks or findings.

We reviewed all the policies and procedures in place, and noted despite these being reviewed in March 2012 and signed by the manager to say no changes, the policies were inadequate and did not provide clear accessible guidance for staff to follow.

On the day of our inspection there were fifteen people living in the home.

People living in the home told us: “I feel very comfortable here. The staff let you do what you want. I like the staff and they’re very kind. I get up when I’m ready.” And “Generally speaking I like the staff.

Overall the home was clean although there were areas which needed improving.

We looked at four peoples records in detail. We Identified in all four records assessments had taken place, however care plans were not person centred and provided limited guidance to staff of the care required to meet people’s needs.

During our inspection we observed people being actively supported by staff over the lunch period to have a meal. Throughout the meal we observed staff were kind and friendly.

We looked at medication records and medication for 11 of the 14 people who were living in the home on the day of our visit. We found concerns relating to the administration and recording of medicines. For example where people needed to take medicine with food this was not adhered to and we found that medicine administration records were not completed accurately.

The provider carried out regular surveys to ask relatives for their views. We noted surveys received in April 2013 gave positive feedback.

During the visit, we spoke with two visitors of people who use the service. They told us they felt the care was safe, excellent and couldn’t be improved. They also told us the staff were very friendly and easy to get along with.

The people we spoke with told us that they had no concerns about the care they received and had been given information on who to contact if they had any concerns or complaints.

One said "I have never had a complaint but I know if I did [the Manager] would sort it out". Staff told us that people were happy to tell them if something was not to their liking, and any issues could usually be sorted out very easily.

People using this service told us that they were happy and were well cared for. They said that their privacy and dignity was respected and they were able to make choices about how they lived their day to day lives.

Some comments we received from people living at Beverley Park Nursing Home were:

“Privacy and dignity is very much respected.”

“The staff are very good here.”

“The food is very good, the cook asks what you like to eat and then makes it for you.”

“We get visits from the local churches and that’s nice.”

“I am happy and if I wasn’t I would tell matron and she would sort it out.”

“Some staff are very, very good.”

We spoke to some visitors to the home who were all positive about the care received by their relative. One visitor told us, “The staff are polite and courteous.” Another comment was “From what I have seen privacy and dignity is always respected.”

Another visitor said” The staff are very kind and pleasant” and “The staff are getting to know ‘x’ and all her likes and dislikes.”

All visitors spoken to said they felt the person they were visiting were safe and well cared for. We were told they had never seen or heard anything that caused them concern.

All staff spoken to said they thought the level of care was good and they had a stable staff team who worked well together. One member of staff said “We are the best.”

As part of this review process we contacted Trafford Commissioners and Trafford Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No concerns were raised by the Commissioners or LINKs.