The inspection was unannounced and took place on 18 April 2017.

The service was last inspected in December 2014 where we rated the service good. At this inspection we found the service remained good.

Barchester Prestbury Beaumont is located one mile outside Prestbury village. The care home is part of a care complex set in its own grounds, comprising of privately rented bungalows and apartments and a care home. On the day of our inspection visit there were 18 people living in the home. There is also a domiciliary care service registered at the same location. This provides a service to people living in the apartments which are in the same building as the care home and the bungalows that are adjacent to the main building.

Prestbury Beaumont has a registered manager in post. 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.

We saw that staff were recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care. Staffing levels were observed to be sufficient to meet the needs of the people living in the home.

We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

We did receive varied comments about responses to calls bells, however all our observations and discussions with staff confirmed that there were sufficient numbers of staff to meet the needs of the people living in the service.

People living in the home and their relatives confirmed that staff were kind, patient and knew them and their needs well.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005. This meant that the staff members were aware of people's rights to make their own decisions.

The food in the home was good and we received positive comments about the choices that people were offered and the standard of the food.

The care plans were person centred and reviewed regularly, so staff knew if any changes in care provision had been made. This helped to ensure that people’s needs continued to be met.

There was a variety of activities and outings from the home which people told us they enjoyed and met the needs of the people living in the home.

There was a complaints policy and people knew who they could speak to if they were not satisfied with their care and were confident they would receive a response.

Staff members we spoke with were positive about how the home was managed. The staff members we spoke with were positive about the service and the quality of the support being provided.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the services, staff and resident meetings as well as spot checks to check the quality of the service as well as gain the views of the people receiving a service. The provider had an internal clinical governance system into which the registered manager submitted monthly information based on the audits undertaken within the agency to the company’s head office. The registered manager was making links with the local community to increase their involvement with the home and vice versa.

During our unannounced inspection on 24 July 2013 we spoke to the registered manager, five members of staff, two people who used the service and five of their relatives. We conducted this responsive inspection as a result of some concerns that we had from a previous inspection.

Staff told us that they were well trained and well able to deliver a high standard of care. People using the service confirmed this, one told us; “The carers are lovely, they are so patient.” One relative told us; “The staff are very good, very caring."

The residents and relatives that we spoke to during our visit had no complaints about the staffing levels. One relative told us; “I have noticed an improvement in staffing recently.”

It was clear that systems were in place to audit and monitor the quality of care provided to people using the service. This meant that people using the service were protected against unsafe care.

People using the service that we spoke to knew that they could complain if they were unhappy about something, one person said "I would be comfortable making a compliant if I needed to.”

During our inspection, we repeatedly requested folders and documentation for examination. These were all produced quickly and contained the information that we had anticipated. This meant that the provider was keeping and storing records effectively

We spoke with six people using the service and with two relatives. People using the service told us they were involved in decision making about their care and treatment. They also told us that they had a choice in how they spent their day. One person said; "They even let my daughter’s dog come on visits, they are very good and flexible”.

People's care records contained detailed information to show how they were to be supported and cared for. People told us they were well looked after. One person said; “It couldn’t be better here it’s absolutely wonderful.”

Equipment at the home was found to be clean and well maintained.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person told us; “Staff here are good and well able to look after me, there isn’t one I would part with.”

The registered person had failed to ensure the protection of people using the service, as effective systems were not in place to; assess, monitor and manage risks relating to the health, welfare and safety of those people.

There was no effective system in place for the identification, receipt, handling and response to complaints from people using the service or their representatives.

We spoke to people who use the service and they said:

“The staff are very kind and I have lived here for a number of years”.

“I like the food here”.

“The staff are pleasant and friendly”.

“This is a happy place to live”.

“My privacy is respected and the staff are warm and friendly”.

“The staff are all right”.

We spoke with staff and they commented:

“The training is good here. I enjoy my job.”

“We do not have formal supervision.”

I “have worked here a long time and have seen a lot of changes.”

I” like my work. The training is good.”

“More staff would be good.”

“There has only been one person organising activities recently due to sickness and the other post has not been covered. It has been expected that they will manage with some support from the care staff. Consequently not been on many outings recently. Hoping that other organiser will return to work soon.”

We also spoke with other professionals, they commented:

“The staff team are good but it can vary dependent on who is on duty. There have been a lot of changes recently.”

“The attitude of the staff is good.”

“Generally positive about the home and the staff team. Staffing levels can sometimes be a problem. There is not enough trained staff available and the pressure on them is high.”

“Staff morale is poor at the moment.”

“Information passed from the manager to the trained staff is not always clear and consistent. Better direction and leadership for staff would be good.”

“Sometimes staff are not always available to give details of resident’s illnesses or concerns which can lead to full information not being received by the visiting professionals”.

The inspection was unannounced and took place on the 18 December 2014. An arranged visit to complete the inspection was then undertaken on the 22 December 2014.

The last inspection took place on the 24 July 2013 when Prestbury Beaumont was found to be meeting all the regulatory requirements looked at and which applied to this kind of home.

Prestbury Beaumont is required to have 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. The provider has appointed a new management team with responsibility for the home approximately six months before this inspection visit. As part of this re-structure a new home manager who is now registered with the CQC was appointed in May 2014. Since these changes were implemented there had been an extensive refurbishment programme within the home. As part of this process the people living in the home had been consulted regarding the new lounge and dining room furniture and the decoration.

New systems such as the arrangement of regular resident/relative meetings had been put into place and posters showing the ‘diary dates’ for forthcoming meetings and the managers surgery dates were on display around the home. The surgeries will allow people to ‘drop in’ or make an appointment to see the manager and discuss any issues.

Prestbury Beaumont care home is located approximately one mile from Prestbury village. The care home is part of a close care complex set in its own grounds, comprising of privately rented bungalows and apartments and a care home. The care home accommodation consists of 28 bedrooms, seven of which can be used as double rooms if desired. Twenty three bedrooms have en-suite facilities. On the day of our inspection visit there were 23 people living in the home. There is also a domiciliary care service registered at the same location. This provided a service to six of the people living in the apartments which are in the same building as the care home and the bungalows that are next to the main building.

Although we did not receive any specific comments regarding whether people felt safe the people we spoke with told us that they liked living in the home and we did observe relaxed and friendly relationships between the people living in Prestbury Beaumont and the staff members working there. We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

We looked at the files for the three most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that it was up to date.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

There was a flexible menu in place which provided a good variety of food to the people using the service.

The care plans were reviewed monthly so staff knew what changes in care provision, if any, had been made. The six files we looked at all explained what each person’s care needs were. This helped to ensure that people’s needs continued to be met.

Staff members we spoke with were positive about how the home was being managed. Throughout the inspection we observed them interacting with each other in a professional manner. All of the staff members we spoke with were positive about the service and the quality of the support being provided.

The provider, Barchester also had its own monthly internal clinical governance system into which the registered manager had to submit monthly information based on the audits undertaken within the home to the company’s head office. This included, care plans, weight losses, accidents, incidents, safeguarding allegations, complaints, infection control and DoLS.