The Beeches Care Home is a purpose built home situated in the Wibsey area of Bradford. It is registered to provide personal care with nursing support and treatment for up to 60 older people. The home has a lift which provides easy access to all floors. The home is on a bus route and there is ample car parking available.

This inspection took place on 16, 24 August and 22 November 2017. The first two visits were unannounced, and the last was announced. The previous inspection took place on 8 and 9 March 2016 where we rated the service as ‘Requires Improvement’ overall and found one breach of regulation relating to complaints. At this inspection we found the provider was no longer in breach of that regulation.

At the early stage of our inspection the service had a manager who was going through the registered manager’s process. A registered manager is a person who has registered with the Care Quality Commission (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. On our third visit we found the manager had registered with the CQC on 11 September 2017.

The home looked well maintained, clean and tidy, and checks were carried out to make sure the premises and equipment were safe.

Although people who used the service and their relatives told us they felt the service was safe, initially we observed care and support was not always delivered safely. For example, we saw some people were prescribed topical medicines such as creams and ointments. However, in some instances there was no indication to show how frequently the cream or ointment should be applied. In the case of one person, the cream prescribed should have been applied to their wrists and or hands. However, records clearly showed that staff on several occasions had applied the cream to the person’s hands and knees and sometimes only to their knees. On the last visit, we saw evidence the new registered manager had addressed earlier concerns regarding topical medicines.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been assessed and care was usually planned. However, during the first inspection visit, we found some care plans had not always been updated when staff had noted significant changes in people’s needs as part of their monthly review. The manager had already identified care plans as an area for improvement and action was being taken to improve them. On the last visit we saw positive changes had been made which addressed people’s care plans and these had been regularly reviewed.

There were sufficient staff with the right level of skills and experience and several staff told us the staffing arrangements had improved. Appropriate checks were carried out before staff were employed.

People who used the service and their relatives told us they were happy with the staff that provided care and support. Staff we spoke with said they felt well supported and received training that ensured they knew how to do their job well. They said they understood their role and responsibilities. Staff we spoke with understood their responsibilities around how they should support people with decision making.

People told us they enjoyed the food, and had plenty to eat and drink. During the early part of the inspection the service was not always found to be acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Some senior staff did not know the people who had a DoLS in place and if conditions were attached. However, we found evidence on the last visit that the registered manager had held meetings with staff and discussed DoLS. Staff were all aware of who had a DoLS in place and any conditions attached.

People told us they were well

This inspection took place 08 and 09 March 2016 and was unannounced.

The Beeches Care Home is a purpose built home situated in the Wibsey area of Bradford. It is registered to provide personal care with nursing care for up to 60 older people. The home has a lift which provides easy access to all floors. The home is on a bus route and there is ample car parking.

The service did not have a registered manager in place. The service had not had a registered manager since June 2015. 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 living in the home told us they felt safe and well cared for. We found there were enough staff to support people effectively. The staff were knowledgeable about the individual needs of the people and knew how to recognise signs of abuse.

The acting manager and provider followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. People were supported with their medicines in a safe way. Bottles of medicines were not always labelled with the date of opening.

The premises and equipment were appropriately maintained and we noted safety checks were carried out regularly. Risks to people's health and safety had been identified, assessed and managed safely.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people's rights were protected and they were encouraged to make decisions for themselves.

People had their nutritional needs met and were offered a choice at every meal time. People were offered a varied diet and were provided with sufficient drinks and snacks. People with specific nutritional needs received support in line with their care plan.

Most staff were not always able to maintain and develop their skills by on-going training. Although staff spoken with told us they had access to range of learning opportunities and said they were well supported by the acting manager and the provider. We found large numbers of staff had not completed all training courses.

We saw staff were caring, positive, encouraging and attentive when communicating and supporting people. Visitors were made welcome in the home and people were supported to maintain relationships with their friends and relatives.

Care records and risk assessments were person-centred and were an accurate reflection of the person's care and support needs. The care plans were written with the person, so they were able to influence the delivery of their care.

Care plans included people’s likes and preferences and were reviewed regularly to reflect changes to the person's needs and circumstances. People had good access to healthcare professionals.

People knew how to raise concerns and complaints if they needed to. However appropriate action was not always taken to address issues that were raised. People's views of the service were sought and responded to appropriately.

There was an open and friendly atmosphere in the home, which showed the staff and acting manager had good relationships and knew people well. We observed staff treating people with respect whilst assisting them to maintain their independence.

All people, most relatives and staff spoken with had confidence in the acting manager and felt the home had clear leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people living in the home and their relatives.

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 report.

During our last inspection on 11th and 23rd September 2014 we had found that the provider was not meeting this standard. This inspection showed that corrective action had been taken by the provider and the previous regulatory breaches had been remedied.

We reviewed the records that were kept at the home and looked at the way they were stored and managed.

We saw that care plans were clearly indexed and information about the needs of people living at the home was therefore easy for staff to access. We saw reviews of care plans had taken place and were fit for purpose.

We looked at people's daily records which were kept by the home. These provided a detailed and accurate record of people's daily routines, activities they had participated in and any information relating to their health and well-being. We saw that each care plan held evidence of audits being completed on a six monthly basis..

We saw that assessments regarding people's hydration and nutritional needs were translated into daily charts to record food and fluid intake. Where needed, these records were supplemented by monthly weight checks.

We saw that all the necessary documentation and supportive evidence was available to enable the requirements of the Mental Capacity Act 2005 to be met when Deprivation of Liberty Safeguards (DoLS) authorisations were being sought.

Maintenance records and safety certificates were readily available for us to inspect.

During the inspection we had the opportunity to speak with five people who used the service, four staff members and three relatives. They told us they were looked after very well and felt safe with the care and treatment provided.

Their comments included: "You get good care here", “They are all very nice” and “I am very well looked after here”.

We found the home had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw evidence there was an appropriate system in place for listening to and acting on people’s comments and concerns.

We spent time observing the lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

All the interactions we saw between carers and people who used the service and visitors were respectful. We saw some people engaged in activities with members of staff such as ‘Happy Hour’, singing, watching TV and arm chair exercises. The Activities Coordinator told us various activities were delivered on a daily basis.

During our visit we spoke with nine out of the 59 people who lived at The Beeches Care Home. They told us they could make decisions about what they wanted to do. One person said, "You can always find something to do if you want ".

People we spoke with told us staff were kind to them. One person said, "Every body is very good".

We were able to speak with two relatives during our visit; one commented "Everybody is very friendly indeed ".

We set out to answer our five questions:

Was the service caring?

Was the service responsive?

Was the service safe?

Was the service effective?

Was the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

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

Was the service safe?

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

We found evidence that people were not always protected from the risks of unsafe or inappropriate care and treatment as the care provider did not maintain accurate and relevant records in relation to the care and treatment provided to people. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to records.

We spoke with five people who used the service and they told us they were pleased with the standard of care and felt respected by the staff. One person said, "Everyone should have staff like these" and another person said, "Staff are like friends here."

The provider told us they were familiar with the requirements of the Mental Capacity Act 2005 (MCA) and was aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

Was the service effective?

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

The home had a good working relationship with other health care professionals and followed their guidance and advice. The input of other health care professionals involved in people's care and treatment was clearly recorded in their care plan.

We saw all staff completed a comprehensive induction programme which took into account recognised standards within the care sector and was relevant to their workplace and their roles.

Was the service caring?

People who used the service told us they were very happy with the care and facilities provided at The Beeches. One person said, “Staff are very nice.” Another person told us, “I try to do as much as I can and the staff respect this.”

We found the staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. They felt confident the service provided to people who lived at the home was good and they encouraged them to remain as independent as possible.

We found the atmosphere within the home was friendly and welcoming and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Was the service responsive?

People’s needs were assessed and care and support was planned and delivered the majority of the time in line with their care plan. Care records contained good information about how care and support should be delivered.

Wherever possible people who used the service and/ their relatives were involved in discussions about their care and the risks associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

People knew how to make a complaint if they were unhappy and were confident if they made a complaint it would be investigated thoroughly and action taken if appropriate. There was evidence that learning from incidents/investigations took place and appropriate changes were implemented.

Was the service well led?

We saw there was a quality assurance monitoring system through audits that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

The staff we spoke with confirmed they were well supported by the manager and seniors and said they could contact them at any time if they had concerns. This ensured the needs of people who used the service were met in line with their agreed support plan.