The inspection took place on 11 and 13 July 2017 and was unannounced.

The Beeches provides residential care for up to 44 people, some of whom may be living with dementia. At the time of this inspection there were 27 people living in the home. Accommodation is in a period building and people benefit from a number of communal areas and gardens.

There was 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.

All the people we spoke with during our inspection consistently talked of a service that went the extra mile to achieve an outstanding quality of life for people who lived at The Beeches. They told us people were cared for in an exemplary manner and that support was delivered in an exceptionally person centred way. Our inspection findings confirmed this.

Staff delivered care and support that epitomised the values set by the provider. People had been fully involved in the decisions around their care and support and staff had used innovative methods to achieve this. People’s past lives, wishes and values had been taken into account when supporting people and this had shaped how care was delivered. This had resulted in people’s individual needs being met in a dedicated, relevant and specialised manner.

People spoke of a service, staff and management team that showed immense kindness and thoughtfulness. This was brought about by a thorough understanding of those that used the service, what was important to them and a commitment to using this knowledge to support people in having an exceptional quality of life.

We were told, by people who used the service and relatives, that staff consistently demonstrated a compassionate, warm and caring approach and that they were able to adapt this to suit the individual needs of each person. Our observations confirmed this and we saw that the atmosphere of the home was one of warmth, joy and positivity. Staff were seen to consistently show respect, patience and understanding when supporting people. People told us that staff had an intuitive way of providing support and promoted choice and independence.

The service had gone to great lengths to meet people’s social and leisure needs and understood the positive impact this achieved. Individual and attentive support was delivered to meet these needs based on people’s wishes, aspirations, interests and hobbies and staff had a sound knowledge of these. People’s interests were also used to shape care and support in a way that empowered people.

The delivery of such high quality care had been achieved by robust quality monitoring systems, an engaged and motivated staff team, comprehensive staff training and support and a nurturing and fully involved management team. The provider understood the importance of all these factors and had demonstrated a commitment to not only achieving and sustaining this but continuing to improve. They used the opinions and suggestions of people who used the service, their relatives and staff to shape decisions and service delivery.

Reflective practice together with regular and meaningful audits had contributed to this. Sector wide information was used to further improve the service and best practice guidance was known and used. Quality monitoring was integral to the registered manager’s working practice and this was supported by visits from the regional manager a number of times each week. Staffing levels were determined by observation, feedback and speaking with people who used the service, their relatives and staff. This approach had been successful as there were enough staff to meet people’s needs in a prompt and very person centred nature.

The provider understood the importance of robust, yet positive

This inspection was carried out on 27 August 2015 and was unannounced.

The Beeches is registered to provide accommodation and personal care for 44 older people, some of whom were living with dementia. There were 25 people living at the home during this inspection. The home is situated over two floors. All bedrooms had ensuite facilities. There are a number of communal areas within the home, including lounges and dining areas, a conservatory and a garden for people and their visitors to use.

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. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and the majority of staff were aware of the key legal requirements of the MCA and DoLS.

People who used the service were supported by staff in a respectful and caring way. People had individualised care and support plans in place which recorded their care and support needs. Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as safe and independent a life as possible. These records guided staff on any assistance a person may require. Arrangements were in place to ensure that people were supported and protected with the safe management of their prescribed medication.

There was an ‘open’ culture within the home. People and their relatives were able to raise any suggestions or concerns that they might have with staff and the registered manager and feel listened too. People were supported to access a range of external health care professionals and were supported to maintain their health. People’s health and nutritional needs were met.

Recruitment checks were in place to make sure that staff were deemed suitable to work with the people they supported. There were a sufficient amount of staff on duty to meet peoples care and support needs.

Staff were trained to provide effective care which met people’s individual needs. Staff understood their role and responsibilities to report poor care. Staff were supported by the registered manager to develop their skills and knowledge through regular supervision and training.

The registered manager sought feedback about the quality of the service provided from people who used the service and staff by sending out questionnaires. They had in place a quality monitoring process to identify areas of improvement required within the home.