This unannounced comprehensive inspection took place on 13 December 2016. The last inspection took place on 8 December 2015. The service was meeting the requirements of the regulations. However, we found very hot water coming from the taps in hand basins used by people living in the service. Some areas of the service were in need of redecoration and some carpeting needed replacing. We made recommendations to the provider regarding the concerns we had with the premises.

The Beeches is a care home which offers nursing care and support for up to 28 predominantly older people. At the time of this inspection there were 26 people living at the service. Some of these people were living with dementia.

The service had 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 walked around the service which was comfortable and bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. From the medication administration records (MAR) we found it was possible to establish if people had received their medicine as prescribed. However, some handwritten entries on to medicine records had not always been signed and witnessed to help reduce potential errors. Some prescribed creams had not been dated when opened. The registered manager addressed these concerns during the inspection. Regular medicines audits were consistently identifying when errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff were supported by a system of induction, training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care. The nursing team had developed specific skills and knowledge to provide specialist care for people at the service. For example, the treatment of leg ulcers.

The registered manager was a registered nurse with experience in providing care for the elderly and those suffering with complex chronic conditions. They had experience in the field of palliative care and acted as education lead within the service. The registered manager had the responsibility for ensuring all members of staff were provided with moving and handling training, as well as all aspects of their continuing development.

The registered manager was a clinical mentor with links to Plymouth University. The service benefited from this relationship by having student nurses on their clinical placements, working regularly alongside the qualified nurses and care workers on shift. This led to the sharing of best practice.

The registered manager assured us that all training and supervision requirements had been provided to staff. We were told all staff received supervision six times a year. However, at the time of the inspection visit the staff training and supervision records were not up to date. This meant the registered manager did not have an overview of when staff were due updates in specific training and when their supervision was due. It was not possible for the inspector to judge what training and support staff had been provided with. However, following the inspection visit this was updated and sent to the inspector. It showed that most staff had received mandatory training as required by the service.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestio

We carried out this unannounced inspection of The Beeches on 8 December 2015. The Beeches is a care home with nursing that provides residential care for up to 28 people. On the day of the inspection there were 26 people using the service. Most people who lived at The Beeches required general nursing care due to illness. Some people also had dementia, physical or sensory disabilities. This was the first service inspection since registration with the Care Quality Commission (CQC) in September 2015.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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.

Water temperatures were checked and regulated at baths and showers. However hot water temperatures being discharged at wash hand basins was hot as there were no water temperature regulators in place. This was not safe practice.

There were suitable facilities available to store medication safely however the medicine room could not be locked due to it accessing a fire exit. Medicine records showed that people received their medicines as prescribed. However some people’s medication was not always being delivered to the service by the supplying pharmacist when it should. This resulted in gaps when people received their medicines. We have made a recommendation about this to the provider.

The home was an older building with a more recent extension of rooms. The environment of the older part of The Beeches needed maintenance and redecoration in some areas. Internally corridors and paintwork in some bedrooms were damaged having been dented by wheelchairs and hoists. A carpet at the entrance to the lounge area was badly stained. The provider was aware of the issues and taking steps to address them.

Storage facilities for equipment were limited resulting in hoists being stored in corridors or peoples rooms. An industrial rotary iron was stored and used at the end of a corridor where people had access. Suitable storage facilities for these items had been identified in the basement however this had not yet been actioned.

The rear lounge was also used as a dining room. However there was only one dining table reducing the availability of dining spaces for people to take their meals. Other people had their meals from side table or in their rooms. This area was a thoroughfare to people’s rooms. When fully occupied it was cluttered and restricted movement. The provider was aware of the current restrictions and was planning action to improve this.

A double room was accessed from the lounge and dining room. There were times during the inspection visit when the door was open and whilst the room was not occupied it impacted on the privacy of their belongings.

Staff working at the service understood the needs of people they supported so they could respond to them effectively. The service training matrix was being updated. Staff told us they received training and support which enabled them to be effective in their care and support of people at the service. Training certificates were also on some files to support this.

Visitors reported good relationships with staff and said the management were approachable. Families told us, “Every time we visit staff always make sure we get an update” and “It’s a busy place but staff are always around when you need them”.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff ha