We carried out an unannounced comprehensive inspection on 6 November 2018.

Two Beeches Nursing Home is a care home with nursing for up to 25 people. On the day of our inspection there were 20 people living at the service.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

At the last inspection on the 18 and 19 April 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

People remained safe at the service. People when asked said they felt safe. Professionals and relatives said people where safe living in Two Beeches. Some people were not able to fully verbalise their views therefore they were not able to tell us about their experience of living there. We spent time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, one person when asked if they felt safe living at Two Beeches they said; ‘Yes’ they did.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff, relatives and professionals said the registered manager was approachable and had made many improvements since being in post. Staff said the registered manager was involved in the day to day running of the service. One relative commented; ““The company is exceptional.” One staff member said; “I love my job here!”

People received their medicines safely from suitably trained staff. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff agreed there were sufficient staff to keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. Robust systems were in place to assess risks and ensure measures were put in place to further reduce those risks to protect people.

People lived in an environment that was clean and hygienic. Areas of the environment continued to be updated and refurbished, considering people’s individual needs.

People received care from a staff team who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) and whether any conditions on authorisations to deprive a person of t

The inspection took place on the 18 and 19 April 2016 and was unannounced.

The service 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 told us they were safe and well cared for at the home. People knew how they could raise a concern about their safety or the quality of the service they received.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff deployed to provide the support people needed. People received care from staff that they knew and who knew how they wanted to be supported.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

Staff knew how to identify abuse and protect people from it.

People were provided with meals and drinks that they enjoyed. People who required support to eat or drink received this in a patient and kind way.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

People and relatives were asked for their views on the service and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

During our visit we spoke with four people who live at the home, one visitor, two carers, two nurses and the registered manager (matron).

People told us that staff frequently asked for their consent to support them in aspects of their lives and that the staff respected their decisions. People told us they were always offered choice giving examples such as support with personal care, options of meals and drinks and what time they would like to wake up.

We observed that members of staff spoke to people with respect and sensitivity.

Individualised care plans detailed the support and care each person required. People confirmed they received the support and care they needed and liked. The home ensured relevant health care professionals were contacted when needed.

We observed that people were enjoying their lunch time meal and those able to respond told us meals were good and that alternatives were provided.

Appropriate arrangements were in place in relation to obtaining, storage, administering and disposal of medicine.

The visitor we spoke with said that they felt staff were available whenever their relative needed assistance. They also said that staff were very pleasant and had the necessary time to meet people’s needs.

There was an effective complaints system. People, who were able to tell us, said that they had no complaints but were sure that if they ever did they believed their comments and complaints would be listened to and acted on effectively.

During the visit we spoke with four people who use the service. People said they felt they were well treated by staff. People said they received the care they needed in the way that they wanted it to be provided. People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised. People told us the matron regularly asked them how things were and took prompt action to resolve any concerns.

During the visit we inspected the care planning records of five people who use the service. Each person had a care plan which provided information about the care and support people needed and how it should be provided.

The training plan showed that all staff had completed all mandatory training, including safeguarding, infection control, manual handling, health and safety and fire awareness.

We saw that the service carries out surveys to get feedback from people who use the service and their relatives. The service had reviewed the feedback and an action plan had been developed. We saw that the service was seeking comments about the quality of service in a number of ways and was acting on the feedback received.

During our visit we spoke with five people who live at the home, two visitors, three staff and the manager. People told us that they were happy at the home; it was easy for them to move about the home if they were able and access facilities such as the bathroom and garden. They liked the interaction with the staff and were very fond of some of the staff. They said they were able to give their opinion for example about the food and they felt respected and heard. They are able to have visitors at any time.

Staff told us that they received regular training and were generally happy with the new working arrangements that had been put in place since the summer when the current manager began work at the home.