Archived: Beechcroft Care Centre

Beechcroft Care Centre is a residential nursing home providing personal and nursing care for up to 30 people with the following support needs: learning disabilities or autistic spectrum disorder, physical disabilities, younger adults. At the time of our inspection there were 15 people living at the service, and one other person who had been living with their parents during the Coronavirus pandemic. There were three lodges (Beechcroft, Chestnut and Hazel) which made up the service. During our inspection Chestnut Lodge was temporarily closed and everyone lived in Beechcroft and Hazel lodges. Each lodge had its own dining area, lounge, medicines room and kitchenette. People had their own en-suite rooms.

Beechcroft Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns previously raised, the provider is currently subject to a police investigation, although this does not affect Beechcroft Care Centre specifically. The investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

People were not receiving safe care and treatment. We found risks around people’s feeding tubes, behaviours that may challenge others, constipation, epilepsy, reflux, choking, and monitoring people's health needs were not being managed safely. Systems to protect people from possible neglect or abuse were not effective.

Staff did not have the competencies to support people with behaviours that may challenge others. Lessons had not been learned consistently. We found learning from a hospitalisation had not been shared with the registered manager. Some issues we raised during previous inspections were still present, despite the provider giving us assurances these had been put right. The culture at the service was not always person centred. Outcomes for people were not positive and there were times we saw people supported in a way that was not safe.

Audits had not been effective in highlighting issues found at this inspection or improving the care and support people received at Beechcroft Care Centre. Management of the service was not effective and had not ensured the necessary improvements were made.

Beechcroft Care Centre was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s experience of care was not always person centred such as at mealtimes or during activities.

Medicines were being managed safely, and people’s medicines were being counted and stored correctly. People had been receiving support with physiotherapy in the two months before our inspection. The provider was working with other agencies to deliver care to people. The service was clean, and people were being protected from infection control risks, including Covid-19.

The model of care and setting did not maximise people’s choice, control and independence.

Staff wore uniforms and had name badges to say they were care staff when supporting people. The service is bigger than most domestic style properties. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of the service to indicate it was a care home.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. People did not always receive person centred care at mealtimes or with their activities.

Rating at last inspection

The last rating for this service was Inadequate (published 9 December 2020).

At the last inspection we found multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11, 12 and 13 December 2019 and an announced focused inspection in September 2020. Breaches of legal requirements were found at both inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has stayed at Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechcroft Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, good governance, and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Beechcroft Care Centre is a residential care home that was providing nursing care and support to 19 people with a learning disability and physical disabilities at the time of the inspection. The service can support up to 30 people. There are three lodges in the service. One lodge is known as the main building or referred to as Beechcroft Lodge and this is where the registered manager and deputy manager's office is based. The other two lodges are Chestnut Lodge and Hazel Lodge. Together the three lodges make up Beechcroft Care Centre. During our inspection only Beechcroft Lodge and Hazel Lodge were accommodating people and Chestnut Lodge had been temporarily closed. Each lodge had its’ own kitchen, dining area, and clinical room. People had their own bedrooms with en-suite facilities. There was a hydrotherapy pool, spa pool and specialist baths for people. The service is based in its own grounds on the outskirts of East Grinstead.

Beechcroft Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns previously raised, the provider is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

Some risks to people were not being managed safely. People were prescribed treatments and medicines for long term health conditions and did not always receive these as they should.

Because people did not always receive the treatments they needed in the way prescribed or assessed there was a risk people could be neglected.

Medicines were not being managed safely. Stock control for some medicines was poor and people did not always receive their prescribed medicines as assessed.

Lessons were not effectively learned from past incidents. Some issues highlighted at previous inspections were found at this inspection and concerns from other of the providers locations were also found at this inspection.

Audits had not been effective in highlighting or putting right shortfalls to make sufficient improvement. We found serious concerns with people’s care and support. Audits completed by external consultants had not been acted on in good time, so similar concerns were identified at this inspection.

The culture at the service was not in line with current best practice and outcomes for people were not consistently good.

The service worked with a range of professionals, some professionals raised concerns with us about how information was not always used and understood by staff to meet people’s needs.

People and relatives were consulted about changes in the service and their opinion was sought.

There were enough staff on duty to keep people safe. The provider had temporarily closed one lodge which helped with staffing levels on the remaining two lodges.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not maximise people’s choice, control and

independence. The model of care delivery at Beechcroft Care Centre focused on people’s medical, rather than their social support needs. The service was isolated from the main town and people relied on their staff to be able to go out. Staff wore uniforms and name badges to say they were care staff when supporting people. The size of the service was larger than current best practice guidance. There were signs on the road before the entrance, in the grounds and on the outside of each Lodge to say it was a care home.

Right care:

Care was not always person-centred or promoted people’s dignity, privacy and human

Rights. Staff did not always respond in the right way when people experienced illness or distress.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people

using services led confident, inclusive and empowered lives. The provider told us they had engaged nationally recognised consultants to review their services for people with a learning disability. However, significant work was still needed to change the existing culture, and ethos at Beechcroft Care Centre in order to achieve this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 10 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. Infection control was being managed safely and Beechcroft Care Centre had kept people, visitors and staff safe from risks around Covid-19.

We previously carried out an unannounced comprehensive inspection of this service on 11 December 2019. Breaches of legal requirements were found. We undertook this focused inspection to check whether the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechcroft Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches at this inspection in relation to safe care and treatment, safeguarding people from abuse, and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Beechcroft Care Centre is a residential care home that provides nursing care and support for up to 30 people with a learning disability and other complex needs, including autism and physical disabilities. Beechcroft Care Centre is in close proximity to East Grinstead and the local amenities. The service comprises of three 'lodges', one lodge is known as the main building or referred to as Beechcroft Lodge. This is where the registered manager and deputy manager's office is based. The other two lodges are Chestnut Lodge and Hazel Lodge. Together the three lodges make up Beechcroft Care Centre. Each lodge has a separate living room, dining room and kitchenette. Rooms were single occupancy and had en-suite facilities. The service offered the use of specialist baths, a spa pool and physiotherapy. At the time of our inspection there were 20 people living at the service. Some people stayed at the service for short breaks.

Beechcroft Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

The service was registered before the 'Registering the Right Support' guidelines were in place. However, the service was not operating in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. These values were not seen consistently in practice at the service. For example, some people were not being supported to be as independent as they could be, and other peoples’ experiences of activities was not person centred.

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Care outcomes for people did not fully reflect the principles and values of Registering the Right Support because of a lack of choice and control, limited independence, and limited inclusion.

People’s experience of using this service and what we found

Several aspects of the service remained unsafe. Some risks were not being managed safely such as risks around people’s behaviours. Not all safeguarding alerts had been sent to the local authority, or statutory notifications submitted to CQC. There were some concerns around staff having the time to provide both activities and direct care. We have made a recommendation about this in our report.

There were concerns found with medicines, such as ‘as required’ medicines not having protocols for their use and some controlled drugs not being managed safely. Risks around infection control were being managed safely and the building was clean and free of any malodours.

Some people who required their fluid intake to be monitored did not have this monitored effectively. Some people took their food, drink and medicines through feeding tubes and we found inconsistencies in care plans. Some people were at risk of not receiving the care and support they needed with their feeding tubes. The building was accessible to people’s needs and people received consistent care when they moved to or from the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There had been a lot of work to complete MCA assessments and hold best interest decision meetings, but some assessments of people’s capacity were inconsistent. We have made a recommendation about this in our report.

Some support we saw was not person centred or dignified. Some people were supported during a lunch service in a way that did not maintain their dignity or promote their independence. Other support we saw was kind and staff used language when speaking to people that was appropriate and kind, but this was not consistent. Staff respected people’s privacy and relatives told us they could visit people freely.

People did not receive personalised support with activities. Staff and relatives told us that since some activities staff had left the service, support staff were struggling to provide activities people required. Complaints were being managed as per the provider’s policy and end of live care plans were in the process of being implemented and updated with personalised information.

Audits had not been effective in highlighting or putting right shortfalls identified at this inspection or previous inspections. Leadership at the service was not effective. The previous inspection rated the well led domain as ‘Inadequate’ and the same rating remained at this inspection. Only two breaches of regulation identified at the last two inspections was met at this inspection with 5 continued breaches.

The registered manager had worked with staff to improve the culture in the service and this was evident form the way staff spoke with people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (published 1 July 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service:

Beechcroft Care Centre is a residential care home that provides nursing care and support for up to 30 people with a learning disability and other complex needs, including autism and physical disabilities. Beechcroft Care Centre is in close proximity to a local pub, shopping and residential area and East Grinstead. The service comprises of three ‘lodges’, one lodge is known as the main building or referred to as Beechcroft. This is where the registered manager and deputy manager’s office is based. The other two lodges are Chestnut and Hazel. Together they make up Beechcroft Care Centre. Each lodge has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The service offers the use of specialist baths, a spa pool and physiotherapy. At the time of our inspection there were 23 people living at the service. Some people stayed at the service for short breaks. We reviewed the care of these people as well.

Beechcroft Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

At the previous inspection in January 2018 we found five breaches of regulations in relation to the safe management of risks, treating people with dignity, person centred care, consent and governance. At this inspection we found these breaches continued. We also found two new breaches of regulations relating to safeguarding and staffing.

The service was registered before the 'Registering the Right Support' guidelines were in place. However, the service was not operating in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. These values were not always seen consistently in practice at the service. For example, some people were not treated with dignity and other people were not being supported to be as independent as they could be with activities or communication.

People’s experience of using this service:

A number of aspects of the service remained unsafe.

Some people were at risk as some aspects of care or treatment were not being managed safely. Some people with behaviours that may challenge others did not have positive behaviour support plans to help them and their staff manage their anxieties.

People were not consistently protected from abuse as systems and staff did not always recognise when an incident was reportable, such as with an unsafe moving and handling procedure.

Nursing staff had not been consistently supported. There were no clinical supervisions for nurses and competency checks were not complete.

Learning from incidents had not been consistently implemented. Most of the areas of concern we found during this inspection, such as risks associated with health needs not being reduced had already been highlighted to the provider following inspections of some of their other services.

Staff did not have the necessary training they required to carry out their role, such as positive behaviour training.

People’s health needs were not being met effectively. People were at risk of not having their needs met in areas such as constipation, epilepsy and monitoring of people’s health when there was risk of deterioration.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Some people were at risk from not drinking enough and fluid charts were incomplete, contained the wrong information or were audited poorly.

People were not consistently treated with dignity and the language some staff used was not person centred.

People did not always receive personalised care. Some people’s communication needs were not met in a personalised way.

Leadership at the service was not effective. The previous inspection rated the well led domain as ‘Requires Improvement’. At this inspection the rating has reduced to Inadequate. The breaches from the last inspection all remain with two new breaches of regulation.

Quality audits had not been effective in highlighting and putting right all the shortfalls we found at this inspection.

We observed some people receiving caring and kind support.

More information is in the detailed findings below.

Rating at last inspection:

At our last inspection in January 2018, the service was rated "requires improvement" overall with a requires improvement rating in all domains. Our last report was published on 12 June 2018. This is the first time this service has been rated Inadequate.

Why we inspected:

We inspected this service due to our analysis of information of concern from a variety of sources.

Enforcement:

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

Follow up:

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

• Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. One allegation relates to Beechcroft Care Centre specifically. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and January 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Beechcroft Care Centre is a care home that provides nursing and residential care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Beechcoft Care Centre is registered to provide nursing and accommodation for up to 30 people who may have a learning disability, physical disabilities and complex health needs. At the time of our inspection there were 23 people living at the home. Accommodation is provided across three units called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The home offers the use of specialist baths, spa pool and physiotherapy.

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.

Beechcroft Care Centre has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Beechcroft Care Centre was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Beechcroft Care Centre in response to changes in best practice guidance. Had the provider applied to register Beechcroft Care Centre today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs.

These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen, but this was not always the case for people. Beechcroft Care Centre is a large clinical setting rather than a small-scale homely environment. Beechcroft Care Centre is geographically isolated on a campus in rural East Grinstead with many people having moved to East Grinstead from other local authority areas and therefore not as able to retain ties with their local communities. For some people, there were limited opportunities to have meaningful engagement with the local community amenities. Some people had limited contact with specialist health and social care support in the community due to specialist staff (e.g physiotherapy) that were employed by the provider. Some people attended a local college for morning or afternoon sessions. However, most people's social engagement and activities took place either at Beechcroft Care Centre or at another service operated by the provider, such as the provider's day centre.

We found inconsistencies within how risks were being managed on behalf of people. We identified gaps within the guidance for staff who supported people with their continence needs, re-positioning and skin integrity guidance and those at risk of aspiration. On one occasion staff failed to seek the advice of a GP in a timely manner when a person became unwell. This was referred to the West Sussex safeguarding team for their review.

People's consent to care and treatment was not always gained in line with the requirements of the Mental Capacity Act 2005 and people were not always treated with dignity and respect.

Care records were not accessible for the people being written about and they did not always reflect that people received personalised care that met their needs. Some care plans relating to people's specific areas of need lacked detailed information and guidance for staff on how to support people in a responsive way, for example, in expressing sexuality. We also identified staff were not working in accordance with some aspects of agreed care planning such as people’s unmet communication needs.

Systems were not effective in measuring and monitoring the quality of the service provided. Where actions were identified, these had not always been completed. There were ineffective systems in place to drive continuous improvement.

Staff received supervisions and appraisals and complimented the training they received which enabled them to carry out their role and responsibilities. They found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore and complaints were managed effectively. The provider sought feedback from relatives regarding the care their family members received.

The registered manager was aware of their responsibilities and talked about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They told us they were keen to improve the quality and safety of care provided to people living at the home.

At this inspection we found the service was in breach of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Since the inspection, the provider has given us an action plan of what they have implemented to improve the care experience for people living at the home. This included improvements in how risks for people were managed and improvements to how people's communication needs were being met.

Beechcroft Care Centre is nursing home that provides accommodation, nursing and personal care to 30 young adults with learning and physical disabilities. Accommodation is provided in three houses called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge, which are all on one site.

There were 28 people living on site at the time of our visit. People living at each house had their own bedroom and en-suite bathroom. There is a communal lounge and separate dining room on the ground floor of each building. This is where people can socialise and eat their meals if they wish. The houses offer the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool. Transport is available for people to access the community.

We previously carried out an unannounced comprehensive inspection of this service on 18, 19 and 20 January 2016. At that inspection, a number of breaches of legal requirements were found. As a result, the service was rated 'Requires Improvement'. We met with the provider to discuss our concerns and issued one Warning Notice, which required the provider to take immediate action in relation to the effective governance of the service.

Following our last inspection, the manager at that time left the service. The provider transferred a manager from another one of their services in April 2016 to manage Beechcroft Care Centre. The appointed manager was already registered with the Care Quality Commission in November 2014. The manager was familiar with the people living at the service and the staffing team due to their previous experience managing the service. 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.

At this inspection, we confirmed that the registered manager and provider had taken sufficient action to address previous concerns and comply with required standards. As a result, the provider has complied with the Warning Notice and requirements we issued and had sustained improvements across all domains. Therefore the overall rating of the service has improved to ‘good.’

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Staff worked closely with community health professionals and therapists to maximise people's well-being. People felt safe and had positive and caring relationships with the staff that supported them.

People were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and the service was responsive to people's individual needs.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training, which equipped them to deliver their roles effectively. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the training, which the provider had assessed as mandatory was up to date. Staff told us that they felt supported and received training to enable them to understand about the needs of the people they care for. People and their relatives felt the staff had the skills and knowledge to support people well.

There were sufficient numbers of staff on duty to keep people safe and to meet people's needs. We saw that staff recruited had the right values, and skills to work with people who used the service. Staff rotas showed that the staffing levels remained at the levels required to ensure all people’s needs were met and helped to keep people safe.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely. Nurses had completed safe management of medicines training and had their competency assessed annually. The nurses were able to tell us about people's different medicines and why they were prescribed, together with any potential side effects.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The members of the management team and nurses we spoke with had a full and up to date understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that appropriate DoLS applications had been made, and staff were acting in accordance with DoLS authorisations.

The service placed a strong emphasis on meeting people's emotional well-being through the provision of meaningful social activities and opportunities. People were offered a wide range of both group and individual activities, which met their needs and preferences. Visiting was unrestricted and people's relatives felt included in the care of their loved ones.

People were provided with a variety of meals and the menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected.

People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. We observed communal mealtimes where people ate together. Where people had been identified to be at risk of choking, staff supported them discreetly to minimise such risks, while protecting them from harm and promoting their dignity.

We looked at care records and found good standards of person centred care planning. Care plans represented people's needs and preferences to enable staff to fully understand people's needs and wishes. The service was responsive to people's individual needs. The good level of person centred care meant that people could lead independent lifestyles, maintain relationships and be involved in the local community.

People’s privacy and dignity were respected. Staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

People were involved as much as possible in planning their care. The manager and staff were flexible and responsive to people's individual preferences and ensured people were supported in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them. People who lived at the service were allocated key workers and we observed trusting friendships between people and staff members. A key worker is a named member of staff responsible for ensuring people's care needs were met.

The service had robust systems in place for monitoring the quality of care and support. The auditing systems showed that the manager was responsive to the needs of people who lived at the service.

Beechcroft Care Centre is nursing home that provides accommodation, nursing and personal care to 30 young adults with leaning and physical disabilities. Accommodation is provided in three houses called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge which are all on one site.

There were 20 people living on site at the time of our visit. In each house there is a communal lounge and separate dining room on the ground floor where people can socialise and eat their meals if they wish. The houses share transport for access to the community and offers the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool.

At the time of the 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. Following the inspection we were informed that the registered manager had left this service and an area manager was managing the service in the interim.

People confirmed they felt safe and staff demonstrated a good understanding of how to protect adults at risk. However risks associated; with people’s care were not always appropriately assessed and plans had not always been developed to ensure that staff met people’s needs consistently and reduced risks.

Recruitment practices and appropriate pre-employment checks were undertaken. The registered manager and staff told us that they had not been operating with sufficient staff on most days. There was a lack of clarity between the registered manager and provider about how many staff were required and how this should be deployed. Staff deployment was not effective and we found that people’s care had been impacted by this. Staff supervisions were taking place although not as frequently as the policy stated and improvements need to be made in supporting staff to understand the specific needs of people using the service.

People confirmed staff involved them in making decisions. The registered manager demonstrated a good understanding of the Mental Capacity Act 2005. Although staff had received training in this area they were unable to demonstrate they had a good understanding of the legislation. However we observed staff following the principles of the Act by seeking people’s consent and offering least restrictive care. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had submitted applications for DoLS for some people living in the home to the supervisory body.

People described staff as kind and caring. They felt they were treated with respect and dignity. Most observations reflected this however we observed examples where staff did not treat people with respect and dignity. Whilst staff knew people well, care plans and care records were not always personalised, accurate, up to date and reflective of people’s needs and preferences.

People and their relatives knew how to make a complaint and these had been investigated. Records were kept of the complaints and actions taken.

Systems were in place to gather people’s views but these were not always used effectively to improve the service. Staff described the registered manager as open and approachable. They were confident any concerns would be addressed and staff and people felt listened to. There were ineffective systems and processes in place to monitor the quality and safety of the service and action had not been taken to respond to known shortfalls and risks. This had impacted upon the quality and safety of the service that people received.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach in Regulation 12 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.