Beechill Nursing Home

Beechill Nursing Home (known as Beechill) is a nursing home providing personal and nursing care for up to 31 people with a range of needs. This included both younger and older adults needing support in relation to physical disability, the misuse of alcohol or drugs, mental health and dementia. At the time of the inspection 26 people were living at Beechill.

There are 23 single rooms and four double rooms across two floors. Each floor has shared bathrooms and toilet facilities.

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 statutory guidance which supports the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

There had been a vast improvement in the relationships between the home and the local authority, commissioning and NHS teams. Beechill had taken part in a pilot project with a range of local authority teams and professionals to complete audits and work together to make improvements. All parties said this had worked well.

The home could not evidence the safe recruitment of staff. References were not in place and there was no evidence of these being requested or chased up. A generic risk assessment was used where there were no references, but this did not evidence additional support for the new staff to ensure they were suitable for working with vulnerable adults.

Assessments of people’s capacity to make their own decisions were completed when they moved into Beechill. Applications for a Deprivation of Liberty Safeguards were made where applicable. However, people’s capacity to make decisions was not regularly reviewed. This meant people were not always supported to have maximum choice and control of their lives. We have made a recommendation for formal capacity assessments to be regularly reviewed.

From our observations, and feedback from people and relatives, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

There were enough staff to meet people’s needs. People and relatives were complimentary about the staff and said communication with the home was good. Staff received the training they needed for their roles. Staff felt well supported by the management team. A new activities coordinator had been appointed and was starting to develop a range of activities within the home and out in the local community.

Risk assessments and care plans were in place and were regularly reviewed. Staff knew people and their needs well. People received their medicines as prescribed. Some guidance for when ‘as required’ medicines should be administered needed to be more personalised. The home was clean throughout and PPE was used appropriately.

People were supported to maintain their health and nutritional intake. Referrals to medical professionals were made appropriately. Where appropriate, people were supported to manage their drug or alcohol misuse.

An electronic quality assurance system was now in place. Audits were regularly completed, and actions identified. Action following the local authority pilot visits had been completed or were in progress. We have made a recommendation for the staff file audit to be reviewed.

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 requires improvement (published 23 December 2021) and there was 1 breach of regulations. 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 been made and the provider was no longer in breach of this regulation. However, a different breach was identified at this inspection.

This service has been rated requires improvement for the last 5 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to the safe recruitment of staff at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations for capacity assessments to be regularly reviewed and for the staff file audit to fully take in to account the information required in Schedule 3 of the Health and Social Care Act 2008 for the safe recruitment of staff.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Beechill Nursing Home (known as Beechill) is a nursing home providing personal and nursing care for up to 31 people with a range of needs. This included both younger and older adults needing support in relation to physical disability, the misuse of alcohol or drugs, mental health and dementia. At the time of the inspection 31 people were living at Beechill.

There are 23 single rooms and four double rooms across two floors. Each floor has shared bathrooms and toilet facilities.

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

The registered manager had a strained relationship with the local authority. The registered manager had refused representatives from Healthwatch to enter the home. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We discussed this with the registered manager. The registered manager and local authority both said they wanted to work with each other. We saw that recommendations from a recent medicines optimisation team visit were being implemented.

A quality assurance system was in place. But not all audits detailed what had been looked at in the audit. A gap in completing fire alarm checks had not been identified for four months.

People and relatives were happy with the care and support they received at Beechill. They were complimentary about the staff team and said the staff knew them and their needs well.

Risks people may face were identified and guidance provided for staff to manage these known risks were well documented. The home was clean throughout and current government guidance for COVID-19 was being followed for visitors, testing and the use of PPE.

There were enough staff on duty to meet people’s needs and staff were safely recruited. Staff said they felt well supported by the management team. People received their medicines as prescribed.

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 requires improvement (published 11 November 2020). There were no breaches of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last eight consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines, how staff respected people’s dignity and the relationship between the home and other professionals, for example the local authority commissioners and quality monitoring team. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key queseieightons. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We found no evidence that people were at risk of harm from the concerns about medicines management and staff respecting people’s dignity. We have found the provider needs to make improvements. Please see the well led section of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechill Nursing Home 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 have identified breaches in relation to the refusal to allow representatives from Healthwatch to carry out a visit and the lack of robust audits.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechill Nursing Home (Beechill) is a nursing home providing personal and nursing care for up to 31 people with a range of needs. This included both younger and older adults needing support in relation to physical disability, the misuse of alcohol or drugs, mental health and dementia. At the time of the inspection 28 people were living at Beechill.

There are 23 single rooms and four double rooms across two floors. Each floor has shared bathrooms and toilet facilities.

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

People and relatives were positive about living at Beechill. The staff knew people’s needs and how to support them.

At the time of our inspection new care plans were being computerised, and paper care records continued to be in use. Records we reviewed identified people's care needs, risks they may face and guidance was provided for staff in how to meet these needs. Staff however didn’t always have immediate access to the computerised care documentation system. After our inspection we were informed by the registered manager the service was reverting to the paper-based system.

People received their medicines as prescribed. Guidelines for when to administer ‘as required’ medicines did not always contain enough details on how the person would inform staff they needed the ‘as required’ medicine. The registered manager told us they would review this.

Staff knew the reporting procedures for accidents, incidents and safeguarding. Records of investigations completed and action taken following these reports were variable, with some not being available on the day of our inspection. We have made a recommendation that national good practice guidelines are followed for the recording of investigations and actions taken following an accident or incident.

The home was visibly clean. Staff wore appropriate PPE when supporting people, however we observed some staff incorrectly wearing their masks in the communal dining area. We have made a recommendation that government guidance for the wearing of PPE through the Covid-19 pandemic is followed in all areas.

A quality assurance system was in place, with regular reviews and audits being completed. Staff were safely recruited and there were enough staff to meet people’s needs.

An activity officer was in place and staff had completed training on activities and exercise provision. Many people did not want to take part in group activities. Unfortunately trips within the local community had been stopped due to the Covid-19 pandemic.

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 requires improvement (published 19 June 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider to discuss our concerns and monitor their progress in meeting the action plan.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This is the seventh consecutive Requires Improvement rating. We will continue to monitor the service and will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good.

Why we inspected

This was a planned inspection based on the previous rating. We undertook this focused inspection to check the service 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, responsive 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 remained requires improvements. This is based on the findings at this inspection.

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.

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

Follow up

We will continue to monitor the service and will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechill is a care home that provides residential and nursing care to people with a range of needs. At the time of our inspection this included both younger and older adults needing support in relation to physical disability, misuse of alcohol or drugs, mental health and dementia.

The home can accommodate up to 31 people in one adapted building. At the time of our inspection, there were 24 people living at the home.

People’s experience of using this service:

We received mixed feedback from people living at the home. Whilst some people were happy living at the home, other people told us they did not want to be there.

The provider had increased the opportunities available to people to go on trips out from the home and had arranged for visiting entertainment to the home. However, day to day there was little of interest to engage or provide meaningful occupation to many people living at the home who told us they were bored.

The home provided care to people with diverse backgrounds and needs. We saw some good examples of how such needs were met. However, we found in one instance that a person was subject to significant restrictions that had not been considered as part of a best interest process. The staff supporting them at the time we visited them were also unable to communicate with them effectively.

People told us staff treated them with kindness and respect. It was also evident that staff knew people well and had developed positive relationships with them. However, during our inspection we saw much of the care provided was task based and not person-centred.

There had been continuing improvements made to the environment, which was light, bright and clean. However, some aspects of the environment continued to need improvement such as the garden area, which was not accessible to everyone and was not enclosed.

Premises and equipment had been maintained as needed. We noted that people could leave the home by the front door freely, including people who would be at risk of harm if they did so. The provider assured us that they did not foresee a risk of anyone living at the home doing this and said they would review the arrangement if such a risk did become apparent. We have made a recommendation that they risk assess this arrangement.

Systems and processes in place to help the provider monitor the quality and safety of the service had been improved. However, we identified shortfalls in relation to keeping accurate records in relation to people’s care, and the provider had not notified the CQC as required about all safeguarding incidents.

Rating at last inspection:

The service was rated requires improvement at our last inspection (report published 16 May 2018). This is the sixth consecutive time that the service has been rated inadequate or requires improvement since its’ first ratings inspection in July 2016.

Why we inspected:

This was a planned inspection scheduled based on the rating awarded at the home’s last inspection,

Enforcement/Improvement Action: Please see the ‘action we have told the provider to take’ section towards the end of the report. Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service. We will ask the provider to supply an action plan detailing how they plan to improve their overall rating to at least good.

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

The home 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.

This was an unannounced inspection which took place on 11 and 12 April, 2018. We last carried out a comprehensive inspection of the service in August 2017 and rated the service as inadequate which meant the service was in ‘special measures’. At that inspection we identified breaches of seven of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, including concerns that placed people at serious risk of harm. We identified breaches in relation to: cleanliness, maintenance, fire safety, security of the building, managing risks, servicing of equipment, wound care, medicines, recruitment, supervision and training, Deprivation of Liberty Safeguards (DoLS), activities and governance.

Some of the concerns we found at the August 2017 inspection impacted on the safety and well-being of people living at the home. We asked the registered manager to take immediate action to deal with the most serious concerns, which they did. These concerns were around fire safety, window restrictors, wound care, servicing of the passenger lift, bed rail risk assessments and the monitoring of legionella. We then carried out a focussed inspection in October 2017 to check that these serious problems had been rectified, which largely they had been, and the risks to people were reduced.

At this inspection we found the service had made further improvements and the service is no longer in ‘special measures’. However, we have found one continuing breach of the regulations. This is in relation to training. We have also made two recommendations. These are in relation to the provision of meaningful activities and the monitoring of people’s food intake.

Systems were in place to help safeguard people from abuse and staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people living at the home.

There had been a significant improvement in the cleanliness and maintenance of the home. Much of the home had been redecorated and new furniture and fittings bought.This made the home a more pleasant environment for people to live in. A programme of improvement and investment in the home had been implemented and was on-going. Maintenance checks on services and equipment were up-to-date. Fire safety had improved since our last inspection. Procedures were in place to prevent and control the spread of infection.

Medicines were managed safely.

Staff had undertaken a variety of training. However, there was a lack of training in the care of people with autism. This meant staff did not have a good understanding of this condition, how it affected people and how they would support someone with autism in the appropriate way. Staff received regular supervision which provided them with an opportunity to voice any concerns and plan their professional development.

Staff encouraged people to make choices where they were able. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People who had poor dietary or fluid intakes had these monitored. However, we found documentation to record this was not detailed enough to provide an accurate picture of what people were eating.

We observed caring interactions between staff and people who used the service. Care plans, which were reviewed regularly, reflected the needs of each person. People had access to other health care professionals for advice and support, when needed.

Although some improvement had been made since our last inspection in the provision of activities, we found there was not always enough for people to do to occupy or stimulate them. There was no pleasant and secure outside area for people to spend time in.

Regular audits were undertaken to monitor the standard of the service. These included checks on medicines, the environment, infection control and care plans.

We rated all domains of our inspection report as ‘inadequate’ and the overall rating for the home was ‘inadequate’. This meant the home was put in 'special measures'. Services in special measures will be kept under review. 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.

At this focussed inspection we looked specifically at the areas of concern that posed significant risk to people using the service. These were concerns around fire safety, wound care, bedrail risk assessments, monitoring of legionella, servicing of the passenger lift, and the window restrictors. Following our inspection on 29 and 30 August we asked the provider to send us an action plan stating how they would address our concerns, which they did. We used information contained in their action plan to inform this inspection. Not all the risks and concerns identified at our comprehensive inspection of 29 and 30 August have been reviewed during this inspection. We reviewed the risks which had caused us to take urgent action against the provider. This means that the ratings for individual domains in our inspection report for our 29 and 30 August inspection will remain unchanged. They will be reassessed at our next comprehensive inspection which will look at all aspects of the service again.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs including substance misuse and other complex needs. It is situated in the Cheetham Hill area of Manchester. Facilities include 23 single bedrooms and four double bedrooms, a large lounge area, dining room, a conservatory and a smoke room. There is a small garden area at the back of the property and car parking at the front and rear of the premises.

We found that fire safety had improved and people were no longer exposed to serious risk in this area. The provider had addressed the concerns we raised around fire safety and the majority of those identified by the Greater Manchester Fire and Rescue Service (GMFRS). GMFRS had carried out their own inspection of the service at our request.

There was new wound care documentation in place and we found this was being completed correctly. Wounds were being monitored and evaluated correctly.

Following our last inspection a new, more comprehensive bed rail risk assessment had been identified by the provider. However, this had not been implemented at the time of this inspection. This meant people living at the home who had bed rails in place still did not have the appropriate risk assessment. We asked for this to be rectified immediately and during our inspection risk assessments were carried out on all people using bed rails to check that they were safe to be used.

At our last inspection we found that the provider was not aware of their responsibilities to ensure people living at the home were protected from the risk of exposure to legionella bacteria. Since our last inspection a legionella risk assessment had been carried out and the provider had taken some steps towards ensuring people were protected from the risk of legionella. We identified that some work had not been carried out, such as ensuring the water temperatures were correct and sampling of the water for legionella. We asked for this work to be carried out.

At our last inspection we identified that the window restrictors were not robust. At this inspection we saw that all but one of the window restrictors had been replaced with a more robust type that could not be disengaged without the use of a specialist tool. One chain style window restrictor remained. This has since been replaced with a more robust type. Regular checks on the window restrictors were being carried out to ensure they were working correctly and that they protected people from the risk of falling from the windows.

Following our last inspection we asked for the passenger lift to be serviced. This has since been carried out and the lift passed as safe to use. However, the service report identified that some maintenance work and cleaning was required. We have since been provided with the maintenance report which shows that this work has been completed.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs including substance misuse and other complex needs. At the time of our inspection there were 25 people living at the home. Beechill is situated in the Cheetham Hill area of Manchester. Facilities include 23 single bedrooms and four double bedrooms, a large lounge area, dining room, a conservatory and a smoke room. There is a small garden area at the back of the property and car parking at the front and rear of the premises.

We carried out this inspection in response to concerns raised about the service by Manchester City Council in relation to health and safety, staffing levels and environmental living conditions for people at the home.

The previous Care Quality Commission inspection took place in March 2017and the overall rating for the service was 'Requires Improvement’. At that inspection we found breaches of eight of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations.

At this inspection we identified breaches of seven of the Regulations of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, including concerns that placed people at serious risk of harm. We identified breaches in relation to: cleanliness, maintenance, fire safety, security of the building, managing risks and servicing of equipment, wound care, medicines, recruitment, supervision and training, DoLS, activities and governance.

We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

At the time of our inspection there was a registered manager who had been registered with CQC since February 2015. The registered manager was also a director of the company that owns Beechill Nursing Home. 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 identified serious concerns around fire safety. Immediately after our inspection we referred the home to Greater Manchester Fire and Rescue Service who carried out an urgent inspection of the premises. They served the provider with an enforcement notice as they found they were failing to comply with fire safety legislation. We will review the action the provider has taken following this enforcement notice at our next comprehensive inspection.

The home was visibly very unclean and poorly maintained. We found two window restrictors broken which put people at risk of injury as they could fall out of the windows. These have since been mended. Paintwork, carpets furnishings and equipment were dirty and stained. Some chairs had ripped cushions.

Safety checks for gas, emergency lighting and hoists had been completed and PAT testing was up-to-date. However, the fire extinguishers had not been serviced. This had been identified at our inspection in March 2017, but no action taken. There was no legionella risk assessment or regular monitoring being undertaken to reduce the risk posed to service users in relation to legionella. Since our inspection a legionella risk assessment has been carried out and the fire extinguishers have been serviced.

Security of the building was poor as we were able to enter the building unchallenged on several occasions during our inspection. This meant there was a risk intruders could enter the building or vulnerable people who lacked capacity could leave without the knowledge of staff.

Risk assessments to ensure bed rails were safe for people to use had not been carried out. This meant service users were at risk from poorly fitted and broken bed rails which could cause injury or fatality through entrapment and asphyxiation.

Although medicines were stored and administered correctly, we found that cream charts were not always completed. This meant we could not be sure people had received their prescribed creams. People with wounds did not have these correctly monitored and evaluated, which meant there was a risk their wounds could become infected or deteriorate.

Recruitment procedures were not robust enough to ensure staff were suitable to work with vulnerable people. One person had been employed without the provider receiving any references.

New staff received an induction, although two induction records we viewed had not been signed by senior staff to indicate the people were competent to take up their roles. Manual handling training had been given by a person who did not have the specialist knowledge to do so. None of the nurses had received any supervision during 2017.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. People we spoke with told us the staff were kind and caring, and we saw that staff respected people’s privacy. We saw positive interactions between staff and people living at the home.

There was a lack of meaningful actives to help improve people's quality of life. Many people we spoke with told us they would like more to occupy their time.

People were happy with the quality and choice of food.

Care plans and risk assessments were not always detailed enough and accurate.

There were not sufficient quality assurance systems in place to monitor the service effectively and ensure standards were maintained and improved and people were kept safe from harm. We were not assured that the registered manager had oversight of the service.

Following this inspection we asked the registered manager to produce an action plan to tell us how they were going to rectify the concerns we identified and within what time frame. We are currently monitoring the implementation of this action plan.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

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.

The previous inspection took place in March 2016 and the overall rating for the service was ‘Requires Improvement.’ The service had a registered manager who had been in post since February 2015. 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.

We made a recommendation that the provider should implement a schedule of supervisions and appraisals to ensure all staff had adequate support and chance to raise issues relating to their work.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to safeguarding people from abuse, medicines administration, recruitment practice, activities and good governance. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe living at Beechill and that staff ensured they were safe. We found recruitment processes in place were not robust to help ensure people were supported by suitable to work in the care industry.

We noted the service had made improvements in ensuring protocols were in place for people who needed PRN (as required) medicines. However we found some gaps still existed in this area. This meant staff did not always have the necessary guidance to know when to offer a person a particular medication.

The service undertook various health and safety checks of emergency lighting and fire systems, for example. We noted however that the inspection certificate for fire extinguishers was out of date and that appropriate fire drills were not taking place. This meant that in the event of a fire we did not have any assurances that people would be safe from harm.

Induction and mandatory training provision did not provide strong assurances that staff were suitably skilled to do their job safely and effectively. This meant that people may be at risk of harm.

Some improvements had been made since our last inspection to ensure staff received regular supervision and annual appraisals. We saw that the registered manager and team leader had undertaken supervision of some staff.

People were supported to eat and drink healthily at the care home. We observed that meals were freshly prepared and that people were always offered a choice.

People and relatives told us staff were caring and knew them well. Staff were familiar with people’s personalities and their individual likes and dislikes.

The majority of people we spoke with said they had been involved in decision relating to their care. However, not everyone could remember having seen their care plans.

People told us staff always treated them respect and they gave us examples of how staff demonstrated this.

There was a lack of meaningful actives to help improve people’s good quality of life. Most people told us there was little to do at Beechill.

The service did not do initial assessments of people before they were admitted; this process would help to ensure the people are safe, effectively cared for and supported.

There was a complaints process in place and everyone we spoke with knew how to raise a complaint.

People told us they found the registered manager approachable and that staff were good at their jobs.

There were gaps in how the service assessed and monitored the quality of its provision. Whilst there were some quality assurance systems in place, these did not effectively monitor service areas. We were not assured that the registered manager had complete oversight of the service’s operations.

The service held regular residents’ meetings which gave people and their relatives the opportunity to give feedback about the service. Staff meetings were held every three months but records did not indicate that staff had any opportunity to discuss issues relating to their work.

Beechill Nursing Home provides accommodation, personal care and nursing care for up to 31 people who have a variety of needs, including some with a history of alcohol or substance misuse. There were 28 people living in the home at the time of our inspection. The home is situated in the Cheetham Hill area of Manchester, within easy reach of shops and other local facilities. There are 23 single bedrooms and 4 double bedrooms on two floors, a lounge and dining area, a conservatory and a smoking room.

Beechill Nursing Home has a registered manager, who is also one of the directors of the company that is the provider. 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 considered themselves to be safe in the home. Although there had recently been some violent incidents action was taken to prevent a recurrence.

We found a range of issues relating to medicines. These included a lack of instructions as to how to give medicines prescribed to be given ‘as required’, and incomplete instructions about giving insulin. These issues were a breach of the regulation relating to the proper and safe administration of medicines.

The building was designed to be safe for people living in the home. However, we were concerned about a possible lack of security due to the absence of a proper signing in book and the CCTV not functioning.

Staff were trained in safeguarding and knew their responsibility in this area. People were protected from the risk of fire.

Staffing numbers were calculated in relation to dependency levels and we considered there were enough staff on duty.

Recruitment records showed that steps were taken to ensure only suitable people were employed. There were effective disciplinary procedures. The home was kept clean and action had been taken following an infection control report.

Consent to care and treatment was recorded on care files but in some cases consent was given by a relative which is not in accordance with the Mental Capacity Act 2005. Consent had not been obtained for bedrails and the home did not conduct mental capacity assessments when needed. This was a breach of the regulation relating to consent.

Applications had been made appropriately under the Deprivation of Liberty Safeguards (DoLS).

The majority of staff had received the relevant training for their role, but there were some gaps. Staff at the home were trained to support people at the end of life. Regular supervision took place but sometimes the sessions were used to communicate messages to staff rather than allow staff to raise issues.

The cook was popular with people in the home and the food was well liked. People had access to health professionals. We have recommended that guidance should be followed to make the environment more suitable for people living with dementia.

Staff had a caring attitude towards people in the home but were often busy with paperwork. We saw one example where someone’s needs for assistance were neglected for a long period during breakfast. We found this to be a breach of the regulation relating to meeting people’s needs.

People’s experiences varied but on the whole they found the home was supportive and encouraged their independence. Provision was made for people whose first language was not English. We saw that people were encouraged to reduce their dependence on alcohol.

People’s personal privacy was respected although there were examples of the confidentiality of documents not being protected.

Care plans and risk assessments were thorough and specific to each individual. Some people told us they had signed their care plan but most could not recall being involved with it. In some cases we found the care planning did not meet all people’s needs, for example one person did not have a plan to deal with their risk of pressure ulcers.

There was evidence that some activities had taken place but there was no activities organiser in post and some people told us they wanted more activities. The shortage of meaningful activities was a breach of the relevant regulation.

There were regular residents’ meetings. We did not see any recent questionnaires for relatives or people living in the home. Only one formal complaint had been recorded in the last nine years.. The complaints policy was not clearly written. The notice in the lounge about how to make a complaint was out of date.

Beechill Nursing Home had a huge range of policies. It was not clear that these were accessible for staff. Staff meetings were held but there were no recent minutes. A statement had been read out at a previous meeting which was patronising towards staff. A memo issued to staff about their conduct in February 2016 was also demeaning.

The registered manager stated that he regarded the home as a business. There were two examples where the emphasis seemed to be on money rather than the safety and wellbeing of people living in the home. Nevertheless, staff we spoke with regarded him as a good manager.

Certain notifications required by regulations had been incomplete. Audits were conducted to monitor the quality of the service.

In relation to the breaches of regulations, you can see what action we told the provider to take at the end of the full version of the report.

The service did not have a registered manager at the time of our inspection. The director was acting in the role of manager, and was intending to apply to become the registered manager. Immediately following our visit such an application was submitted. He is referred to as the director in this report.

This inspection was limited in scope, to look at the specific areas where we had found the service to be in breach of regulations at the last inspection, and to see whether or not the actions taken meant the service was no longer in breach.

In the area of safeguarding, we found that the service had improved its accounting system for recording people's money. There were now always two staff signatures for any transaction. We found that there had not been a clear process for distinguishing between care fees and personal allowances when money arrived, because they went into the same account. A separate bank account was opened immediately after our inspection which remedied this problem.

At the last inspection there had been only one cleaner working, and we found a number of areas that required attention. At this inspection we found that a second cleaner had been employed, and that the standard of cleanliness and infection prevention had improved, although there was room for further improvement.

Some records had gone missing before the last inspection which made it difficult for the director to demonstrate adequate monitoring and quality control. We found that there was insufficient analysis of questionnaires and internal audits. At this inspection we found that these and other issues had been addressed. The director was actively engaged in procedures to drive up the quality of the service.

We found that steps had been taken to ensure that records were kept securely, following our last inspection. Personal care records had been improved in order to reduce uncertainty. We saw that records were kept systematically.

The director told us they had applied to become the registered manager of the home.

During the inspection we were told by the director there was an investigation on-going into the disappearance of keys and various records at the home.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered our inspection findings to answer questions we always ask:-

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There was an assessment completed of the needs of people who were living at the home.

People were cared for in an environment that was not always clean and hygienic.

We asked people if they had any concerns about the care provided by the home and they told us that were happy with the care provided and that the staff were caring. One person said, 'I feel safe living here. I am fed, having my clothes washed and staff tidy up for me. What more could you need?'

There were effective recruitment procedures in place and staff had appropriate checks completed on them.

Not all risk assessments were in place and the provider needed to ensure staff complied with fire safety precautions.

We found concerns with financial procedures at the home, although we saw safeguarding procedures were in place and that staff understood how to safeguard the people that they supported.

At the time of the inspection, there was no one at the home subject to an authorisation under the Deprivation of Liberty Safeguards.

There were quality checks and audits completed to make sure the premises and procedures were maintained. However, we found the provider had not always actioned any issues arising from these.

Is the service effective?

Relatives were satisfied with the care and treatment being delivered to their loved ones. One relative told us, 'They are very poorly and staff are doing their best.'

We saw daily notes being completed to ensure all staff were aware of the current situation of people who lived at the home.

We had a mixed response from people that we spoke with. Some told us they were happy with the care that was delivered and their needs were met, while others were less positive. We noticed all of the people who lived at the home had a key worker.

We saw evidence of the improvement in one person's health conditions since they came to live at the home.

We saw people walking around the home freely and making their own decisions about where they wanted to go, including some people going out to smoke or go to the local shops. We saw one person returning from a walk to the park.

One relative told us that they were kept regularly updated by the staff team if any changes occurred, they said, 'Staff keep me up to date if anything changes with my relatives health.'

Staff had received appropriate training to meet the needs of the people who lived at the home. Although we did not see all of the certificates to verify this, staff confirmed this information.

We also saw people had a choice of where they ate meals and what they had.

We found people's care records were not kept securely.

Is the service caring?

Observations during the visit showed staff and people who lived at the home were comfortable in each other's company. During the day we saw some positive interactions taking place and staff responding in a kind manner to people who lived at the home.

We saw staff using equipment within the home and ensuring that the person who they were supporting kept their dignity, for example, when hoists were used.

Is the service responsive?

Regular reviews were carried out to make sure that people's care and treatment needs had not changed. This helped ensure staff supplied the correct care and treatment. However, some people told us they were not fully involved with their reviews.

When a person who lived at the home needed other professional input, we saw the staff had ensured this happened. We saw staff supporting one person to attend a GP appointment.

Meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service, although records were missing; staff confirmed these took place.

We were told by staff that people who lived at the home held meetings with staff to discuss their views on living there, however we found no recent minutes and two people we spoke with said they were unaware of meetings taking place.

Completed questionnaires were seen at the home. However, no record of conversations with people who lived there was recorded and not everyone we spoke with could remember completing one of these forms.

Is the service well-led?

There was no registered manager in post at the home, although the director had applied to become the registered manager.

People who used the service had contact with the director and other senior staff to check their wellbeing. We were told a meeting with people who used the service had been arranged to update them with changes that had recently occurred within the home.

People and relatives we spoke with knew who to contact if they wanted to complain.

There were on call systems in place in the event of an emergency.

We found that people's needs were assessed before they were admitted to the home. This meant that nursing and care staff had an understanding of people's needs prior to their admission.

During our inspection we observed staff and how they interacted with people who lived at the home. We saw that staff supported and cared for people with sensitivity and interacted with people appropriately.

We found that the day to day routine of the home was 'relaxed and flexible'. We saw people had a 'leisurely breakfast'. We saw that people got up when they wanted to and came down to the dining room for breakfast at a time that suited them. We heard kitchen staff offer people hot drinks and take breakfast requests.

People who lived at the home told us they felt safe and well cared for. One person said: 'It's nice here and it always clean and warm. The food is good too.'

We found that nursing staff that had responsibility for administering medication had completed medication training including a senior carer.

We found the premises were suitable for people who lived at the home and equipment used was safe and maintained.

We found that there was a sufficient number of staff on duty to meet the needs of people and staff were trained to meet their needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

'I am quite satisfied about the way I am looked after at Beechill and so are my family'.

'The staff are all very good and help me do the things I can't do for myself anymore'.

'The staff know what I like, if there is something on the menu I don't like I can always have something else'.