The Beeches

The Beeches provides residential care for up to 44 people, some of whom may be living with dementia. At the time of this inspection there were 32 people living in the home. Accommodation is provided in a period building including a number of communal areas and a large woodland garden area.

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

People received exceptionally personalised care and support which they were in control of. Staff and management were fully committed to providing an exceptional level of person-centred care. Staff had an excellent understanding of people’s support needs and personal preferences, activities were planned very closely with people to establish their individual interests. People were at the forefront of their care and support. The service was passionate about providing compassionate and respectful end of life care to people.

The service was extremely well managed at both provider and service level. We received lots of positive feedback about the service and their motivation to provide an exceptional service. People, their relatives and staff were involved in the way it was run and given plentiful opportunities to feedback their opinions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were happy living at The Beeches and with the care they received. People felt safe and well-treated by staff. Staff were kind, considerate and treated people with respect and dignity.

Risk assessments were in place, providing guidance for staff in how to reduce risks and keep people safe from harm. People's medicines were administered as prescribed. Accidents, incidents and near misses were used as an opportunity to learn and make necessary improvements.

People were provided with a nutritious and varied diet and a choice of food to meet their preferences. Staff supported people to maintain their health and they sought timely advice from health professionals, when needed. A package of induction and training was provided to staff in developing the skills they needed to safely and effectively deliver care and support to 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 Outstanding (published 22 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

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

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

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

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

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

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

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

The provider understood the importance of robust, yet positive, risk management and had processes in place to support this. The risks associated with the people who used the service, working practices and the premises had all be identified and well managed in order to mitigate risk. Accidents and incidents had been robustly recorded and used to identify any trends or patterns in order to reduce the risk of future occurrence. Staff had received training in safeguarding people and together with additional procedures in place, this helped to reduce the risk of people experiencing abuse.

Procedures in place meant that only those staff suitable to work with the people who lived at The Beeches were employed. Comprehensive and focused induction, training and support of staff ensured people received care from a skilled, knowledgeable and capable workforce. They worked efficiently, but flexibly, as a team and told us they felt valued, motivated and encouraged.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had a robust knowledge of this legislation and fully adhered to its principles. Staff had received training in the subject and relevant others had been involved in best interests decisions as appropriate.

People’s nutritional needs were well met and the service was flexible and adaptive in its approach to this. People told us they enjoyed the food, that it was to their liking and that there was plenty of choice. Support for people who required assistance to eat and drink was thoughtful, dedicated and at a pace directed by them. People could have what they wanted and at a time they requested it.

The service was adept at managing people’s healthcare needs. Staff were knowledgeable in this aspect of care and promptly recognised any factors that may compromise people’s emotional or physical wellbeing. They took appropriate and swift action in response and ensured staff were aware of what related support was required. Healthcare professionals were requested appropriately and those we spoke with confirmed the service’s sound capability in managing people’s healthcare needs.

All the people we spoke with told us they would wholeheartedly recommend the service to others. They told us this was because of the caring nature of the service and the positive impact it had on enhancing people’s lives. Relatives felt reassured at having their family members cared for in a nurturing, kind and compassionate environment. They told us the service delivered personal touches that made a vast difference to the quality of life of their family members.