Downhurst Residential Home Limited

Ealing Eventide Homes Limited – Downhurst is a care home for up to 26 older people. At the time of our inspection, 21 people were living at the service. Some people were living with the experience of dementia. The service is managed by Ealing Eventide Homes Limited, a charitable organisation. This is their only registered care home.

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

Medicines were not always administered as prescribed and records did not always reflect the medicines received by people. Incidents and accidents were recorded but lessons learned were not always recorded to reduce future risks. The provider did not ensure their safeguarding procedure was always followed. Quality assurance procedures were not robust enough to enable the provider to identify where action may be required to make improvements.

The provider had made improvements in relation to the management of risk and information was now provided for staff on how they could reduce the possible risks to the person’s health and wellbeing. The provider had also made improvements to the care plans to ensure they were person centred and identified people’s current support needs. Improvements had been made to the range of activities provided for people living at the home.

Relatives felt their family members received care in a safe and appropriate manner. There was a robust recruitment process in place. The provider followed an infection prevention and control procedure and staff had access to personal protective equipment (PPE).

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Relatives were aware of how they could raise any concerns about the care provided. The provider had a process for responding to complaints. The provider worked in partnership with a number of organisations. Relatives were happy with the care provided to their family member. Relatives felt the registered manager was accessible, listened and responded to any questions they might have.

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 16 December 2022). 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider seek and implement national guidance on the provision of social and recreational activities for older people in care settings. At this inspection we found the provider had made improvements to the activities provided.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 and 18 October 2022. Breaches of legal requirements were found. 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, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm if they now met legal requirements. We have found evidence that the provider still needs to make improvements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. 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 Ealing Eventide Homes Limited - Downhurst on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and good governance 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 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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Ealing Eventide Homes Limited – Downhurst is a care home for up to 26 older people. At the time of our inspection, 18 people were living at the service. Some people were living with the experience of dementia. The service is managed by Ealing Eventide Homes Limited, a charitable organisation. This is their only registered care home.

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

Since the last inspection the provider had made some improvement to the management of risks but we found there were still risks which had not been assessed, monitored or managed in relation to people’s health and wellbeing. Medicines were not always administered as prescribed and records did not always reflect the medicines received by people.

The provider had made some improvement to care plans, but they still did not always provide information on people’s current care and support needs. There were therefore risks that people might not receive the care and support they needed. There had been some improvements in the quality assurance processes the provider had in place, but further improvements were required to ensure these were robust and effective so that areas for improvement were identified and addressed.

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. We identified that mental capacity assessments had not always been completed, where required, in relation to vaccinations. We made a recommendation in relation to mental capacity assessments.

The provider had made some improvements to activities which were provided in the home but further actions were required. We have made a recommendation to the provider in relation to the provision of activities.

Despite the above people and their relatives felt care was provided in a safe manner. The provider had a robust recruitment process. Relatives were happy about the care their family members received and they felt the care workers were kind and caring. People’s support needs were assessed before they moved into the home to ensure their care needs could be met. People were supported to access healthcare professionals when required to promote a healthy lifestyle. Care plans and risk assessments were updated with the lessons learned following an incident and accident, but the lessons learned and how these had been shared with staff had not always been recorded to demonstrate there had been wider learning. The registered manager confirmed they would ensure the records were always completed in full.

Care workers completed a range of training courses and they felt supported in their role. Care plans identified people’s food and drink preferences with any dietary requirements. People’s religious preferences were identified, and these were supported with visits from the local faith community. The provider had a complaints process in place that people and their relatives were aware of. Relatives felt the home was well run and the registered manager was effective.

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 5 July 2022). 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 the provider remained in breach of regulations. This service has been rated inadequate for the past two inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ealing Eventide Homes Limited – Downhurst on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to person-centred care, safe care and treatment and good governance 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

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Ealing Eventide Homes Limited – Downhurst is a care home for up to 26 older people. At the time of our inspection, 20 people were living at the service. Some people were living with the experience of dementia. The service is managed by Ealing Eventide Homes Limited, a charitable organisation. This is their only registered care home.

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

The provider had not always ensured risks to people were assessed, monitored or managed. Care plans and risk assessments were not always updated following a fall to ensure any lessons learned in relation to reducing the risk of reoccurrence had been identified and communicated to care workers. Medicines were not always administered safely and recorded to make sure people always received their medicines as prescribed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. This was because mental capacity assessments were not completed appropriately.

People’s care plans did not always reflect their current care needs and care plans did not always provide care worker’s with adequate information on people’s wishes and preferences in relation to how they wanted their care provided.

Although there had been some improvements in the provider’s quality assurance processes, further work was required to ensure these were robust and effective enough to identify areas for improvements so the necessary remedial action could be taken.

The provider had made improvements to staffing levels and the management team. There was now a registered manager and deputy manager in post and they were in the process of making improvements in relation to the oversight of the home. The staffing rota demonstrated the number of staff on duty was in line with the assessed staffing requirements for the service. Training records demonstrated care workers had completed the training identified as mandatory by the provider.

The provider was in the process of making improvements to the home’s environment to make it more dementia friendly and to ensure it complied with fire safety regulations. People’s care plans identified their food preferences and any specific dietary requirements. People were supported to access healthcare and other professionals when required.

The provider had an infection prevention and control (IPC) policy and procedures in place and had developed COVID-19 risk assessments for people living at the home and staff. Staff had completed infection control training and we found they complied with safe IPC practices.

Despite the concerns we found at the inspection, relatives told us they felt their family member/friend was safe, living at the home and care workers provided support in a kind and caring way. We saw individual care workers providing support in a caring, polite and respectful manner. People’s religious preference were identified and supported.

The provider had a complaints process and relatives confirmed they knew how to raise any concerns. Relatives felt the provider was making improvements since the previous inspection and felt positively about the registered manager.

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 15 October 2021). 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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to person-centred care, consent to care and treatment, safe care and treatment and good governance 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

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.

Ealing Eventide Homes Limited – Downhurst is a care home for up to 26 older people. At the time of our inspection, 21 people were living at the home. Some people were living with the experience of dementia. The service is managed by Ealing Eventide Homes Limited, a charitable organisation. This is their only registered care home.

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

People were not cared for safely. The provider had not always assessed, monitored or managed risks to people, staff and others. There were not always investigations or analysis when things went wrong, to find out what happened and to learn from these. A number of recent safeguarding concerns have shown that the provider had sometimes failed to identify and record any lessons learned following an investigation to reduce possible risks.

We found concerns with regard to staffing levels. The management team was very depleted at the time of our inspection. The home was without a manager and deputy manager and two of the four senior support workers posts were vacant. This had impacted negatively on the safe oversight of all aspects of managing the home. In addition, staffing levels at night were not always safe. This was because the provider had not allocated senior support staff for every night in line with the assessed staffing requirements for the service.

The provider did not have a robust oversight of the service, which meant they had not adequately monitored and assessed the quality of the service which has deteriorated through time. The lack of an effective management team had impacted on addressing the concerns found at the last inspection. At the time of the inspection the nominated individual and the acting deputy manager were managing the service and leading the staff team. However, they did not have full access to the management systems supporting the service delivery and did not have the operational knowledge to provide the assurance that the service would be managed safely and in a responsive manner.

Medicines were not managed in a safe manner. This was because people were not always administered their medicines as prescribed.

Whilst the provider had infection prevention and control (IPC) policy and procedures and had provided staff with infection control training, we found some staff and management did not always comply with safe IPC practices, for example they habitually wore their PPE masks in an unsafe manner. In doing so they put people at risk of cross infection.

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. This was because mental capacity assessments were not completed appropriately.

The provider had not always ensured people’s care plans reflected their current care needs and care plans did not describe people’s wishes as to how they wanted their care provided. There was insufficient guidance for staff on how to provide care in a person-centred manner.

People told us staff were “good” and they felt safe at the home. We observed individual care workers providing support in a caring, polite and respectful manner.

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 20 April 2021) 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 the service had deteriorated to a rating of inadequate and the provider continued to be in breach of multiple regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the lack of a robust management team. We also received concerns from whistle blowers. These concerns included failure to report safeguarding incidents in a timely way, failure to investigate these and about poor care. We also inspected to see if the provider had made improvements in line with their action plan to address the previous breaches of regulations.

This was a focussed inspection. We have found evidence that the provider needs to make further improvements. Please see the safe, effective and well-led sections of this full report. In addition, we also looked at part of the responsive and caring key questions but did not award a rating for these key questions. So, the ratings from the previous inspection were used to give an overall rating for the 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.

The overall rating for the service has changed from requires improvement to 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 Ealing Eventide Homes Limited – Downhurst 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 of regulations in relation to person-centred care, consent to care and treatment, safe care and treatment, premises and equipment and good governance 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 meet with the provider 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.

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.

Ealing Eventide Homes Limited – Downhurst is a care home for up to 26 older people. At the time of our inspection, 23 people were living at the service. Some people were living with the experience of dementia. The service is managed by Ealing Eventide Homes Limited, a charitable organisation. This is their only registered care home.

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

People were not always safe because the provider had not fully assessed, monitored or mitigated the risks within the environment and for the individual activities people undertook. We were so concerned about this that we wrote to the provider asking them to take immediate action to address these concerns. They provided us with assurances that they were addressing the most pressing safety risks.

People were not always treated with respect. Staff custom and practice did not always take account of people's individual needs or how they experienced interactions, and as a result they sometimes provided care which was inappropriate and disrespectful.

The staff had not always proactively planned to meet people's needs. This meant people did not always receive personalised support.

The provider had not always ensured allegations of abuse were properly reported and investigated.

The provider's systems for monitoring the quality of the service and assessing risk were not always operated effectively.

Most people using the service and their relatives who spoke with us felt they received a good service and named specific members of staff who they felt provided good care and support.

The provider had effective systems for preventing and controlling the spread of infection. They had updated these since the start of the COVID-19 pandemic.

The provider responded promptly to concerns we raised.

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 good (Published 5 October 2017).

Why we inspected

The inspection was prompted in part due to concerns about safety, following a serious fall which resulted in a person being admitted to hospital. This was investigated under the local authority safeguarding procedures and the provider was found to have neglected the safety of this person. A decision was made for us to inspect and make sure the provider had implemented the recommended actions to improve safety at the service.

As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led. During our inspection, we found there were also concerns with the way people were being treated so we widened the scope of the inspection to include the key question of caring as well.

We reviewed the information we held about the service. No areas of concern were identified in relation to the key question of effective. We therefore did not inspect this. Ratings from previous comprehensive inspections for this key question was used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of this full 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 Ealing Eventide Homes Limited - Downhurst 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 person-centred care, dignity and respect, safe care and treatment, safeguarding people from abuse and good governance at this inspection.

We wrote to the provider telling them we were considering urgent enforcement action in relation to our concerns about safety at the service. The provider responded with an action plan which gave us assurances they were addressing these concerns and minimising the risks to people's safety.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ealing Eventide Homes Limited - Downhurst is a service which provides accommodation and personal care for up to 26 older people who have a range of needs, including dementia. At the time of inspection there were 25 people using the service.

The service is required to have a registered manager in post, and there was a registered manager for this service. 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.

Medicines were being managed and people received their medicines as prescribed. Guidance for the crushing of medicines was not always being followed. We have made a recommendation.

Staff recruitment procedures were followed to ensure only suitable staff were employed by the provider. There were enough staff available to meet people’s needs and temporary staff were accessed to cover staff absence. Systems were in place to safeguard people from the risk of abuse and staff understood the action to take if they had any concerns. People were encouraged to express any concerns, however minor, so they could be addressed. There was a complaints procedure in place and people and relatives felt confident to speak with staff about any issues they might have.

Individual risk assessments were comprehensive and care plans evidenced the action to be taken to minimise each risk. People’s risk and care records were monitored by the registered manager and action was taken promptly to address any shortfalls identified with any of the documentation. Risk assessments were in place for premises, equipment and safe working practices and these were reviewed annually to keep the information current.

The service was clean and fresh throughout and infection control procedures were being followed. Systems and equipment in use in the service were being maintained and were serviced at the correct intervals to keep them in good working order.

Staff received training in a variety of topics to provide them with the skills and knowledge to care for people effectively. Staff were encouraged to undertake and had obtained recognised qualifications in health and social care.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). People’s mental capacity had been assessed. For some people DoLS were in place to ensure that their freedom was not unduly restricted. Staff understood people’s needs and always acted in their best interests.

People’s dietary needs and preferences were identified and met and there was a wide range of meals available. People’s nutritional needs and status were assessed and monitored. People’s healthcare needs were identified and they received input from healthcare professionals when required.

People, relatives and healthcare professionals were happy with the care and support being provided at the service. People, and where appropriate their relatives, had been consulted about care needs and the care plans had been drawn up with their input. Care records were very person centred and up to date and changes in peoples’ needs and care were identified and included in the care plans.

Staff demonstrated a good knowledge of people’s individual care and support needs and provided this in a kind and caring manner. Staff offered people choices and treated them with dignity and respect. The service provided a wide range of activities and outings for people to take part in and people enjoyed participating in these.

Systems were in place for auditing and monitoring and these were being followed to ensure all areas of the service were reviewed and action taken to address any issues that were highlighted. The management team were approachable and listened to people, relatives and staff so that any issues could be promptly addressed.

At the inspection of 21 February 2017 we checked care records to see if risks had been assessed and care plans reviewed to reflect the findings of the risk assessments. We found the provider had taken action. There had been improvements in reflecting the risk assessment findings in the care plans, however further improvements and monitoring of the care records were required. Therefore we have made a new requirement for this finding.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ealing Eventide Homes Limited – Downhurst’ on our website at www.cqc.org.uk.

Ealing Eventide Homes Limited - Downhurst is a service which provides accommodation for up to 26 older people who have a range of needs, including dementia.

The service is required to have a registered manager in post, and there is a registered manager for this service. 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.

Improvements had been made with the risk assessments and associated care records, however further improvements were required to ensure all the records accurately reflected changes in people’s needs.

The processes in place for monitoring and reviewing the care documentation were not robust and shortfalls were not always being identified and addressed in a timely way.

The majority of risk assessments and care records had been completed and these were comprehensive and reflected any changes in people’s needs.

At this inspection we did not speak to any people who lived in the home. We looked at the storage and record keeping of medicines. We saw that medicines were stored appropriately and good record keeping provided us with the evidence that people were receiving their medicines as prescribed.

People expressed their satisfaction with the service and the care they were receiving. They said staff were helpful and looked after them well. One person said, 'staff are very kind'. Satisfaction surveys had been carried out and comments from people using the service included, 'the staff are nice and helpful. I am very happy here.'

Surveys completed by relatives contained comments such as, 'A very warm and caring environment, with lovely staff', 'Really lovely, calm and happy atmosphere. Interesting activities for residents and annual events to include families. Staff always pleasant and good relations between residents and staff' and 'a caring environment well run, providing a comfortable home for residents.'

Systems were in place for the management of medicines, however these were not always effective and shortfalls were identified, which could place people at risk of unsafe care.

Action had been taken to address shortfalls with the environment identified at the last inspection.

Staff had received training and supervision to provide them with the knowledge and skills to care for people effectively.

Systems were in place for the auditing and monitoring of equipment, systems and safe working practices, and action was taken to address any shortfalls identified.