Warren Lodge Care Centre

Warren Lodge Care Centre is a residential care home registered to provide personal and nursing care for up to 55 people. At the time of inspection there were 39 people living in the home. The service supported people requiring care for reasons of age and frailty, some of whom were living with the experience of dementia. The service was divided into two units known as the Main House and the Courtyard. The Courtyard was designed and adapted specifically to meet the needs of people living with dementia.

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

People experienced safe care and were protected from avoidable harm by staff who had completed safeguarding training and knew how to recognise and report abuse.

Staff identified and assessed risks to people effectively and managed them safely. Assessment and monitoring records demonstrated that people received the support required to keep them safe, in accordance with their risk assessments and support plans. Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them.

The registered manager ensured enough staff were deployed, with the right mix of skills to deliver care and support to meet people’s needs.

Staff were effectively supported to develop and maintain the required skills and knowledge to support people according to their needs. Staff had completed a robust recruitment process, including their conduct in previous care roles to assure their suitability to support older people.

People received their medicines safely from staff in accordance with their medicine management plans and recognised best practice. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection, in accordance with provider's policies and procedures, and government guidance. Accidents and incidents were recorded and reviewed daily by the management team, who took prompt action to implement any lessons learned.

The management team led by example and promoted a strong caring, person-centred culture where people and staff felt valued. Staff were passionate about their role and placed people at the heart of the service, clearly demonstrating the caring values of the provider.

The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent further occurrences.

The registered manager and staff worked effectively in partnership with external health and social care professionals to achieve good outcomes for people with complex needs.

The registered manager ensured there were robust measures to monitor quality, safety and the experience of people within the service. Quality assurance was embedded within the staff culture to drive continuous improvement.

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.

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 requires improvement (report published 1 October 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Warren Lodge Care Centre is a care home without nursing. The service supports people requiring care for reasons of age or frailty, some of whom are living with dementia. The service is registered to accommodate up to 55 people. During the inspection there were 19 people living at the service. The service is divided into two units known as the Main House and the Courtyard. The Courtyard is designed specifically to meet the needs of people living with dementia.

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

The registered person and the management team worked to improve and sustain the systems in place to oversee the service and ensure compliance with the fundamental standards. There had been more positive improvements made since the last inspection. We noted to the management team to review some of the audits and action plans to ensure it was fully detailed and consistently robust. Whilst we saw overall improvements, we also needed to be assured these improvements would be embedded and sustained.

We spoke with the management team about ensuring records for people who use the service reflected their care plans and what care and support was provided consistently. The service had highlighted this requirement to staff and, prior to the inspection, had enrolled all senior care staff onto a training for care planning. This training would support the staff completing care plans have training in the current best practice on writing care plans and recording appropriate prevention measures and outcomes. The mental capacity assessment needed consistency in detail when considering certain decisions. Thus, it was discussed with the management team and part of this inspection.

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.

The staff supported the management team more to review and maintain systems and processes to ensure they could assess and monitor the quality of care in a more consistent way. The provider was taking proactive steps as part of the quality assurance process to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment.

Recruitment processes were in place and robust to ensure as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines was safe. People with specific condition received their prescribed medicines safely and on time. Storage and handling of medicines was managed appropriately. Where risks were identified more prompt action was taken to reduce the risks where possible. Staff recognised and took appropriate action to manage risk in more timely manner.

The registered person reviewed and established a clear process to ensure they maintained clear and consistent records when people had injuries and the Duty of Candour was not applied.

The registered person reviewed and improved the environment to ensure it was more dementia friendly. They also made changes to ensure the principles of the Accessible Information Standard were met. We noted to the management team to ensure they fully completed care plans for end of life care.

People were able to access healthcare professionals such as their GP. Staff were more knowledgeable, confident and proactive to ensure people’s needs and risks were addressed in a consistent and timely way. The service had improved communication and worked better with other health and social care professionals to provide effective care for people. People‘s nutrition and hydration needs were met. Hot beverages, cold drinks and snacks were made available between meals.

Observations and conversations with staff demonstrated they treated people with dignity and respect. Engagement and interaction over meal times were supportive, enabling and caring. We observed people enjoying and laughing with staff whilst undertaking activities in the lounges as it was more meaningful to them. The atmosphere was relaxed and welcoming.

People and relatives reported they felt safe at the service. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. These were addressed appropriately. People told us staff were available when they needed them, and staff knew how they liked things done. The manager monitored staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times.

We observed kind, considerate and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided. People confirmed staff respected their privacy and dignity. People and their families were involved in the planning of their care. They encouraged feedback from people and families, which they used to make improvements to the service.

The manager had planned and booked training to ensure staff had appropriate knowledge to support people. Staff said they felt supported to do their job and could ask for help when needed. The manager held residents and relatives' meetings as well as staff meetings. The staff team had handovers and daily meetings to discuss matters relating to the service and people's care.

There were contingency plans in place to respond to emergencies. The premises and equipment were clean and well maintained. The staff team followed procedures and practices to control the spread of infection and keep the service clean.

Staff felt the management was open with them and communicated what was happening at the service and with the people living there. People and relatives felt the service continued to be managed better and that they could approach management and staff with any concerns.

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 8 June 2019) and there were multiple breaches 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 regulations.

This service has been in Special Measures since November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. It was carried out to follow up on action we told the provider to take at the last inspection.

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

Follow up

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

Warren Lodge Care Centre is a care home without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service supports people requiring care for reasons of age or frailty, some of whom are living with dementia. The service is registered to accommodate up to 55 people. During the inspection there were 21 people living at the service and one person was in hospital. The service is divided into two units known as the Main House and the Courtyard. The Courtyard is designed specifically to meet the needs of people living with dementia.

People’s experience of using this service

The registered person did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards were always effective in identifying when the fundamental standards were not met.

Recruitment processes were in place however they were not as robust as they should be, to ensure as far as possible, that people were protected from staff being employed who were not suitable.

The management of medicine was not always safe. People with specific condition did not always receive their prescribed medicine safely and on time. Storage and handling of medicine was not always managed appropriately.

People were able to access healthcare professionals such as their GP. However, people did not always have their healthcare needs identified and addressed in a consistent or timely way.

The service did not always assess risks to the health and wellbeing of people who use the service and staff. Where risks were identified action was not always taken to reduce the risks where possible. Staff recognised and responded to changes in risks to people better however, a timely response and appropriate action was taken inconsistently.

The registered person did not always ensure they maintained clear and consistent records when people had injuries and the Duty of Candour was not applied.

We made a recommendation to explore relevant guidance on how to ensure environments used by people with dementia were more dementia friendly.

We have made a recommendation about seeking guidance from a reputable source to ensure the principles of the Accessible Information Standard were met.

There had been significant management changes since the last inspection. This also affected the service management. The new interim manager and new nominated individual had to review and establish systems and processes to ensure they could review, assess and monitor the quality of care in a consistent way.

The provider was taking steps proactively as part of the quality assurance process to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment. There was progress in making various improvements but not sufficient at the time of the inspection for us to judge this would be sustained.

The service had improved communication and worked better with other health and social care professionals to provide effective care for people.

There was an activity programme and some people were involved in activities. The manager took action to ensure all people had opportunities for social engagement and meaningful activities according to their interests to avoid isolation. However, improvement was needed to ensure activities were more personalised.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People felt safe living at the service. Relatives felt their family members were kept safe.

Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately.

We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided.

People told us staff were available when they needed them, and staff knew how they liked things done most of the time. The manager reviewed and improved staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times.

The manager had planned and booked training to ensure staff had appropriate knowledge to support people. Staff said they felt supported to do their job and could ask for help when needed.

There were contingency plans in place to respond to emergencies. The premises and equipment were clean and well maintained. The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean.

People had sufficient to eat and drink to meet their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals.

People confirmed staff respected their privacy and dignity. The manager was working with the staff team to ensure caring and kind support was consistent.

People and their families were involved in the planning of their care. They encouraged feedback from people and families, which they used to make improvements to the service.

The manager held residents and relatives' meetings as well as staff meetings to ensure consistency in action to be taken. The staff team had handovers and daily meetings to discuss matters relating to the service and people’s care.

Staff felt the management was open with them and communicated what was happening at the service and with the people living there. People and relatives felt the service was managed better and that they could approach management and staff with any concerns.

Rating at last inspection

At the last inspection the service was rated Inadequate overall and placed into Special measures (Report was published 22 November 2018).

Why we inspected

This was a planned comprehensive follow-up inspection based on the rating at the last inspection.

Enforcement

We found breaches of six regulations relating to mitigating risks, staff recruitment, assessing and responding to people’s needs, Duty of Candour, submitting notifications and the provider's system to ensure compliance with the fundamental standards. 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.

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 have asked the provider to send us a report that says what action they are going to take. We will check that the action is taken. We will continue to monitor all information we receive about this service. We will carry out a comprehensive inspection within six months of the publication of this report in line with our methodology for services rated as inadequate if we have not proposed to cancel provider’s registration.

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

Warren Lodge Care Centre is a care home without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service supports people requiring care for reasons of age or frailty, some of whom are living with dementia. The service is registered to accommodate up to 55 people, during the inspection there were 42 people living at the service. The service is divided into two units known as the Main House and the Courtyard. The Courtyard is designed specifically to meet the needs of people living with dementia.

The service did not have a registered manager as required. At the last inspection the registered person had taken immediate action following the resignation of the registered manager to appoint a new manager. However, during this inspection the home manager was still in the process of applying to CQC. A registered manager is a person who has registered with the 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. The home manager, four operations managers and the nominated individual assisted us with our inspection.

The registered person did not ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. Not all staff were up-to-date with their safeguarding training.

The registered person did not ensure staff kept clear and consistent records when people's care and treatment needs changed. In some cases, this put people at risk. They were not having their individual health and care needs met on time. There was inconsistent and ineffective support for people who became distressed or who were unable to make their needs known. When we raised queries or issues with support or records at our inspection, the evidence was not always available. We gave the provider the opportunity to provide the evidence needed but they were not able to.

We did not receive information to evidence the provider operated safe recruitment and selection processes to ensure suitable staff were employed. Staff training records indicated which training was considered mandatory by the provider. Not all staff were up to date with, or had received, their mandatory training. We saw evidence that learning was not always put into practice when staff supported people. Staff felt some training was missing to help them care for people more effectively. The provider could not be sure staff had the appropriate knowledge and qualifications to meet people's needs. Staff did not have regular support and supervision sessions to review their work and performance. However, staff felt supported to do their job and could ask for help when needed.

People had access to health care professionals. However, staff did not always record and act upon health issues promptly. Therefore, appropriate care and treatment was delayed and did not help people stay as healthy as possible. People had sufficient to eat and drink to meet their nutrition and hydration needs, however support from staff at meal times was not always available.

People's safety was compromised in the service as the premises were not well maintained. People received their prescribed medicine safely and on time. Storage and handling of medicine was managed appropriately. We found some errors with recording and storage which was not picked up by the provider's audit system. There were no specific plans for people receiving medicine covertly and anticoagulants as the provider’s policy.

Most of the staff knew people's individual communication skills, abilities and preferences. However, they did not always follow their knowledge or have detailed guidance for staff to follow to reassure a person if they were distressed or uncooperative. Staff were not always following the care plan to provide the right support to people.

We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided. There was an activities programme and people were involved in activities. However, not all people had opportunities for social engagement and meaningful activities according to their interests to avoid isolation.

The provider had a system to assess staffing levels and make changes when people's needs changed. The provider was using agency staff to ensure the right numbers during shifts and was trying to book the same agency staff to maintain continuity of care and support. Staff felt there were often times when they needed more staff to support people appropriately.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity to make decisions. However, we could not be sure all staff understood people’s capacity and helping them make decisions in their best interests. We reviewed information held regarding Deprivation of Liberty Safeguards (DoLS) to ensure people's liberty was not restricted in an unlawful way and people's rights and freedom were protected. Although the provider had taken some action with the local authority to apply for DoLS, we did not have clear information regarding all the people living in the service to ensure appropriate measures were in place. We have made a recommendation about staff training on the subject of restraint, consent, MCA and DoLS.

The provider had systems in place to assess and monitor the quality of care. However, the quality monitoring system did not effectively identify all issues, practices or concerns with the service. Without an effective system the service was not able to make improvements where and when necessary so that people could receive the support and care they needed. There was a management team of three senior staff at the service to help address the issues and concerns raised by us and other professionals. However, we saw little evidence of ongoing and sustained improvement.

We were concerned that the lack of overview of the service, inconsistent record keeping and proactive approach prevented improvements being achieved promptly. The provider did not take prompt action to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment. The provider’s own quality assurance systems and audits had not identified all of the shortfalls and risks to people’s safety we identified during the course of our inspection.

The provider investigated and responded to people's complaints. However, they did not record verbal or informal concerns raised, as per the provider's complaints procedure. Annual questionnaires were sent so people and relatives could share their views.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of this report.

The provider is working alongside with the local authority and relevant healthcare professionals to ensure people’s immediate safety. The provider has a current action plan in place with the local authority, which is regularly reviewed and updated.

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.

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

Warren Lodge Care Centre is a care home without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home supports people requiring care for reasons of age or frailty, some of whom are living with dementia. The service is registered to accommodate up to 55 people, during the inspection there were 50 people living at the service. The service is divided into two units known as the Main House and the Courtyard. The Courtyard is designed specifically to meet the needs of people living with dementia.

At the last inspection in October 2015, the service was rated Requires Improvement in the Safe domain. At this inspection we found the service had made improvements and is now rated Good in Safe, Effective, Caring and Well-led, while the Responsive domains has been rated Outstanding.

There was no registered manager in place at the time of the inspection. However, the provider had taken immediate action following the resignation of the registered manager to appoint a new manager. The new manager was experienced and had worked in another of the provider’s services for many years before transferring to Warren Lodge. They were in the process of applying to become registered with the Care Quality Commission (CQC) to manage the service. A registered manager is a person who has registered with the 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.

Warren Lodge Care Centre provides high quality care and support to people who live there. The whole management team with support from the provider had worked towards improving the quality and outcomes for people. Since the previous inspection improvements had been made to help ensure care was provided safely and a number of innovative and creative ideas had been implemented and embedded, resulting in people receiving person centred care that met their individual needs.

Initiatives included “People Like Me", through which people who use the service and the staff team including the chief executive were encouraged to make positive connections with people based on shared interests. This had resulted in meaningful and positive relationships being developed that benefitted people and staff alike. Another initiative reflected the provider’s interest in evidenced based practice. Internal research had resulted in an award and accomplishment framework for all leaders and managers being implemented to encourage and support outstanding practice.

People told us they felt safe at Warren Lodge. Staff were knowledgeable on how to protect people and were confident to report concerns. Where concerns had been identified appropriate action had been taken. People’s needs were assessed before they moved into Warren Lodge. Risks to individuals and the environment were identified and managed. Robust recruitment procedures helped to ensure suitable staff were employed. People received their medicines when they required them and there were procedures in place to manage medicines safely.

Staff were well trained and supported in their role, their contribution was recognised and valued. Initiatives had been developed to support and mentor staff as well as acknowledge their achievements. People were able to access healthcare professionals when necessary and staff supported them to keep as well as possible. People’s nutrition was monitored and any concerns were addressed. The catering department worked with the care team to provide a pleasant dining experience for people and to ensure people’s nutritional needs were met. Staff were aware of the importance of hydration and encouraged people to make use of water stations around the service throughout the day.

Staff treated people with kindness and compassion, they were committed to providing high quality care and doing the best for people they supported. People spoke of staff being “wonderful” “caring” and “kind”. Relatives confirmed their family members were treated with respect and told us staff were “quick to help” “always kind” and said “wonderful, they know people so well”. We observed staff providing compassionate care and responding to people promptly when they required help. There were excellent examples of care being responsive which had had a positive impact on people’s lives.

We received consistently positive feedback from health and social care professionals about the care and support provided at the service. They commented on the way people’s needs were responded to flexibly and the effective management and leadership of the service. Professionals felt the service worked in partnership with them to bring about the best possible outcomes for the people who lived there.

The care and support provided was person centred and recognised people’s diversity and respected individual choice. People and when appropriate their relatives felt involved in planning care. People were encouraged and supported to make decisions. Consent to care and support was sought in line with legislation and guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The life enrichment team enthusiastically provided imaginative and varied activities for people to join in with and enjoy. People were involved in choosing and organising activities and could decide what they wished to take part in. As part of the enrichment programme professional entertainers, artists and therapists were included as well as links with the local community. These included connections with primary schools, the girl guides, the local church and the mobile library. People were also supported to go out into the community by taking part in trips to local towns or places of interest.

People were fully involved and engaged in the running of the service, their views were sought and listened to. The manager told us people were “in control” and we found numerous examples of people’s ideas being adopted to improve the service. Person centred care was embedded into day-to-day life. Each person using the service was respected and treated as an individual.

Thought and imagination had been used in the design and adaptation of the service to meet people’s needs. The courtyard area provided a safe and stimulating environment for people living with dementia while the whole service presented a light and well maintained setting which was welcoming and friendly. People and their relatives commented positively on the cleanliness of the service.

The complaints policy and procedure was rarely used as people and their relatives reported they had not needed to complain. They told us small “niggles” were dealt with promptly. However, when a complaint had been raised the matter was investigated and responded to appropriately.

The provider had a clear vision and a set of values that were reflected by staff who told us they were led by example. An open culture encouraged views from people, relatives, staff and stakeholders which led to improvements in the service. Staff were enthusiastic to share future plans to further improve the service illustrating their wish to always strive for better. People using the service, their relatives and staff spoke highly of the management team and found them extremely supportive.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We looked at the personnel records for eight members of staff. We saw evidence that every staff member was up to date with all of their mandatory training. We reviewed the training records the provider kept for all members of staff. There were 12 training topics that the provider had identified as mandatory for all staff. In five of the subjects 100% of staff were up to date with their training. In four of the subjects 98% of staff were up to with their training and three of the subjects 96% were up to date. One care worker told us 'We can ask for training. They [the management] are pretty good at providing what we identify staff need.'

The provider was reporting applicable incidents as required by the regulations. This meant we could effectively monitor the quality and safety of care received by people who use the service.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at three people's care records. They were person centred and contained detailed information about how each individual's care needs should be met. A relative told us they were 'very happy with the care'.. received'.

People were provided with a choice of suitable and nutritious food and drink and were supported to be able to eat and drink sufficient amounts to meet their needs. One person said, 'The food at the home is good.'

There were not enough qualified, skilled and experienced staff to meet people's needs. People who use the service and staff told us there were times when there were not enough staff on duty. Some staff did not demonstrate they had the suitable skills to meet the needs of people who use the service at all times.

When we spoke with staff they told us they felt well supported by managers and they had enough training to enable them to meet the needs of the people they support. We looked at the appraisal and supervision records which showed evidence of appraisals and regular supervision. However, other records showed that most of the appropriate mandatory training for staff was not up to date.

The provider had not reported applicable incidents to us which concerned the provision of care and welfare to people who use the service. This meant we could not effectively monitor the safety and quality of services provided to people.

In this report the name of a registered manager appears who was not in post and 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.