Albany Lodge Nursing Home

Albany Lodge Nursing Home provides nursing and personal care and support to older people, some of whom are living with dementia. At the time of the inspection, there were 89 people using the service.

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

Risks to people were not always identified, assessed, fully documented, and mitigated to ensure people’s safety and well-being. The provider was not working within the principles of the MCA. 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.

People were not always central to the planning and reviewing of their care. Assessments and care plans were not always person centred. The service was not always well managed. Systems and processes in place for monitoring the quality and safety of the service were not always effective in identifying and addressing issues and concerns we found at this inspection and for helping to drive service improvements.

There were safeguarding procedures in place and the manager had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work at the home. There were enough staff deployed to meet people’s needs. There were procedures in place to reduce the risk of infections. There were effective systems in place for monitoring, investigating, and learning from incidents and accidents. People’s medicines were managed safely.

We found 4 breaches of regulation. We have made recommendations about the management of medicines.

People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. The design of the premises was meeting people's needs. People had access to end-of-life care and support when it was required.

The manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. Staff told us they enjoyed working at the home and received good support from the manager and deputy manager.

Rating at last inspection. The last rating for this service was good (published,13 April 2023).

Why we inspected

The Inspection was prompted in part due to concerns received about the quality and safety of care provided and the management and oversight of the service. A decision was made for us to inspect and examine those risks.

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.

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

Follow up

We have identified breaches in relation to safe care and treatment, person centred care, the need for consent and good governance. 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.

Albany Lodge Nursing Home is a care home that provides nursing and personal care for up to 100 older people some of whom were living with dementia. At the time of our inspection there were 82 people using the service including those living with dementia.

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

At the last inspection the service provided was not always safe for people to use as risks relating to pressure ulcer prevention, the home environment and the use of equipment were not always managed appropriately, and people were at risk of harm. The provider did not always demonstrate a strong focus on capturing learning to improve the service when things went wrong. The service was not always well-led as the quality assurance systems were not sufficiently robust to identify and resolve some issues or follow them up within a suitable timescale.

At this inspection risks to people regarding pressure sore prevention, the home environment and use of equipment and robustness of the quality assurance systems were addressed.

People, their relatives and staff told us that the home was a safe environment for people to live and staff to work in. Risks to people were assessed, regularly updated, reviewed and minimised. This meant they were able to enjoy their lives safely by taking acceptable risks. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were enough staff provided by the home to support people and meet their needs. Staff had been recruited and trained appropriately including how to safely administer medicines. Personal Protection Equipment (PPE) was used safely, effectively and the infection prevention and control policy were up to date.

Albany Lodge Nursing Home was led and managed in a way that was transparent, open, and positive way with an honest culture. The provider had a vision and values that were clearly set out, staff understood and followed. Areas of responsibility and accountability for management and staff were identified, clarified and a good service was maintained and regularly reviewed. There were thorough audits conducted, and records kept up to date. Where possible community links and working partnerships were established and kept up to minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals said that the service was well managed, and people’s needs were met in a professional, open and friendly way.

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 (published 30 September 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, and Well-led which contained requirements. A decision was made for us to inspect and examine the risks associated with these issues.

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.

We did not inspect the key questions of effective, caring and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Albany Lodge Nursing Home is a residential care home providing personal and nursing care to 92 people at the time of the inspection, some of whom were living with dementia. The service can support up to 100 people.

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

We received positive feedback from people and relatives about their experiences of using the service. One relative summed up the service as “a good care home, no issues. Staff are really supportive. Four and a half stars out of five.”

The service had experienced inconsistency in clinical leadership since our last inspection in February 2019, which meant some standards had deteriorated. We found risks relating to pressure ulcer prevention, the home environment and the use of equipment were not always managed appropriately and people were at risk of harm. We also found instances where the provider had not demonstrated they learned lessons when things went wrong. When we fed this back to the registered manager, they promptly took action to address the issues we raised. However, at the time of our inspection the provider's systems were not sufficiently robust to identify and resolve such issues or follow them up within a suitable timescale.

We have made a recommendation about improving the home's quality assurance systems to ensure actions are followed up promptly.

The home had systems to ensure there were enough staff to care for people safely and safe recruitment processes were followed. However, staff were not always deployed effectively around the service to ensure people in all parts of the home always had enough support. Staff understood how to protect people from the risk of abuse and ill treatment. Medicines were managed safely and there were systems in place to protect people from the risk of infection.

Although we found some shortfalls in safety and quality, the provider had begun taking steps to ensure that in future these issues would be identified and addressed more effectively. This included recruiting new staff to clinical leadership roles. A comprehensive range of checks and audits was used to continually improve other aspects of the service and people’s experience of their care. People, staff and relatives were involved in the process and their feedback was used as part of this. Staff were aware of their responsibilities and communicated well. They shared a clear vision and values that put people at the centre of what they did. The provider worked well in partnership with other agencies.

Staff supported people in ways that respected and promoted privacy, dignity and independence and were kind, respectful and empathetic. They treated people with compassion and dignity, provided emotional support when needed, supported people to feel included and valued, and supported people to make choices about how they lived their lives.

People experienced care that was personalised and considered their needs, preferences, backgrounds and interests. The provider made an effort to strike the right balance between meeting people’s needs and respecting their preferences, and involved people and relatives in decisions. Care plans included individual needs and preferences around end of life care. People’s communication needs were met and there were enough suitable activities to keep people meaningfully engaged and protected from the risk of social isolation. People knew how to complain and told us the provider was responsive to any concerns they raised.

Rating at last inspection

The last rating for this service was good (published 29 March 2019).

Why we inspected

We received concerns in relation to pressure ulcer risk management, communication with relatives, standards of personal care and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect the key question of effective. Ratings from previous comprehensive inspections for that key question 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 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 and well-led sections of this full report. The provider took action to mitigate the risks to people that we found, and we will check the effectiveness of this at our next inspection. 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 Albany Lodge Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach of regulation in relation to safe care and treatment. 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.

Albany Lodge Nursing Home is a residential care home that provides accommodation, nursing and personal care to up to 100 older people in a purpose-built building over four floors. At the time of the inspection 85 people were using the service, several of whom were living with dementia.

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

People were not always protected from avoidable harm due to trip hazards and equipment being stored incorrectly. However, there are plans in place to carry out outstanding work to remedy issues around the service.

The service has robust monitoring systems in relation to health and safety which are carried out on a regular basis by trained staff.

People were kept safe from the risks of infection by staff who adhered to infection prevention and control measures in place. The service is regularly cleaned and there are donning and doffing stations for safe application and removal of PPE.

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 1st April 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had received around aspects of health and safety and condition of the premises. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

• Albany Lodge Nursing Home is a residential care home that provides accommodation, nursing and personal care to up to 100 older people in a purpose-built building over five floors. At the time of the inspection 98 people were using the service, several of whom were living with dementia.

People’s experience of using this service:

• People felt safe using the service. There were systems in place to protect people from abuse and harm. Risks were appropriately assessed and managed. Staff made sure equipment people needed was safe to use.

• People were protected from the risk of infection because staff followed appropriate guidance.

• Medicines were managed safely.

• The provider responded appropriately to accidents and incidents to prevent them from happening again where possible.

• There were enough staff to care for people safely. There were robust recruitment procedures to avoid unsuitable staff being recruited.

• People’s needs were assessed and, where appropriate, other agencies were involved in assessments and care planning to ensure care was delivered in line with appropriate guidance.

• Staff had appropriate training and support to equip them with the skills and knowledge they needed.

• People had a choice of nutritious, good quality food. People had enough to eat and drink and received support to use healthcare services when they needed to.

• The environment was adapted to meet people’s needs. The home was spacious, wheelchair accessible and pleasantly decorated.

• Staff obtained people’s consent before providing care to them. Where people did not have the capacity to consent, the provider followed appropriate legal processes to ensure decisions about people’s care were made in their best interests, including where decisions were made to deprive people of their liberty as part of the care they received.

• People were involved and enabled to make choices about their care. Staff knew how to communicate information to people so they understood it, including people who did not speak English and people with sensory or cognitive impairments.

• Staff spoke to people in a friendly and respectful way so that people felt comfortable and valued. Staff took time to get to know people well.

• People received care and support from staff who had a good understanding of how to respect and promote their privacy and dignity.

• Staff gave people enough time, encouragement and support to enable them to do as much for themselves as possible.

• People had person-centred care plans that they and their relatives were involved in developing. The care plans contained detailed information about people’s needs, preferences, routines and interests.

• Care plans took into account people’s diverse needs relating to, for example, religion or sexuality.

• The provider had improved the activities that were on offer since our last inspection. People now had more opportunities to engage in individual activities if they did not want to take part in group activities.

• Staff made sure people’s social needs were met, particularly if they did not have relatives visiting them regularly.

• People had end of life care plans to ensure they received appropriate care in their last days.

• There was a robust complaints procedure. The registered manager dealt with concerns and complaints appropriately.

• The provider had clear values and made sure these were communicated to staff. The registered manager made an effort to get to know people and make sure people knew who they were.

• There were clear lines of accountability within the staff team and the registered manager took action where appropriate to ensure staff were clear about their roles and responsibilities.

• Records were generally kept to a high standard. However, we identified some minor concerns around the recording of people’s food and fluid intake and unnecessary paperwork in care files, which the registered manager told us they would address.

• People, relatives and staff had opportunities to express their views and be involved in the running of the service.

• The provider used a range of audits and checks to ensure care was of a high standard, monitor the service and continuously improve the service. They learned from difficult situations and had a proactive approach to solving problems.

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

Rating at last inspection:

• At our last inspection, this service was rated “requires improvement.” Our last report was published on 27 February 2018.

Why we inspected:

• All services rated “requires improvement” are re-inspected normally within 12 months of the last comprehensive inspection report being published.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

We undertook an unannounced inspection on 23 and 24 January 2018. At our previous inspection on 12 and 13 September 2017 we rated the service ‘requires improvement’ and identified six breaches of legal requirements relating to safe care and treatment, person centred care, good governance, staffing, notifications about deaths and other incidents. We issued warning notices in relation to the breaches of regulation relating to good governance and staffing. We undertook this inspection to review the quality and safety of the service and to ensure action had been taken to address the breaches identified at our previous inspection.

The registered manager remained 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.

At this inspection we found the provider had taken sufficient action to address the breaches of regulation identified at our previous inspection. We also saw the provider had taken sufficient action to improve their rating to ‘good’ for the key questions ‘safe’, ‘effective’ and ‘caring’. However, we found the provider was still rated ‘requires improvement’ for the key questions ‘responsive’ and ‘well-led’.

We found that whilst improvements had been made and people were now receiving person-centred care, that some staff’s lack of verbal and written English was impacting on the quality of interactions with people and/or their relatives. The provider had begun providing English classes to staff where English was not their first language and they told us they would continue to do so. Care records had been updated and improved and now provided clear information about people’s support needs and the support staff delivered. However, we found some care records were disorganised and there was a risk that some information may be missed. The provider’s quality and compliance team were in the process of redesigning the care records which would address these concerns.

The group activities programme remained in place and people continued to enjoy the activities on offer. However, we continued to find there was a lack of engagement and stimulation for people who were unable or did not want to engage in the group programme, particularly for people living with dementia. We recommend the provider implements best practice guidance and resources to further support meaningful engagement with people living with dementia.

The registered manager improved their practices to review and improve the quality of service delivery. We saw the programme of monthly audits of key areas of service delivery were adhered to, as well as analysis of key service data to identify any trends which indicate additional support or improvement is required. Whilst much progress was made to improve the monitoring of the quality of service delivery, we saw the staff had not undertaken health and safety checks at regular intervals. The management team told us they would ensure this was rectified.

People felt safe at the service. Risk management processes had been improved and staff were knowledgeable about the risks to people’s safety and how these were to be mitigated. Equipment was regularly checked to ensure it was in good working order and being used appropriately. Staff continued to support people with their medicines and followed good practice in regards to the prevention and control of possible infection. All staff spoken with felt there were sufficient staff to keep people safe and safe recruitment practices remained in place.

The provider had introduced a new training programme to ensure staff had the knowledge and skills to undertake their roles, this included reviewing staff’s competency after completion of each course. Staff were also now receiving regular supervision and an annual appraisal. The chef met with people and specialist healthcare professionals to ensure people’s preferences and dietary requirements were catered to. Staff liaised with a range of healthcare professionals to ensure people’s health needs were met and staff had access to specialist advice and guidance. Staff continued to support people in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff had improved their practice to ensure they supported people with kindness, respect and compassion. Staff were prompt to offer support to people. They communicated to people whilst supporting them and encouraged people to be involved in day to day decisions. Staff respected people’s privacy, dignity, religious and cultural needs.

The provider improved opportunities for staff, people and relatives to feedback about the service and we saw staff were now having regular meetings to discuss service provision. A complaints process remained in place and complaints were investigated and responded to appropriately. Staff worked with other agencies, including the local authority, in order to continuously review and improve practice.

At our last comprehensive inspection in September 2016 the service was rated requires improvement and a breach of regulation relating to good governance, specifically in relation to care records, was identified.

The registered manager had been in post since February 2016. 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.

Sufficient action had not been taken since our previous inspection to address the concerns relating to good governance. Accurate, complete and contemporaneous records were not maintained in regards to the people using the service. Detailed records were not maintained about the support provided. Robust systems were not adhered to in order to review and improve the quality of service provision.

Staff assessed the risks to people’s safety, however, sufficient action was not always taken to minimise and mitigate the identified risks. Risk management plans were not always updated in response to changes in people’s needs and equipment was not sufficiently checked to ensure it was used in a safe way.

Staff did not always follow advice and guidance provided by multi-disciplinary professionals which impacted on the quality of care provision, and at times there was a lack of action recorded in response to changes in people’s health and support needs. There were varying levels of communication between staff and people which impacted on staff’s ability to provide person-centred care.

An activity programme was in place and we observed the activities delivered were well attended and people appeared engaged and enjoying the entertainment. However, for those that did not attend the group activities there was little stimulation and engagement provided. People were often left sitting in silence and staff did not use the resources available to support people living with dementia.

The registered manager had not ensured staff had the knowledge and skills to undertake their duties. Staff had not completed the provider’s mandatory training. The registered manager did not assess staff’s competency to undertake their duties. Staff did not receive regular supervision and appraisal.

The registered manager had not adhered to the requirements of their registration. They had not submitted notifications about death of a service user or allegations of possible abuse.

People received their medicines as prescribed and on the whole safe medicines management processes were followed. However, we identified that accurate records were not always maintained in regards to the administration of topical creams. Staff adhered to the principles of the Mental Capacity Act 2005 and arranged best interests’ meetings for people that did not have the capacity to consent to particular decisions. Staff adhered to the restrictions authorised through Deprivation of Liberty Safeguards (DoLS) in order to keep people safe. Staff supported people with their dietary requirements. A GP visited the service regularly and staff supported people to access healthcare appointments.

Staff respected people’s privacy and did not enter a person’s room without their permission. People were supported to practice their faith. Staff respected people’s wishes in regards to their end of life care decisions.

Mechanisms remained in place to obtain people’s and relatives views and opinions. A complaints process remained in place and staff supported people to raise any concerns they had.

Staff were aware of signs of possible abuse and safeguarding reporting procedures. Additional practices had been implemented in response to safeguarding investigations to minimise the risk of harm to people.

Whilst staff were busy and some staff reported they felt their time was pressured which meant at times they felt unable to give dedicated time to certain tasks, we found there were sufficient staff on duty to keep people safe. Since our previous inspection the registered manager had adjusted their process for allocating staff across the home to help with covering staff sickness and improve flexibility in staffing.

Since our last inspection new Directors had been appointed and they were in the process of strengthening the provider’s senior management team. This included strengthening systems to review the quality of service provision and increasing the support to operations managers and registered managers.

We found the provider was in breach of legal requirements relating to safe care and treatment, person-centred care, staffing, good governance and notifications. You can see what action we have asked the provider to take at the back of the report.

We received concerns that staffing levels had been poor over the weekend especially on Sundays. We undertook a focused inspection on 11 December 2016 to check staffing levels on each floor. At our previous inspection we saw staffing levels had improved and the way the registered manager monitored staffing across the service was getting better. However, we felt there were still improvements to be made to the way staffing levels were determined and monitored. During this focused inspection we found staffing levels were adequate. Staff allocated to each floor were found to be working where and when they should be.

At our last inspection during 24 and 25 November 2015 five breaches of legal requirements were found. This was because there had been a lack of contingency plans to deploy sufficient staff when required. Medicine procedures and records did not always keep people safe. The provider did not always consider peoples mental capacity and follow procedures to make sure people were protected from abuse. Not all care and treatment met people’s needs and reflected their preferences and systems and processes were not in place to identify and assess risk, health and safety and the welfare of people using the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. During this comprehensive inspection we found that the provider had followed their plan and the above legal requirements had been met.

Albany Lodge Nursing Home provides nursing care for up to 100 people over the age of 65, some of whom are living with dementia. It is a purpose built nursing home located over four floors all accessible by lift. At the time of our inspection 89 people were using the service. The manager had applied to the Care Quality Commission (CQC) to be a registered manager for 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 and associated Regulations about how the service is run.

People's care records were in the process of being updated to focus on each individual. These now included details such as peoples likes, dislikes, social histories and how they would like to be cared for. These were near completion at the time of our inspection. The service had also introduced bedside folders to help staff understand individual needs and preferences. These also contained essential information about people’s daily care and checks to ensure people received the care they needed. However, we found some of this information was not completed at times or completed incorrectly. We spoke with managers about our concerns.

People told us they felt safe living at the service. They said staff were kind, caring and respected their privacy and dignity. Staff spoke with people in a kind and sensitive way. They were helpful and polite while supporting people at mealtimes to make sure people had sufficient amounts to eat and drink. People and their relatives were mostly positive about the food at Albany Lodge Nursing Home. Special dietary requirements were catered for and people’s nutritional risks were assessed and monitored.

Staffing levels were adequate at the time of our inspection to help make sure people were safe. New systems had been introduced to ensure a flexible workforce. People, their relatives and staff told us staffing levels had improved, however, there were still times when additional staff cover was needed. Managers were working on new ways to monitor staff numbers to further reduce the risk of inadequate numbers of staff deployed in the home.

The recruitment procedures were appropriate at the time of our inspection and any gaps in staff training had been identified.

We found improvements in the way people’s medicine was being ordered and managed. People received their prescribed medicines at the right times and these were stored securely and administered safely by registered nurses.

People had access to healthcare services when they needed it and received on going healthcare support from GPs and other healthcare professionals.

The provider was aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. Improvements had been made in the way people’s consent to care and their capacity to make decisions had been recorded. When a person was found to lack capacity the reasons for making decisions on people’s behalf were clearly noted.

People’s rooms contained personal belongings and items that were special or of personal value to them and improvements had been made in the signage used and the environment in the communal areas for those people living with dementia.

There was an activities programme at Albany Lodge. The activities staff tried hard to ensure people had the opportunity to be involved in meaningful pastimes to help stop them from feeling lonely or isolated.

Staff felt supported by managers and the provider. The provider had improved the quality assurance process in place that allowed them to identify issues and areas they could improve on.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to accurate record keeping.

During our inspection we spoke with the people who were using the service, their visiting relatives and several members of staff that regularly worked there.

All of the people we spoke with told us they were happy with the overall standard of care provided at the home and felt that staff who worked there were always kind and caring. One person said 'all the staff are lovely' I cannot fault any of them'. Another told us 'the health care assistants are fantastic here. They are so kind and caring to my mother'. Throughout our inspection we saw staff interactions with people who use the service and their guests was always characterised by kindness, warmth and empathy.

However, although people using the service and their visiting relatives told us they were happy with the staff that worked at Albany Lodge; we found people's needs may not always be fully met because the provider had failed to ensure that, at all times, there were sufficient numbers of care staff working in the home. One person told us 'all the staff are so nice, but sometimes you have to wait ages for someone to answer your call bell because they're so busy'. Another person said 'the staff work so hard here, but there's often not enough of them around to look after all the people here properly.

We were able to see that staff training within the service had improved. Staff told us that during the last six months they had attended training to help them fulfil their role and we were able to see documentary evidence of this as well.

Since our last inspection we have been made aware of a number of safeguarding concerns that have occurred within the service. This is where the health and safety of one or more people may not have been protected. All of these concerns were reported to us and to the local authority in line with current guidance. We were able to talk with the manager about the measures that had been put in place to minimise the risk of any future concerns

People told us 'I like the food here, but if I don't like the choices they make me an omelette', and 'the food here is excellent', the food is very nice' and 'there is always plenty to eat'. We saw that tea coffee and soft drinks were available throughout the day.

We have raised some concerns about the way staffing levels were organised in the home. We saw that some people, particularly on the dementia units, were not being appropriately supported. We also judged that not all of the staff had been able to access training to provide them with the necessary skills to meet the needs of the people using the service.

One person said "this is the best, it's really good here" and another told us "we have lovely rooms, always clean and I could bring things in from home, it made it feel more like my own".

People knew how to raise a concern, should they need to. One person said " I know how to make a complaint, but I haven't got any". Another told us " if we have any complaints they ( the management team) sort them out straight away".

On the day that we visited the service we judged it to be compliant. However, during the course of our review of compliance, we had been informed of a previous serious safeguarding matter. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. There was evidencethat the provider had taken the appropriate action by immediately informing the relevant authorities and following their own procedures for responding to it. Since that time some staff have ceased to be employed by the service and there have been changes within in the management structure.

There had also been an improved programme of monitoring by senior personnel within the organisation and a new person had been appointed to manage the home.