Oban House Residential Care Home

Oban House Residential Care Home is a residential care home providing accommodation and personal care to up to 30 people. The service provides support to people with age related frailties and people living with dementia. At the time of our inspection there were 24 people using the service.

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

People’s health and associated risks were not robustly assessed. People’s care records did not contain enough information for staff to safely support them. Risk assessments for people who required support with conditions such as, diabetes, epilepsy and Parkinson’s disease were either vague or not completed. Risk assessments had not been conducted for people who had catheters. People’s weight and the risk of pressure damage to their skin were not routinely assessed and monitored.

People were not always protected from the risk of being supported by unsuitable staff. The provider’s recruitment policy was not followed; staff were deployed before recruitment checks had been carried out and appropriate training had been given. The registered manager was unable to demonstrate safe recruitment of staff. One staff member had an out of date visa and no references on file.

People were at risk of accidents due to environment checks not being completed to identify and mitigate risks. People were able to access areas of the service which were in need of repair. A bathroom and toilet were both in disrepair and were being used to store items. Storage was not orderly, and items posed a trip hazard to people. The registered manager was not aware of all accidents and incidents, healthcare professional advice was not always sought for people following falls. Trends analyses were not completed to learn from and prevent further accidents and incidents.

People were not always protected from the risk of abuse; the provider’s policy did not contain details of local safeguarding arrangements and staff were not aware they could raise concerns with the local authority. Not all staff had received safeguarding training, new staff had not always received this training as part of their induction package.

People and their relatives had no formal processes to feedback on the service. Surveys had not been routinely carried out and meetings had not taken place. Quality assurance audits had not been conducted to identify shortfalls at the service. The medicine audit had gone missing at the time of our inspection.

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. The registered manager had not assessed any person’s mental capacity, they told us everybody had capacity although people openly told us they struggled with their memories. People were subject to some restrictions, the registered manager told us this was to ensure people’s safety, however, restrictions were not documented with a rationale to why they were necessary.

People mostly had access to healthcare services. Due to the lack of analyses and investigation to accidents and incidents, there were missed opportunities for staff to seek healthcare professional advice to support people. The registered manager gave examples where staff had worked well with professionals. We saw people had access to visiting chiropodists and opticians. At the time of our inspection, people were receiving COVID-19 boosters. A visiting healthcare professional told us, “I have found staff to be professional and friendly with the residents at all times.”

People’s care plans did not contain person-centred information about how they wished to be supported. There was little evidence of people’s involvement when planning their care. However, we observed person-centred and kind interactions between staff and people.

People and their relatives told us staff were kind and considerate. One person told us, “I’m quite, happy, lovely staff, no complaints.” A relative said, “They look after [person] well.”

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 28 February 2020).

Why we inspected

We received concerns in relation to the management and reporting of injuries to people, and the storage and disposal of medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Oban House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to assessing safety to people’s health risks and the environment, infection control, staffing, recruitment, safeguarding and good governance.

We have made a recommendation about the induction for new staff.

Follow up

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

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.

Oban House Residential Care Home is a care home providing personal care to 24 people aged 65 and over at the time of the inspection. The home is registered for up to 30 older people living with conditions associated with older age, with the majority of people living an active independent lifestyle. Oban House accommodates people in one adapted building

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

People and their relatives felt the service was safe. A person said, “I feel very safe, the staffing levels I think mean people get the care they need, and more. They are very responsive to when I call my bell. They are always checking in on me and making sure I have everything I need. It provides me with security.” A relative said, “[Person] is very well looked after and they call me if needed.”

Staff understood how to recognise and report concerns or abuse. The provider continued to have a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. There were sufficient staff to meet people's needs.

There were risk assessments in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were enough staff to support people with their daily living and activities.

Training and observation of staff practice, as well as supervision, ensured staff were competent in their roles. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. A person said, “I don’t feel discriminated against for being the age I am and needing the help I need. The staff treat me very well. I am included in all the decisions being made in my life. I know that I am getting older, but the girls keep at me for doing the things I can do myself.”

People were supported to have enough to eat and drink. People and relatives spoke positively about the quality and choices of food and drinks. Staff contacted medical services promptly for advice if there were concerns about people's health.

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

People and relatives said the support provided from staff was kind and caring. A person said, "I think the staff treat me like a member of their family. Very friendly. There is always banter and laughing. It’s a nice place to be. No chance of getting lonely. They care about me.” People commented on how well staff knew them and supported them in the ways they preferred. People said they felt involved in making decisions about their care.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes. There were systems to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people's views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

People and relatives felt the service was well-led and commented on the pleasant working atmosphere amongst staff. The provider and registered manager provided a visible presence. People were encouraged to be involved in the development of Oban House. Staff said the management team were open to suggestions, approachable and felt supported in their roles.

A system of audits monitored and measured all aspects of the service and were used to drive improvement. The registered manager worked proactively with the NHS and Social Services to meet people’s care needs.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 19 February 2019). The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service: The management of ‘as required’ medicines was not always safe. Guidance for staff to safely support people to take their PRN medicines was not in place and recording of PRN medicines was inconsistent. This did not provide assurance that people received these medicines safely. This is an area of practice that needs to improve.

Quality assurance systems and audits did not always identify issues in practice. Medicines audits had failed to identify issues with recording of medicines and staff not having access to information to support the safe administration of PRN medicines. This is an area of practice that needs to improve.

People were safe from the risk of abuse and other identified risks relating to them. One person told us, “I feel safe because they give me assistance when I need it and there is always people around to help.” Specific risks to people had been assessed and were known by staff. Accidents and incidents were well managed and lessons had been learned to improve people’s care. The home was clean and people were protected from infection risks. Staffing levels met people’s needs and staff had been recruited safely.

People received effective care from skilled, supported and knowledgeable staff. The registered manager and staff took opportunities for training and development and worked well as a team and with other professionals to meet people’s needs. People were supported to maintain a balanced diet. People were given choice and control over their lives which promoted their independence. Each person was respected as an individual, with their own social and cultural diversity, values and beliefs.

People received kind and compassionate care. A relative told us, “we are very happy with the care. The staff do all they can and they make such an effort. They are very kind caring towards her.” People’s privacy and dignity were respected and their views listened to. A person told us, “staff really listen to me-really listen.”

People received person centred care that was specific to their needs. The provider and registered manager had implemented a range of activities to enhance people’s lives. There was a complaints procedure in place which was accessible to people. People were supported with compassionate end of life care.

People, staff, relatives and professionals spoke positively of the registered manager. One person told us, “the manager always has time for me, she is very good and cares.” There were a range of audits in place with the aim of driving the quality of the home and most were effective in this. People were supported to be engaged in the running of the home and their opinions were listened to.

Rating at last inspection: Requires Improvement. The home has been rated Requires Improvement at the last three inspections. However, there has been significant improvement across all key questions following the last inspection and the ratings for Effective, Responsive and Well-Led have all improved at this inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had registered with us in March 2018.

This is the third time the home has been rated Requires Improvement. At a comprehensive inspection in January 2017 the overall rating for this service was Requires Improvement with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 identified. At an inspection in September 2017 we found five breaches, and the overall rating remained Requires Improvement. These related to a continued breach of the regulation relating to good governance and four further breaches of regulation in relation to safeguarding people from abuse, providing safe care and treatment, gaining suitable consent to care and notifying us of significant incidents that occurred while people were being supported. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well-led to at least Good. We met with the provider and they confirmed their action plan stating they would have addressed the breaches by February 2018.

This unannounced inspection took place on 19 June 2018 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We identified there were continued breaches as we were not assured that people’s capacity was being assessed in line with best practice guidance or relevant people were involved in best interest decisions. Risks for people were not consistently being assessed, documented and mitigated to ensure their safety. Systems in place to manage accidents and incidents were not robust. Accidents and incidents forms were completed and reviewed, however, action was not always taken to ensure future risks were mitigated and lessons learned.

Quality assurance systems were not robust and did not consistently identify shortfalls in care. The registered manager and provider did not have robust oversight of the home, this is the third consecutive breach of this regulation. The provider failed to ensure they had notified CQC of an allegation of abuse and authorised DoLS applications. The provider had met a breach from the last inspection, people were now safeguarded from abuse as the registered manager investigated allegations promptly. People did not receive consistently safe care. Risks for people were not always assessed and mitigated to ensure their safety.

There was no documentation to evidence that mental capacity assessments had taken place and relevant people were involved in the process for making best interest decisions. Staff were not working in line with the provider’s policy around mental capacity. This practice increased the risk that people’s rights in relation to their mental capacity were being respected.

We identified areas which require improvement that the provider's systems and process had not identified. For example; lack of access to meaningful activity and incomplete records. The registered manager and provider did not have consistent oversight of working practices at the home. They did not fully understand their responsibilities in relation to their registration with the Care Quality Commission (CQC) and had failed to notify us of an allegation of abuse and authorised DoLS applications.

Some records and documents were not complete or accurate.’ Some people’s care plans were brief and lacking guidance for staff. This increased the risk the person would not receive care in line with their assessed needs.

Access to meaningful activity at the home was inconsistent. People gave variable feedback about access to activities at the home. One person told us, “I’d like to go out more. I’ve only been out twice in one year.”

People’s needs were not responded to consistently. People’s care plans did not always reflect their social, cultural or wellbeing needs. This increased the risk that the persons need would not be met in a way that was responsive to their preferences.

People received their medicines in a safe and timely way. There were safe systems in place to manage, administer, store and dispose of medicines. When medicines were required on an ‘as and when’ basis, people had access to them and there was clear guidance in place about their use to ensure safe practice.

Staff received safeguarding training and knew the potential signs of abuse. They understood the correct safeguarding procedures should they suspect people were at risk of harm. The registered manager ensured staff were suitable to work in a care setting prior to them starting.

People were protected from the spread of infection and the home was clean and hygienic. Staff had a good understanding of infection prevention and control issues and they received regular training.

People were asked their consent for day-to-day decisions, for example, their choice of food and drinks. People had access to a balanced diet. We observed people’s lunch time experience, there was a relaxed and friendly atmosphere We also observed staff asking people’s consent before supporting them in a considerate way. People were supported by staff with the skills and knowledge to deliver effective care and support. Staff received training in relation to the needs of older people.

People's everyday health needs were managed by the staff who accessed support from a range of health and social care professionals such as GP’s, a practice nurse, district nurses, social workers and a chiropodist.

People were supported by caring staff. People and their relatives told us that staff were caring and kind. One person told us, “Staff are very pleasant, caring and they do respond to calls for help.” People and their relatives told us they could express their views and be involved in making decisions about their care. One person said, “They do communicate with me about my care” and “I do feel I can make decisions for myself in here.”

People’s independence was promoted and people felt they had the right to make choices. People were offered the opportunity to plan for the end of their lives. Discussions had taken place with people and their families about their end of life care wishes.

People were given information in a way they could understand. The registered manager had considered the use of technology to improve people’s experiences. Staff had access to electronic tablets and a system to monitor people’s health needs. People and staff spoke positively of the management. One member of staff said, “Since the manager has been here it is different, there are new staff and it has improved.”

People, relatives and staff were engaged in the running of the home. There were staff meetings, residents’ surveys and newsletters to keep people informed. One relative told us, “You can approach the manager if there was an issue.”

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.

Oban House Residential Care Home can provide accommodation and personal care for 30 older people. Some people living at the home were living with dementia and some needed support with mobility and sensory needs. There were 23 people living at the home at the time of our inspection.

The home was run by a company who were the registered provider. There was not a registered manager in post but the home had an acting manager who was not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the home. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run. The previous registered manager had been registered from October 2016 to August 2017. The current acting manager began with the home in July 2017 as a deputy manager and became the acting manager in August 2017.

In this report when we talk about the provider or the company we will refer to them as ‘the provider’. Although the registered manager had left the home, they are discussed within the report and will therefore be referred to in this instance as the registered manager.

At the last inspection on the 10 January 2017, we found two breaches of the regulations. The home was rated as ‘Requires Improvement’ and we asked the provider to provide us with a report on the actions they planned to take in response to the breaches. The provider wrote to us to say what they would do to meet the legal requirements in relation to good governance and the provision of sufficient staffing to meet people’s needs. We undertook a comprehensive inspection on 12, 14 September and 26 October 2017 in response to information of concern we had received about the home and to check whether the required actions had been taken to address the breaches previously identified. This report discusses our findings in relation to these breaches.

At this inspection we found improvements had been made in some areas, for example at the last inspection there was insufficient staffing, at this inspection there were now sufficient staff available with the skills to provide care that met people’s needs so there was no longer a breach of this regulation. However further areas of improvement were identified, including a continued breach of the regulation relating to good governance and four further breaches of regulation in relation to safeguarding people from abuse, providing safe care and treatment, gaining suitable consent to care and notifying us of significant incidents that occurred while people were being supported.

At the last inspection the provider was in breach of regulation because their governance and quality assurance checks had not been effective in resolving a number of problems in the running of the home. At this inspection that insufficient progress had been made in this area and this was a continuing breach. Quality assurance systems continued to not be suitably used to promote good governance, safety and the wellbeing of people. Personal and environmental risks including, falls risk, food hygiene and fire safety that could impact on people’s wellbeing were not always suitably managed. Accident reporting was not sufficiently robust and at times the provider was reliant on other agencies to identify and ensure that the home was safe for its intended purpose.

Records and assessments were not consistently reviewed, kept or used to mitigate risks to people’s wellbeing and safety. Staff and the acting manager acknowledged that peoples’ care plans were not detailed enough and that they were not as personalised as they could be. There was a complaints system in place, but people and relatives were not fully aware of it, it was not consistently used and it did not demonstrate that the home learnt lessons from people’s feedback.

The acting manager was building relationships with people, relatives, the staff team and community based health and social care professionals which is positive. However since the last inspection in January 2017 the home has deteriorated and there are now an additional breaches of Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider acknowledged that they had not had full oversight of the home as it continued to deteriorate. They had worked on the basis that the registered manager had quality assurance and management tasks in hand, and had been reassured that actions were being taken when they regularly met with the registered manager. The provider recognised that they would need to have more oversight of quality assurance systems in future and told us that they would be drawing up an action plan with the acting manager to address areas of poor practice discussed at the inspection.

People were not fully protected from the risk of abuse or potential abuse. Staff could tell us about different types of abuse and how they should report it; however, we found evidence that in at least two incidences peoples’ wellbeing was not promoted as the registered manager did not effectively investigate or act on evidence that abuse may have occurred. They also failed to notify the CQC of these incidents and did not inform local safeguarding bodies in a timely way.

Practice around the safe administration of medicines had improved but was still not consistently safe. There were some improvements in how people’s medicines were administered, however there was a lack of guidance in records of what medicines were for and when they should be taken. There was also a significant event investigation completed by a health professional when one person’s wellbeing was impeded by their medicines not being administered as prescribed.

Peoples’ nutritional needs were met, but they felt that they needed more choice in relation to different foods and wanted more home cooked food. Some dietary needs were not fully met, for example people with diabetes did not have guidance available in their care plans that supported catering or care staff to ensure they received a suitable diet.

People with and without capacity were not always supported in line with the principles of the Mental Capacity Act (MCA) 2005. People felt that they could make some day to day choices and some were also able to spend time independently in their local communities. However consideration of people’s capacity had not consistently been given in areas such as having access to a front door key or living in a secured building.

Improvements in supporting people’s privacy had been made. People felt listened to and that their dignity, right to privacy and their diversity was respected by staff. Religious beliefs and access to a place of worship or being able to take part in a religious activity at home were made available. People and their relatives felt that they were involved in planning their care. Some people had more control over their daily experiences then others. Some people were more independent and could take part in meaningful activities in the community. Other people were reliant on relatives visiting and planned activities and many people told us that they missed not having as many activities at the home as there had been in the past.

Improvements in supporting staff had been made. Staff felt well supported and were very positive about the changes the acting manager had made since they began at the home in July 2017. They felt there was more structure in place and that the environment that people lived in was improving as it was cleaner. Staff had not received regular training and the acting manager was planning a schedule of courses to ensure this improved.

Improvements in staffing levels and recruitment processes had been made. People told us that there were enough staff to help them with their needs. This view was also shared by their relatives and other people visiting the service. People felt safe and that they were cared for by kind staff. People and relatives told us that staff were welcoming, and knew how to meet their care needs. Staff were recruited through suitable recruitment processes.

We found 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 the report.

Oban House Residential Care Home can provide accommodation and personal care for 30 older people. There were 14 people living in the service at the time of our inspection.

The service was run by a company who was the registered provider. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that there were not always enough staff on duty to promptly give people the care they needed. We also found that quality checks had not been effective in resolving a number of problems in the running of the service. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the end of the full version of this report.

In addition to these shortfalls we found that medicines were not consistently being managed in the right way and suitable steps had not always been taken to avoid preventable accidents. The procedure used to recruit new staff was not robust and parts of the accommodation were not clean and hygienic. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment.

Some areas of the accommodation were not well maintained and people had not been reliably assisted to ensure they had enough nutrition. Although staff knew how to care for people in the right way they had not received all of the training and guidance that the registered persons said they needed. The registered persons had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People’s right to privacy was not fully promoted. Staff treated people with kindness and compassion. Confidential information was kept private.

People had been consulted about the care they wanted to receive and they had been given most of the assistance they needed. Positive outcomes were promoted for people who lived with dementia. People were supported to express their individuality and they were helped to pursue their hobbies and interests. There was a system for quickly and fairly resolving complaints.

People had not fully benefited from staff acting upon national good practice guidance. People had been consulted about the development of their home and the service was run in an open and inclusive way. Good team work was promoted and staff were supported to speak out if they had any concerns.

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection there were twenty people living in the home. We spent time with fifteen people and asked them about the care they received. We spoke with three people's relatives and a health professional involved with people's care. We also spoke with five staff and the home's registered manager/owner.

We observed how staff supported people and looked at documents including four care plans, training records and management reports.

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

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective

Is the service well led?

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and comments included, 'I couldn't be happier. I came for two weeks and stayed because I felt so well cared for and much safer than I was living on my own.'

There were systems in place to support the provider to learn from events such as accidents and incidents and these were reported to the statutory bodies when required. The home provided staff with guidance in relation to the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure people's freedom and rights were protected. No applications had needed to be submitted. Meetings had been held with families and other professionals to ensure people's best interests were upheld where people required assistance in making some decisions about their lives.

We observed how members of staff cared for and treated people. We saw this was done in a friendly, patient and caring manner. People told us they were always treated kindly and with respect. Comments included, 'It is very nice here, very homely and there is always good food. The staff are lovely, in fact excellent, they give people time and we are never rushed.'

Is the service effective?

People's health and emotional needs were assessed and kept under regular review. People told us they knew about their care plans and families told us they were given opportunities to be involved in all aspects of their relative's care. Care plans detailed people's nutrition and hydration needs and these were regularly reviewed and updated.

People told us they had access to good healthcare support. A healthcare professional that visited the home regularly told us, 'In my opinion it is a relaxed, comfortable and homely home. So much so that when a relative of mine was unwell they went to live in the home for over a year.'

Is the service responsive?

We observe that staff responded promptly to people's requests. Call bells were answered straight away and requests for assistance were treated promptly and with kindness. During our visit we saw that a staff member accompanied a person to a hospital visit. When they returned feedback was given to the manager and their care plan updated to reflect their changing needs.There were activities on offer and people's spiritual needs were addressed.

Is the service well-led?

Records we examined showed us that the home worked with a variety of healthcare professionals on a regular basis. This included local doctors, the community nursing team and palliative care team.

There were systems in place to audit the quality of service provided and for the safety of the environment.

Staff told us that they felt well supported and they were aware of the need to protect people and ensure they received a good quality service at all times. A family member that spoke with us said, 'I am really, really pleased with the care my relative gets. The staff are all lovely and you can speak to the manager or deputy manager at any time. They will always listen and do what they can to help.'

People told us they were happy with life in the home. They told us they were treated with respect and dignity. We saw staff knock on peoples doors. People spoken with confirmed that staff knock on their doors prior to entry. One person told us 'I like everything about the home'.

Care needs were assessed and people confirmed that care was carried out as they wished.

People were protected from abuse in the home. A relative told us that they never saw or heard anything that concerned them.

There were effective infection control procedures.

People were protected by the homes recruitment, training and support practices.

We spoke with ten people, three individually in their rooms and two groups of people in the dining room, two relatives, five staff and the manager. We looked at care plans for four people.

People spoken with told us they were happy with the care they received and that staff were kind. Relatives spoken with told us that they were happy with their family member's care and did not have any complaints.

We were told by people that they felt safe in the home and we saw policies and procedures were in place to safeguard people living in the home. However safeguarding adults training was not in place.

We found that there were not effective infection control systems in the home.

Recruitment procedures were not robust and training and supervision was not up to date.