Eston Lodge care home

Briarwood Care Home is a residential nursing home providing care and support to up to 49 people. The service provides support to older people and people living with a dementia. Bedrooms are situated over 2 floors. At the time of our inspection there were 21 people using the service, only accessing bedrooms the ground floor.

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

Following the previous inspection in July 2022 the provider sent us an action plan to make the necessary improvements to the service. Whilst some improvements to the service had been made, some areas were identified as needing further action.

People’s medicines were still not always managed safely. Records demonstrated medicines were not always given as prescribed.

Care plans were not person centred. They did not always contain information on how people wished to receive their care and support. Risk assessments were in place for people around risks to their health and wellbeing and there was guidance for staff around supporting people. However, there was still some inconsistency in how information was documented.

Actions had been taken to continue to improve the provider oversight, however audits had not always identified the areas for improvement evidenced during inspection.

People told us they felt safe and well cared for. We observed staff supporting people with kindness and compassion. We saw people smiling and joking with staff, appearing comfortable in their presence.

People were supported to eat enough food and drink. Staff were knowledgeable about people’s nutritional needs. People were supported to access the appropriate healthcare professionals to support their physical and emotional wellbeing.

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.

There were enough staff to meet people’s care and support needs, improvements had been made regarding the use of agency staff. Appropriate background checks and inductions were now in place and recorded.

Staff spoke positively about the management of the service and the support they received. They felt there had been some improvements since the last inspection, especially around the recruitment of permanent staff. There was a new home manager in post who, along with the regional manager, offered reassurances regarding their commitment to make the necessary improvements.

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 10 August 2022) with 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 some improvements had been made in some areas. However, the provider remained in breach of some regulations.

Why we inspected

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

You can read the report from our last inspection, by selecting the 'all reports' link for Briarwood Care Home on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified continued breaches in relation to good governance. We continued with the recommendation around ensuring consistency and clarity within people's support plans.

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 and meet with the manager and provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Briarwood Care Home is a residential nursing home providing care and support to up to 49 people. The service provides support to older people and people living with a dementia. At the time of our inspection, there were 16 people using the service.

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

There were enough staff to safely support people and provide people with person-centred care. However, appropriate checks on agency staff and agency staff inductions were not always in place. The use of agency staff had significantly reduced now, as recruitment had been successful in recent weeks and was ongoing. There were gaps in staff training, but the provider had a training plan in place and additional training had been booked.

People’s medicines management had improved but medicines were still not always safely managed. Guidance and records around covert medicines, creams and lotions, and medicines prescribed on a ‘when required’ basis were not always robust.

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. However, systems in place for monitoring compliance with the Mental Capacity Act were not robust and records were not always clear or effective.

Although provider oversight had improved, audits had not always identified the issues we found on inspection.

The assessment and management of risks to people had improved. The environment was safe and appropriate safety checks were regularly completed. There were some inconsistencies within people’s support plans and we have made a recommendation around reviewing people’s care plans.

People told us they felt safe and lessons were learnt when things went wrong. Good improvements had been made to the decoration and cleanliness of the environment.

People were supported to eat and drink enough to maintain a balanced diet. People were given choice at mealtimes and appropriate support. People were supported to access healthcare services and referrals to professionals were made in an appropriate and timely manner.

People were treated with kindness and compassion. Staff were attentive to people’s needs and people were given choice. People were supported to be independent where possible and people spoke positively about the staff. People were supported to take part in activities which were meaningful to them. The provider dealt with complaints appropriately and understood their responsibility to support people’s individual communication needs.

Engagement with staff, people and relatives had improved. People’s feedback was listened to and acted upon. Regular meetings took place and people spoke positively about the new manager. The regional manager and home manager were open throughout the inspection process and were committed to further and ongoing improvements.

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 28 April 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made. However, not enough improvement had been made in all areas, and the provider remained in breach of some regulations.

This service has been in Special Measures since 21 March 2022. During this inspection the provider demonstrated that some 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 inspection was carried out to follow up on action we told the provider to take at the last inspection. We checked to see whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to good governance and staffing at this inspection. We have made a recommendation around ensuring consistency and clarity within people’s support plans.

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 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.

Briarwood Care Home is a nursing home, which provides care and support for up to 49 older people and people living with a dementia. At the time of our inspection 23 people were using the service.

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

Systems to monitor the quality and safety of the service were ineffective and failed to identify the issues we found. Record keeping throughout the home was poor. People’s care records were not always complete and information we requested about the running of the service could not be located. Staff worked extensive hours and were poorly supervised and supported. The provider failed to act on the feedback sought from people and staff.

Risks to people were not always recognised and mitigated. Medicines were not managed safely. There were not enough staff on duty to ensure people's care and support needs were being met. Appropriate checks were not always conducted prior to agency staff working at the service. Safeguarding and accident and incident records were inaccurate and incomplete, which impacted on the provider’s ability to analyse information and to learn when things went wrong. Effective infection prevention and control measures were not always in place. Areas of the home and equipment were visibly dirty.

People were not always treated with dignity and respect. Staff did promote people’s dignity, independence and self-esteem. People were restricted from accessing toilets and bathrooms independently. Reviews of people’s care and support needs were not always effective.

People’s nutritional and hydration needs were not appropriately managed. People did not receive care and support from suitably skilled and experienced staff. Training and support for staff was not well managed. The home did not always work within the principles of the MCA. Staff did not always act upon guidance from health and social care professionals.

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice.

Care plans did not always reflect people’s current care and support needs. Information from health and social care professionals was not always added into care plans to ensure staff had up to date, accurate information. Information was not readily available in a format people could understand. People were not provided with opportunities to engage in meaningful activities and there was little social interaction between staff and people. The home had created a COVID-19 safe visiting area for relatives and friends to maintain contact with people.

The provider and regional manager were responsive to the concerns and shortfalls found at the inspection and they took immediate action to address the concerns.

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

Rating at last inspection

The last rating for this service was good (28 May 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the safe care and treatment of people. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, dignity and respect, meeting nutritional and hydration needs, good governance and staffing. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan 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.

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.

Briarwood is a nursing home, which provides care and support for up to 49 older people and people living with dementia. At the time of our inspection 24 people were using the service

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

People and their relatives spoke positively about the caring, friendly nature of the service. There was a new manager in post, and we received positive feedback about the improvements made to the service. Regular checks ensured care plans were up to date and included information to provide safe, person centred support for people.

We were assured that people were supported safely with good infection control practices followed.

People received their medicines safely as prescribed. Associated records were in place and completed by suitably trained staff.

Systems and processes in place, ensured people were safe from avoidable harm. A range of quality audits and checks were completed. Provider oversight ensured any required preventative actions were implemented to keep people safe.

Enough suitable staff were employed and supported by the manger. Staff worked well as a team and with other health professionals where additional support was required. 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 enjoyed a range of activities and were supported to remain free from social isolation. Relatives told us communication with people was well managed during the pandemic and that they were looking forward to enjoying direct contact with their loved ones as the restrictions eased.

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 6 December 2019)

Why we inspected

We undertook a focused inspection to review the key questions of safe, effective responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings 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.

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

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.

We found the following examples of good practice.

Systems were in place to allow safe visiting, including screening visitors to reduce any potential infection risk, before they entered the building. Arrangements were being put in place to allow future visits using a specially purchased visiting ‘pod’

Social distancing was encouraged, and changes had been made to communal areas to promote this.

Staff wore personal protective equipment (PPE). Training in infection prevention and control measures and the appropriate use of PPE had taken place. Refresher training had been delivered by the infection control specialist nurse.

Systems were in place to admit people safely into the home.

A regular programme of Covid-19 testing was in place for people and the staff team.

Further information is in the detailed findings below.

Briarwood Care Home is a residential nursing home providing personal and nursing care to older people and people living with a dementia. It accommodates up to 49 people across two units in one purpose-built building. There were 34 people using the service when we visited.

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

People and relatives spoke positively about the care the service provided. Comments from people included, “They couldn’t do more” and, “The staff are there when you need them.”

Risks to people were assessed and addressed. Medicines were mostly managed safely, with further and sustained improvement needed in some areas. Clear and effective infection prevention and control procedures were in place.

People’s consent to care and best interest decisions were recorded.

Care reflected people’s assessed needs and preferences. Steps had been taken to improve activities at the service.

A range of effective quality assurance audits were used to monitor and improve standards.

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 6 December 2019) and there were three 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 targeted inspection to check whether the requirement notices we previously served in relation to breaches of regulation had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

As part of CQC's response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. The Safe domain also therefore contains information around assurances we gained from the registered manager regarding infection control and prevention.

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.

Briarwood Care Home is a residential nursing home providing personal and nursing care to older people and people living with a dementia. It accommodates up to 49 people across three units in one purpose-built building. There were 44 people using the service when we visited.

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

Medicines were not always managed safely. Risks to people were not always assessed or reviewed. Infection control processes were ineffective. Consent was not always obtained or recorded. Care records did not always reflect people’s needs and preferences. Governance systems were not always effective.

We have made a recommendation about staff training on activities for people living with a dementia.

Staffing levels were monitored to ensure people received safe support. Accidents and incidents were reviewed to see if lessons could be learned to keep people safe.

Staff received regular training, supervision and appraisal. 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 staff were caring and kind. People were treated with dignity and respect. Advocates were arranged where this would assist people to make their voice heard.

We received positive feedback on the leadership provided by the registered manager. Staff worked closely in partnership with external professionals and agencies. Feedback was sought from people, relatives and staff.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 November 2018) and there were two 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 enough improvement had not been sustained and the provider was still in breach of regulations.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management, risk assessment and management, infection control, consent and quality assurance processes. 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 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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected in January 2017 and was rated Good. When we returned for this latest inspection we found that medicines were not managed safely. We also found issues with staffing levels, training and governance and management processes. As a result, the rating of the service changed to requires improvement.

This is the second time the service has been rated requires improvement. It was last rated requires improvement at an inspection in 2016.

Briarwood Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Briarwood Care Home accommodates up to 49 people across two units. One unit provides general nursing and residential care, and one unit provides nursing and residential care for people living with a dementia. At the time of our inspection 44 people were using the service.

The service had a manager, who joined the service in June 2018 and had applied to be registered manager at the time of our inspection. 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. They will be referred to as the manager in this report.

The provider, Premier Nursing Homes Limited was taken over by Hill Care Limited in March 2018. Hill Care Limited retained the name and legal status of Premier Nursing Homes Limited as the provider of this service, but replaced them as the legal owner.

Medicines were not always managed safely. Staffing levels were not always sufficient on the unit for people living with a dementia. Staff at the service had not always received the training deemed mandatory by the provider. The provider’s governance processes were not always effective at identifying and resolving issues.

The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Risks to people were assessed and plans put in place to reduce the chances of these occurring. The premises were clean and tidy and the provider had effective infection control systems. Plans were in place to support people in emergency situations. People were safeguarded from abuse.

Staff were supported with regular supervisions, and appraisals were planned. 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 service worked closely with a wide range of external professionals to ensure people received the healthcare they needed. People were supported to manage their food and nutrition. The premises were adapted for the comfort and convenience of people living there.

People spoke positively about staff at the service, describing them as kind and caring. Throughout the inspection we saw numerous examples of staff delivering kind and caring support. People were treated with dignity and respect and were supported to be as independent as possible. Policies and procedures were in place to support people to access advocacy services.

Care plans were in place based on people’s assessed support needs and preferences. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. Nobody at the service was receiving end of life care at the time we inspected, but policies and procedures were in place to support people.

Staff spoke positively about the manager and the change of leadership at the service. The manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Feedback was sought from people, relatives and staff at regular meetings. The manager was working to develop and strengthen a number of links with community groups and agencies.

We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicine management, training records and good governance. You can see what action we took at the back of the full version of this report.

At the last unannounced, comprehensive inspection on 15 December 2015, we identified short falls in staff training and medicine management. There was a lack of recruitment checks for agency staff and best interest decisions were not being made when people lacked capacity. The premises were not clear and there was a malodour throughout and some furniture was in need of replacement. We asked the provider to take action to make improvements to ensure they were meeting regulations. At this inspection we found that the registered provider had taken appropriate action and the service was no longer in breach of any regulation.

Briarwood provides nursing and residential care for up to 49 people and is a purpose built home with a residential unit downstairs and a nursing unit upstairs. The service predominantly supports older people with dementia care needs. The service provides lounge areas, dining areas and bathing facilities. All rooms at the service are en-suite. The service is located close to local amenities and bus routes.

There was a manager in place, who had started the process of applying to be the registered manager. 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.

People and their relatives told us they felt safe. Risk assessments were in place for people who needed these and they had been regularly reviewed and updated when required.

Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks. Falls were also monitored to identify if any trends were occurring.

Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the provider had a policy in place to minimise the risk of abuse occurring. Safeguarding alerts had been made and recorded when needed.

Emergency procedures were in place for staff to follow and personal emergency evacuation plans (PEEPS) were in place for everyone. PEEPs provide staff and emergency services with information about how they can ensure an individual’s safe evacuation from the premises in the event of an emergency. A robust procedure for recording fire drills had been implemented.

Medicines were stored and managed appropriately. The provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when medicines had been administered and disposed of. People we spoke with confirmed they received their medicines when they needed them.

Certificates were in place to ensure the safety of the service in areas such as electrical testing, controlled waste, legionella and fire fighting equipment. Regular checks were made by the maintenance staff in areas such as water temperature, emergency lighting and fire alarms.

A safe recruitment process was followed to reduce the risk of unsuitable staff being employed. All new staff completed a thorough induction process with the registered provider.

There was sufficient staff on duty to meet the needs of people who used the service and people and relative we spoke with confirmed this. Call bells were answered in a timely manner and staff were visible throughout the service.

Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely.

People were supported to maintain their health. People spoke positively about the nutrition and hydration provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take if they suspected a person lacked capacity. Documentation was available in care plans to show best interest decisions that had been made.

Each person was involved with a range of health professionals and this had been documented within each person care records. From speaking with staff we could see that they had a good relationship with health professionals involved in people’s care. People’s care records contained evidence of appropriate referrals to professionals such as falls team, tissue viability nurses and speech and language therapists (SALT).

The service was clean and neutrally decorated throughout but was not always adapted to support people living with a dementia, however plans were in place for improvements to be made. People were able to bring their own furniture and personalise their bedrooms if they wished.

People spoke highly of the service and the staff. People said they were treated with dignity and respect.

People, and where appropriate their relatives, were actively involved in care planning and decision making. This was evident in signed care plans and consent forms. Information on advocacy was available for anyone who required it.

Care plans detailed people’s needs, wishes and preferences, and were person centred. Care plans had been regularly reviewed and we saw evidence that people and relatives had been invited to these reviews.

The service employed an activities coordinator. We saw a range of activities that were on offer; and on the day of inspection we saw activities taking place. People were able to tell us about the activities on offer and told us they enjoyed the activities provided.

The service had a clear process for handling complaints. People we spoke with confirmed they knew how to make a complaint.

Staff told us they enjoyed working at the service and felt supported by the manager and that standards had been improved. Staff told us they were confident any concerns would be dealt with appropriately. We could see from our observations and speaking with people that the manager had a visible presence at the service.

Quality audits were completed by the manager in areas such as care plans, medication, nutrition, accidents and incidents, falls and infection control. Where issues had been identified, action plans had been developed.

Feedback questionnaires had been sent to people and relatives to ask their views of the service. Action plans had not been developed, but we saw minutes of resident meetings which showed that any issues that had been identified had been discussed and appropriate action had been taken as a result.

The service worked with various healthcare and social care agencies and sough professional advice to ensure the individual needs of people were being met.

The manager understood their role and responsibilities and was able to describe when they would be required to submit notifications to CQC.

Briarwood is a purpose built care home which provides residential and nursing care for up to 49 people. At the time of the inspection 40 people were living at the service. The service provides residential care on the ground floor, nursing care on the first floor and the second floor of the premises accommodates the kitchen, laundry and office facilities.

Briarwood supports people living with dementia. The service had four beds which were funded to support people who are experiencing acute difficulties with confusion and needed support when leaving hospital before they go home or whilst assessments can be completed.

The home did not have a registered manager in place. 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 the time of the inspection a manager was in post and had been since 25 June 2015, they confirmed at the inspection they had commenced their application to become the registered manager.

The communal environment in the service was poor as it had a bad odour, plus the flooring and seating was badly stained and in need of replacement. The manager had already recognised this and was working with the registered provider to organise replacements.

We found that safe recruitment and selection procedures were not always followed to ensure appropriate checks had been undertaken before staff began work. Gaps in employment history were not always explored and where agency staff were used to cover shifts we found the manager was not obtaining robust information on the staff the agency was providing.

People told us that there was enough staff on duty to meet people’s needs. The records we saw and observations we made confirmed this.

We found that medicines were not administered safely. We looked at all the records relating to the management of risk and incidences. We found improvements were needed around the risks associated with fire.

We saw that records where staff recorded accidents and incidences did not reflect any learning to prevent future reoccurrence.

Staff who worked at the service had not received appropriate levels of training to enable them to carry out their duties effectively.

Although staff we spoke to told us they felt supported, records showed that staff had not received enough supervision from their line manager or an annual appraisal.

We found that the service was not using the Mental Capacity Act (MCA) to support people who may lack the capacity to make their own decisions to receive support that was deemed in their best interests. Staff had basic knowledge of the MCA and were observed to be working in a way that empowered people to make their own choices and delivering support how people liked to be supported.

The service could not provide us with the number of people who were authorised to be deprived of their liberty at the time of the inspection. Due to the system being unorganised could lead to people being deprived of their liberty unlawfully.

The registered provider had a system in place for responding to people’s concerns and complaints. But this was not always adhered to. People regularly had opportunity to voice their views. There were no effective systems in place to monitor and improve the quality of the service provided.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Although people were weighed regularly we saw that weight was not fully assessed across a time period to look for patterns and long term weight loss or gain.

Care plans were person centred regularly evaluated, reviewed and updated

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with was able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect.

People were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities.

We found that the registered provider was breaching The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; you can see the action we told the provider to take at the end of this report.

The registered provider was also breaching the Care Quality Commission (Registration) Regulations 2009. The Care Quality Commission will deal with this outside of the inspection process.

The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out to answer our five questions; 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?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. The manager

Care plans and risk assessments were in place and updated on a regular basis and were based on people's individual needs and preferences.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes and any issues highlighted and addressed.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew people well. Assessments included dietary, social and leisure and emotional needs.

One person spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals and all relevant information was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with. The manager maintained on-going communication with relatives who lived some distance away from the home via email.

One person told us; 'I can relax here.'

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

Discussion with the manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

Is the service well-led?

There were systems in place to assure the quality of the service provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people said:

People who were able to express their views told us; 'The girls are all nice' and 'I can relax here'. We saw lots of patient and caring interaction with people who were not able to communicate well. Staff told us they felt able to raise any issue with their manager and that they worked well as a team. One staff member said; 'I love it here, I love the people I look after' and another told us; 'We are able to air our views and things get discussed and changed if they are not working'.

We found that staff presumed people lacked capacity to make choices for themselves.

We found that staff did not understand the actions they needed to take to assess someone's capacity.

Records did not contain an assessment of a person's capacity to make decisions for themselves and staff had not acted appropriately when people had been placing themselves at risk.

At this inspection we went back to check the action staff had taken to ensure that people were asked for their consent before any care or treatment was given. We also checked that where people didn't have the capacity to consent, that the provider acted in accordance with legal requirements. We looked at six of 40 (15%) of the care records.

People told us that they were happy with the care and service received. Two relatives we spoke with told us that the care given was good and their family member was settled and comfortable. One relative said, "I visit regularly and I am always made welcome. Staff keep me up to date with how my mother has been." Another relative told us that their family member was always clean and tidy when they visited and there was a good atmosphere.

One person we spoke with told us, "I am very happy with the care here and the staff always treat me respectfully." Another person told us, "I like it here, I have no regrets about the move and the staff are very helpful." A relative we spoke with told us, "Staff always contact me if there are any changes in my mother's condition."

We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. They provided reassurance when one person was restless and disorientated. We saw that staff communicated well with people and explanations of care were given in a way that could be easily understood.

We saw that equipment was suitable for people who needed it.

The manager took steps to ensure the quality of the service.

We saw that records were accurate and kept up to date. Records were stored safely and securely.

During the visit, we spoke with six people who used the service. People told us that they always found the staff to be really kind and helpful. They said, 'They are a lovely set of staff and so kind', 'The girls are good to me', and 'I like living here, there's always people around to give me hand.'

We found that staff were not always able to meet people's personal care needs, particularly if they displayed challenging behaviour. Also the records failed to show that staff had taken appropriate steps to follow the advice of visiting healthcare professionals. Neither had they alerted CQC to incidents that were occurring in the home.

We talked with six staff who were on duty about people's ability to make decisions. We found that staff were unaware of positive risk taking practices or requirements of the Mental Capacity Act 2005. Staff had been made aware that they needed to complete Deprivation of Liberty Safeguard authorisations (DoLs) for some of the people who used the service but had not completed these applications.