The Hurst Residential Home

The Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety, alcohol dependency and personality disorders. Peoples ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary). There were 22 people living at the home during our inspection. The provider for The Hurst Residential Home is also the registered manager.

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

The provider’s quality assurance systems failed to identify that care and treatment was not provided in a safe way. Audits had not been used to identify and manage risks to people. The registered manager knew the people who lived in the home very well, but had not ensured that staff had access to the information needed to keep people safe. The management structure was not robust and did not include a deputy manager or senior staff that could support the registered manager in the running of the service.

An infection prevention control audit was carried out by CQC during the inspection. It was found the provider was not meeting government guidelines for COVID-19. There was a lack of clarity on procedures to be followed. There had been no COVID-19 person specific risk assessments completed for people or staff, specifically for those who were vulnerable due to their complex health needs.

People were not always protected from harm as staff were not always provided with effective guidance to know how to keep people safe from harm. Not everyone’s specific health needs were identified and planned for to promote their safety and well-being. There were people who had recently arrived at the home who had not been assessed and therefore had no care plans or risk assessments. When people had accidents or were involved in an incident, there was no review or follow up documented for staff to follow to prevent the same thing happening again. There were outstanding actions on a recent fire assessment from February 2022, for example, non-functioning door guards.

There were some care plans and risk assessments that were comprehensive, and reflected changes to their health and well-being. Medicines were managed safely, and people said they got the medicines they needed. Staffing levels were consistent and were seen be enough to meet people’s needs at the time of inspection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Feedback from people who lived at the Hurst was mostly positive. People told us that, “Staff were really good,” and “The home is a home with good home cooking.”

Staff were open and transparent during the inspection. Staff were kind to people and were committed to delivering good care and support. One staff member said, “This is my first job in care, I am learning so much and really enjoying it here.” Another staff member said, “The Manager is really supportive and the people are such characters. It’s not always straight forward and every day is different.”

There was good partnership working with health care professionals. This was confirmed by their comments. Feedback was sought from people in the form of small house meetings and daily one to one meetings.

The registered manager knew people well and had systems in place to keep staff up to date about people’s needs, this mitigated some of the risks that would otherwise have placed people at more serious risk of harm as documentation was not in place or up to date.

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 13 January 2022).

Why we inspected:

We undertook this focussed inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service.

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

The overall rating for the service has remained Requires Improvement. This is the third time the service has been rated Requires Improvement since the Inadequate rating in 2019.

We have found evidence that the provider needs to make improvements. Please see the relevant key question, safe and well-led sections of this full report.

Enforcement:

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

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up:

We will 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 Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety, alcohol dependency and personality disorders. Peoples ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary) before they return to live in the community. There were 21 people living at the home during our inspection. The provider for The Hurst Residential Home is also the registered manager.

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

Whilst the quality assurance systems have improved, the provider's systems failed to identify that care and treatment was not provided in a safe way. Audits did not always identify and manage risks to people. The provider acknowledged that following a COVID-19 outbreak in June 2021, they haven’t been able to sustain improvements. Senior staff had left, and there was a new team of staff who were settling in, and time was needed to embed systems. The registered manager knew the people who live in the home very well, however there was a lack of management support which meant that they dealt with the day to day running of the home, care planning and staff management. He was also on call everyday. The management structure was not robust and did not include any a deputy manager or any senior staff.

An infection prevention control audit was carried out by CQC during the inspection. It was found the provider was not meeting government guidelines for COVID-19. There was a lack of clarity on procedures to be followed and practice to follow in of infection. There had been no COVID-19 person specific risk assessments completed for people or staff during the pandemic.

Care and treatment was not consistently provided in a safe way. Staff had not all received essential training and the specific training necessary to meet people’s individual needs. There was also minimal evidence that competency assessments for training that had been undertaken.

Not everyone’s specific health needs were identified and planned for to promote their safety and well-being. There were people who had recently arrived at the home who had not been assessed and therefore had no care plans or risk assessments. However, for most people, care plans for were comprehensive, person centred and reflected changes to their health and well-being.

People told us that they were looked after well and enjoyed living at The Hurst. One person said, “I do get the support I need.” Another one said, “The foods good, its clean and I feel safe here.”

Staff were open and transparent during the inspection. Staff were kind to people and wanted to deliver good care. One staff member said, “I haven’t been here long, but I am enjoying it here, interesting job.”

Rating at last inspection:

The last rating for this service was Requires Improvement (published 10 January 2020).

Why we inspected:

We undertook this focussed inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service.

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

Enforcement:

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

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up:

We will 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 Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety, alcohol dependency and personality disorders. Peoples ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary) before they return to live in the community. There were 23 people living at the home during our inspection. The provider for The Hurst Residential Home is also the registered manager.

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

The provider's systems failed to identify that care and treatment was not provided in a safe way. Audits did not always identify risks to people and provide a safe environment. Staff practice was not always effectively monitored. The registered manager knew the people who live in the home very well, however there was a lack of management support which meant that the registered manager dealt with the day to day running of the home, medicine management, care planning and staff management. He was also on call everyday. This was a heavy work load for one person and resulted in the shortfalls we found.

An infection prevention control audit was carried out by CQC during the inspection. It was found the provider was not meeting government guidelines for COVID-19. There was a lack of clarity regarding the use of personal protective equipment (PPE) and prevention of infection. There had been no COVID-19person specific risk assessments completed for people or staff during the pandemic.

Care and treatment was not consistently provided in a safe way. Staff had not all received essential training and the specific training necessary to meet people’s individual needs. There was also minimal evidence that competency assessments for training had been undertaken.

Not everyone’s specific health needs were identified and planned for to promote their safety and well-being. There were three people who had recently arrived at the home who had not been assessed and therefore had had no care plans or risk assessments. However care plans for all but those three were comprehensive, person centred and reflected changes to their health and well-being.

People told us that they were looked after well and enjoyed living at The Hurst. One person said, “I do get the support I need.” Another one said, “The foods good, its clean and I feel safe here.”

Staff were open and transparent during the inspection. Staff were kind to people and wanted to deliver good care. One staff member said, “I haven’t been here long, but I am enjoying it here, interesting job.”

Rating at last inspection:

The last rating for this service was Requires Improvement (published 10 January 2020).

Why we inspected:

We undertook this targeted inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service. We inspected and found there were concerns with infection control, management of people’s safety and provider oversight, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement:

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

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up:

We will 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 Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety, alcohol dependency and personality disorders. Peoples ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary) before they return to live in the community. There were 16 people living at the home during our inspection.

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

The registered manager had made significant improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including with their medicines. Care plans and care delivery was more person centred, however not all people were motivated to engage in activities or life skills and there was a risk of isolation that could impact on their mental health. The registered provider had plans to introduce more person-centred life skill activities. The improvements made at this inspection, needed more time to be sustained, maintained and fully embedded into the culture of the service.

People received safe care and support by sufficient numbers of staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe here, they look out for me.” Another said, “It’s my home, I feel safe.” Improvements to care plans and risk assessments meant peoples’ health, safety and well-being were protected. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent.

Staff had all received essential training to meet peoples support and care needs. Further service specific training was being arranged. This will include managing alcohol addiction. There was an induction programme to introduce new staff to the service and during this process they got to know people and their needs well. One new staff member said, “It’s really lovely here, the people are all individual and characters and the staff team have been really supportive.” People's dietary needs were assessed, and people were provided with a choice of cooked meals each day. Feedback about the food was positive and the majority of people said they enjoyed the meals. There was the opportunity of a fried breakfast three times a week which was enjoyed by people. People’s health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Staff were caring in their approach to the people they supported and at this inspection we saw people were treated with respect and dignity. People and visitors to the service were consistent in their views that staff were kind, caring and supportive. One health professional, “The atmosphere is more positive, there have been improvements, especially in the leadership, communication has improved.” People were relaxed, comfortable and happy in the company of staff and engaged with in a positive way. People’s independence was considered important by all staff and staff supported them to go out in the community.

People confirmed they were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Further training in end of life care was being sought from the local hospice.

People, their relatives and health care professionals had the opportunity to share their views about the service and the care received by regular reviews and meetings. Complaints and ‘grumbles’ made by people were taken seriously and investigated. There had been no formal complaints made since the last inspection.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “We have definitely moved forward, we are having meetings and sharing information. We all feel we can contribute and our views are respected.” People told us, “It’s a happier place,” and “I feel much safer now.”

Some people were enabled to maintain their independence and make their own decisions and choices about what they did each day. People went out into the community and were able to make friendships.

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

Rating at last inspection:

The service was last rated Inadequate (published in June 2019).

This service has been in Special Measures since 28 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

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

Follow up

We have requested monthly progress reports from the provider to understand what they will do to sustain and continuously 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 Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety and personality disorders. Peoples' ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary) before they return to live in the community. There were 20 people living at the home during our inspection.

People’s experience of using this service:

The provider’s governance systems had not identified the shortfalls found at this inspection. There was a lack of clear and accurate records regarding some people's care and support and personal details, such as next of kin and current GP details. The culture of the service was task focused and staff had not always recognised poor practice. For example, the management of behaviours that challenge were not managed safely and effectively. Staff said they had concerns about a lack of teamwork. Feedback from staff and people who lived at The Hurst were not always appropriately acted upon by the provider.

The provider lacked effective quality assurance systems to identify concerns in the service and drive necessary improvement. Audits to improve service delivery had not been done on a regular basis, for example, the daily cleaning check list for the kitchen had not been completed since January 2019. We found concerns about the cleanliness of the kitchen and cooking equipment. This has been referred to the environmental health agency. Immediate requirements from the fire service had not all been actioned and there was no action plan as to how the provider was to action the fire requirements. Environmental audits had not identified the poor maintenance within the home and garden. A fire risk assessment had been completed however, we found areas of potential fire risk in the home that had not been included in this risk assessment.

People’s health, safety and well-being was not always protected, because not all people who lived at The Hurst had a care plan and risk assessment that reflected their identified needs, such as diabetes, epilepsy and anxiety.

Risks to people’s safety was not always mitigated. Infection control procedures were not being followed to prevent spread of infection. Incidents were not fully investigated and analysed to prevent future occurrences. This meant that people's safety and welfare had not been adequately maintained at all times.

Staffing levels had not always ensured that people’s personal care was delivered in line with their assessed needs and preferences. Some staff training was out of date and staff did not always have the skills and expertise required to provide safe care and support. Some staff were unsure of the safeguarding procedures and of how to ensure peoples safety and well being.

Staff were not consistently caring in their approach to the people they supported and people were not always treated with respect. There was a lack of person-centred care and people were not all offered meaningful activities. People told us they were ‘bored’ and ‘nothing much happens here’.

We have made a recommendation about involving people in discussions about their personal care and seeking advice as necessary.

People were supported to receive their medicines safely and when they needed them. One person said, “Staff make sure I take my tablets and that keeps me well” and “I get my pills and insulin on time.” People were supported to have access to healthcare services when they needed them. People told us “The manager takes me in his car” and “The doctor comes and sees me here, much better.”

People's dietary needs were assessed, and people were provided with a choice of cooked meals each day. Not all feedback about the food was positive but the majority of people said they enjoyed the meals . There was the opportunity of a fried breakfast three times a week which was enjoyed by people.

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.

Some people were enabled to maintain their independence and make their own decisions and choices about what they did each day. People went out into the community and were enabled to make friendships.

Recruitment processes were thorough and ensured that staff were suitable for working with people in a care setting.

The service met the characteristics of inadequate in safe and well-led.

Rating at last inspection:

The service was last rated Requires Improvement (published in May 2018).

At that inspection, improvements had been seen, but needed to be embedded in to practice and sustained over a period of time. There were no breaches of regulation.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: Following the inspection we took action to ensure the provider improved the safety in the service. We informed the local authority and clinical commissioning group (CCG) of our concerns.

The overall rating for this registered provider is 'Inadequate' and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

The Hurst Residential Home is registered to provide accommodation and support for people who experience mental health difficulties including depression, anxiety and personality disorders. The home can provide care and support for up to 29 people. There were 13 people living at the home during our inspection. Accommodation is provided over two floors with communal lounge and dining areas. The Hurst Residential 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.

At a comprehensive inspection in January and February 2015 the overall rating was Inadequate and we took appropriate enforcement action at that time. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. We undertook a focussed inspection in December 2015 to see if improvements had been made. Whilst we could see that some action had been taken to improve people’s safety, the poor management of risk to individual people remained. Improvement was still needed to ensure people received support in a person centred way and that care and treatment of people had not been provided with the consent of the relevant person. There were still concerns in respect of the quality assurance systems to drive improvement. We received an action plan from the provider that told us how they were to meet the breaches of regulation by December 2016. We undertook a comprehensive inspection in January and February 2017. We found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and the breaches of regulation previously found had been met. We however found a new breach of regulation in that care plans did not reflect changes to people’s needs and therefore people had not received person centred care. The overall rating in February 2017 was requires improvement.

Following the last inspection in February 2017, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, caring, responsive and well led to at least good. This inspection found improvements had been steadily made and the breach of regulation met. However it was acknowledged that there were still improvements to make, care delivery and practices to embed into everyday practice. The action plan supplied during the inspection identified timescales for areas of improvement to be completed. This was the second consecutive time the overall rating was ‘Requires Improvement’.

A registered manager was 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 and associated Regulations about how the service is run.

Care plans lacked sufficient information on some people’s individual specific health needs. There were people who lived with diabetes, catheters and pressure wounds whose care plan lacked the detail required to provide safe and effective care. These were immediately updated by the registered manager and the risk to people reduced. However there remained a need for the care plans and risk assessments to be continually reviewed and updated to reflect people’s individual needs.

The provider had progressed quality assurance systems to review the support and care provided. However improvements were needed to ensure that an independent overview was also undertaken to capture where improvements were needed alongside the internal audits.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and stair lifts. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in care decisions.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems to ensure medicines had been stored, administered, audited and reviewed appropriately. People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People were given choice about what they wanted to eat and drink. People told us they received food they enjoyed. People were supported to maintain good health. Staff were proactive in ensuring people had access to external healthcare professionals when they needed it. Staff had a good understanding of equality, diversity and human rights. People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals, were in place.

People said they felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people's preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People's end of life care was discussed and planned and their wishes had been respected.

People were encouraged to stay in touch with their families and receive visitors. People were encouraged to express their views and had regular resident meetings. They also said they could talk to the staff and felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people's care provision.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held and staff were able to contribute to the meetings and make suggestions. People said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

The Hurst Residential Home is registered to provide accommodation and support for people who experience mental health difficulties including depression, anxiety and personality disorders. The home can provide care and support for up to 29 people. There were 13 people living at the home during our inspection. Accommodation is provided over two floors with communal lounge and dining areas.

At a comprehensive inspection in January and February 2015 the overall rating was Inadequate and we took appropriate enforcement action at that time. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. We undertook a focussed inspection in December 2015 to see if improvements had been made. Whilst we could see that some action had been taken to improve people’s safety, the poor management of risk to individual people remained. Improvement was still needed to ensure people received support in a person centred way and that care and treatment of people had not been provided with the consent of the relevant person. There were still concerns in respect of the quality assurance systems in place to drive improvement. We received an action plan from the provider that told us how they were to meet the breaches of regulation by December 2016.

This unannounced comprehensive inspection on the 31 January and 3 February 2017 found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and that they had now met the breaches of regulation previously found.

We did however identify a breach of Regulation.

A registered manager was 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 and associated Regulations about how the service is run.

Care plans lacked sufficient information on people’s individual social well-being and specific health needs. Where people’s health needs had changed, such as reduced mobility, care plans did not reflect the changes and therefore new staff may not be aware of important changes to ensure peoples safety.

Information was not always readily available on people’s life history and the reasons why they had to come to live at The Hurst Residential Home. There were no specific goals identified for those who were only there for short term care. The lack of meaningful activities for people at this time impacted negatively on people’s well-being.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However there were areas to improve in regards with mental capacity assessments and best interest meetings.

This inspection showed that the provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and stair lifts. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in care decisions.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there were a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care and falls prevention. Staff said the training was good and helped them to understand people's needs.

Care plans reflected people’s assessed level of support needed for their mental health needs and included peoples input as much as possible. Risk assessments included behaviours that distress, nutritional risks, medicine risks and risks to personal safety. The care plans also highlighted health risks such as diabetes and epilepsy. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

The registered manager undertook all initial assessments and had developed the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on-going. Food and fluid charts were completed when required and showed people were supported to have a varied and nutritious diet.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and friendly. Staff interactions demonstrated staff had built rapport with people and communication was open. Some people preferred their own company and staff respected this.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held regularly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

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

Below is a summary of what we found. The summary describes what the people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is the summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person who uses the service told us 'I feel safe living here, everyone is so kind'.

Systems were in place to make sure that both managers and staff learn from events such as accidents and incidents, complaints and concerns.

Policies and procedures were in place to make sure that unsafe practices were identified and the people were protected.

Is the service effective?

People we spoke with told us they were happy with the care they received and felt their needs had been met. From what we observed and also speaking with the staff it was clear that they understood people's care and support needs and they knew them well. One person told us 'If I need any help with anything the staff are always there for me'.

Staff had received training and development to meet the needs of the people living at the home.

Is the service caring?

Staff were attentive and kind to the people who needed support. Staff told us they encouraged people to maintain their independence. We saw staff were patient and attentive to the needs of the people when supporting them.

People's preferences, interests and diverse needs had been recorded in the care plans we viewed.

People using the service were offered a resident quality assurance survey to complete. Where shortfalls or concerns were raised they had been addressed and discussed with the person.

Is the service responsive?

People's needs had been assessed before they moved into the home. Information had been recorded on detailed care and support plans. People told us they regularly discuss their needs with their support worker.

People knew how to make a complaint if they were unhappy. The complaint's policy was displayed on a notice board to remind people.

People living at the home completed a range of activities. One person we spoke with told us 'we do lots of different things, yesterday we went out for lunch which was lovely'.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way.

A quality assurance system was in place and records we viewed identified shortfalls and these were being addressed by the manager. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurances that were in place. This helped to ensure that people received a good quality service at all times.

There were 13 people living in the home on the day of our inspection visit. One person told us they were, 'Happy living here.' Another said that they were, 'Well cared for,' and that, 'Staff are nice.' One person expressed sadness about staff they liked who had left. However, they told us they liked living in the home. We observed good interaction between staff and people who lived in the home. Staff demonstrated good knowledge of people's needs. We saw some people going out shopping on their own.

We spoke with three external health care professionals. They all said that staff complied with any advice and requests on care and treatment for people who used the service. They told us they received appropriate and timely referrals.

We found improvements in staff training with staff training needs assessed and a programme in place. We found that communication between the manager and staff had improved. The manager had undertaken relevant training for the role with a plan in place for continued update and development. There was evidence of good record keeping and regular review of people's care plans and risk assessments.

We observed that staff treated people with kindness and professionalism.

We spoke to one visiting healthcare professional during our visit. They told us, 'The staff take on the clinical information and they act on it. Information is shared with staff (about people's needs).'

We saw that processes relating to the response to and recording of falls had been improved. Staff that we spoke with were aware of their responsibilities in the updated procedure.

We spoke with four staff, the team leader and the manager. Staff told us that the number of staff working in the afternoon had been increasing. The manager told us that three new staff had commenced employment and three more were awaiting disclosure and barring clearance. A revised induction training process had been introduced.

We found there had been improvements made by the home in response to the warning notices we issued.

People were asked for their permission before any task or activity was undertaken and people's nutritional needs were met. We observed good support from staff towards people who used the service. However, the processes of assessing and monitoring people's needs were not robust.

We spoke with thirteen members of staff. All the staff we spoke with told us they loved working at the home. Staff raised concerns with us about the levels of staffing in the home.

We looked at staff records and saw there was programme of mandatory training, supervision and appraisal for staff. We found that people were at risk because staff training was not up to date. All the staff that we spoke with told us they did not feel listened to by the manager. All staff felt supported by the team leader.

We looked at the standard of record keeping in the home. There had been some improvements since our last visit. However, there continued to be inconsistencies in the care plans.

We reviewed the training undertaken by the registered manager and found that the home's mandatory training requirements had not been met.

We spoke with three members of staff who told us that things had been improving. One care worker told us, 'I love to coming into work.' Another said, 'We try our very best for the people living in the home, making them happy is what it's all about.'

One person that we spoke with told us, 'Everything is all right.' We observed that care provided in the home was caring and respectful.

We found that staff were aware of ways to protect and keep people safe from abuse. There were policies in place and staff understood their responsibilities for observation and reporting. There were no safeguarding incidents to report.

We found that improvements had been made to the storage and administration of medications.

We found that training for staff was being monitored and training sessions were being planned.

We found that care plans had been updated and risk assessments had been reviewed.

There were some inconsistencies in the record keeping which could place people using the service at risk.