Nazareth House - Manchester

Nazareth House – Manchester is a nursing home providing personal and nursing care for adults over 65 years. The home is registered with the Care Quality Commission (CQC) to accommodate a maximum of 66 people. At the time of our inspection there were 27 people living in the home.

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

Care and support was provided to people by a team of staff who were dedicated, passionate and committed to their roles. Staff were caring and always sought to ensure people were treated in a dignified and respectful way.

Managers and staff had worked to address issues found at the last inspections to improve the management of medicines. We found systems in place to manage people’s medicines were safe. We have recommended the service continues to monitor the management of medicines to ensure the improvements made are sustained.

Leadership and management was effective. It was evident throughout the inspection the new registered manager and new wider leadership team had made a positive impact; this was supported by feedback which was wholly positive. Leaders now led by example, creating and embedding a culture where people felt valued, and their individual contributions recognised.

Systems for audit, quality assurance and questioning of practice had improved with clear lines of accountability now established. The provider fully understood the importance of maintaining systems and processes which support good governance. Credible data now being gathered from internal audit and quality assurance meant themes and trends could be identified early, which in turn helped managers and staff to identify risks sooner and take remedial action.

Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. There were enough appropriately trained and skilled staff to meet people’s needs and to keep them safe. We were assured any future new admissions into the home would be done on a phased basis to ensure safe staffing levels were maintained.

The provider had commenced a significant premises improvement and refurbishment programme. Improvement works included redecoration of communal areas, people’s rooms, new flooring and plans to significantly enhance the outside space. To best support people living with dementia and memory problems, we have recommended the provider consults national best practice guidance for creating a dementia friendly environment.

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 those important to them were involved in planning their care. Staff evaluated the quality of care provided involving the person, their families, and other professionals as appropriate.

A desire to re-establish Nazareth House – Manchester as a valued place within the local community was a recurring theme amongst everyone we spoke with. At the heart of this, was renewed commitment made by leaders and staff to a set of shared core values. This was underpinned by the well-established and valued association with the roman catholic church. People affectionately referred to the ‘Nazareth House family’ a family that welcomed people of all faiths, and those of none, and one which embraced and celebrated people from diverse backgrounds.

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 11 October 2022). This service has been in Special Measures since April 2021.

The provider worked collaboratively with local authority and healthcare partners to implement an improvement plan, 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. 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 actions we told the provider to take at the last inspection.

Follow up

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

About the service

Nazareth House – Manchester is a residential care home providing nursing and personal care for up to 66 people. The service provides support to people over the age of 65. At the time of our inspection there were 32 people using the service, some of whom were living with dementia. The service consisted of one nursing unit and one residential unit.

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

Since our last inspection, the provider had started to make some improvements in the governance of the service. However, during this inspection, we continued to find concerns relating to the safe management of medicines.

We identified medication had been out of stock for five people in the four week period prior to the inspection. People had therefore gone without medication they required. We also found the service still required improvement in relation to recording of topical creams being applied, protocols for medication which is to be given ‘when required’ and medication which is to be given at specific times or with food. There continued to be concerns around the storage of creams and medications for waste disposal.

Staff were recruited safely and gave positive feedback about recent face to face training they had completed. Relatives were supported to visit the service. People had detailed risk assessments in place to mitigate risks. However, we found one person’s care plan did not include a falls risk assessment. We raised this with the provider who informed us that these were in the process of being updated.

There were improvements with the oversight of the service, however we found accidents and incidents had not been consistently reviewed by a manager. We also found some inaccuracies with medication audits. The service had begun to identify medication concerns themselves and raised these appropriately with the local authority. Staff and people living at the service gave positive feedback about the recent changes in management at the service. People were aware of the management team and how to raise concerns. Staff morale had also improved at the service. We received positive feedback from people about the support they received from staff.

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

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

Rating at last inspection and update

The last rating for this service was inadequate (published 11 May 2022). At this inspection we found some improvements however, the provider remained in breach of regulations.

Why we inspected

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

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

The overall rating for the service has remained inadequate.

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nazareth House – Manchester on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

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

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

Follow up

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

Nazareth House Manchester is a care home registered to provide nursing and personal care. At the time of the inspection the service were supporting 38 people, the service can support up to 66 people. The service has a nursing unit and two residential units. At the time of our inspection electrical works were ongoing, following an electrical conditions report. This had resulted in people being temporarily moved within the service and being supported across two units.

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

During our previous inspection visits in April 2021 and July 2021 we found people did not receive safe care. At this inspection we found that the provider had made some improvements, but people continued to be at risk of harm. Medicines were not managed safely. Although staff had received training and training compliance had improved it was not clear how staff practice had improved to ensure people received a safe service that met their needs. Governance systems in place to identify shortfalls and ensure improvement were not effective.

Issues relating to the management of medicines have been identified at our last three inspections. At this inspection we found medicines had been out of stock for 15 people in the eight weeks prior. Protocols were missing for medicines which are given as required and instructions on topical medicines administration records did not include the necessary detail. Audits completed by the service had not identified the concerns we found relating to medication

.

Staff training compliance had improved since the last inspection. However, there were concerns about the effectiveness of training due to the ongoing concerns around medicines and maintaining detailed records of care and support provided to people. Staff we spoke with could not recall having a recent supervision.

The provider had made some improvements to the governance and oversight systems in place by introducing a wound care tracker and safeguarding tracker. The safeguarding log at the service and clinical key performance indicator document was not fully completed and up to date on the first day of the inspection. The providers overview document had failed to identify the repeated concerns in medicines and shortfalls we found at this inspection as they relied on the inaccurate medication audits.

Wound care plans were in place where required and record keeping around supporting people with pressure area care had improved.

Infection control practices at the service had improved. Staff were seen wearing appropriate personal protective equipment (PPE) throughout the service. Staff completed lateral flow tests before the start of their shifts, to reduce the risk of transmission of Covid-19 within the service. Following the last inspection additional nurses had been recruited, staff had been recruited safely.

People had end of life care plans in place. However, these often lacked detail. Following a reduction in activities, in part due to the Covid pandemic, the availability of religious services had started to increase. People were engaged in regular meetings about the service. Staff we spoke with were committed to driving improvement at the service. People told us they felt they could approach the manager, if they had concerns.

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

Rating at last inspection and update

The last rating for the service was inadequate (published 8 October 2021). At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 15 June 2021.

Why we inspected

This was a planned inspection based on the previous rating.

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

This was a focussed inspection looking at the Key Questions Safe, Responsive and Well led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the “all reports” link for Nazareth House – Manchester on our website at www.cqc.org.uk

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 monitor the service and will take further action if needed.

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

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

Follow up

We have shared our concerns around medicines with the local safeguarding team. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

Nazareth House Manchester is a care home providing personal and nursing care to 58 people aged 65 and over at the time of the inspection. The service can support up to 66 people. The service consists of one nursing unit and two residential units.

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

Since the last inspection the provider has made limited improvements at the service and there continue to be breaches of regulation at the home.

Poor practice was observed during the inspection around the administration of medication. The frequency of medication audits has increased since the last inspection however, errors continue to be found and there are continued breaches relating to the management of medication within the home. At the last inspection, it was identified that patch medication was not applied correctly in line with the guidance. At this inspection we found continued errors in the application of patch medication.

Concerns around pressure area care were not escalated to healthcare professionals in a timely way. Pressure wound management was not consistently and accurately recorded to ensure appropriate care was given. Insufficient action was taken to provide pressure area care. This may have increased the risk of harm to people.

Appropriate infection prevention and control measures were not maintained. We observed staff wearing their personal protective equipment (PPE) incorrectly on multiple occasions. For example, staff had their masks around their chins. The registered manager had failed to ensure that visitors who needed to complete a lateral flow test had done so before visiting their relatives. This may have increased the risk of transmission of coronavirus within the home.

The provider’s governance systems did not support the provider to have a clear oversight of the home. The systems did not provide an accurate reflection of the concerns within the home. The systems provided limited detail about people living at the home. Accurate records of complaints were not maintained. Records did not always show that the newly recruited staff had been supported in their role or that competencies checks had been completed.

At the start of the inspection there was a registered manager in place. Following the site visit we were informed by the provider that the registered manager had left the organisation. A manager came from another service within the organisation to take over this role.

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 15 June 2021) and there were breaches of regulation.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out a focused inspection of this service on 15 April 2021 and found breaches of legal requirements. We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (safe care and treatment) and Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements. The ratings from previous comprehensive inspections for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

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

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the reports from our previous inspections by selecting the ‘all reports’ link for Nazareth House – Manchester on our website at www.cqc.org.uk.

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 and good governance at this inspection.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

Nazareth House – Manchester is a care home registered to provide nursing and residential care for up to 66 older people. At the time of inspection 65 people, some who lived with dementia, were receiving support.

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

A lack of provider oversight impacted the ability of the service making the required improvements. The provider's inspection history demonstrated improvements had not been sustained and embedded.

Since our last inspection the provider had made limited progress in addressing the concerns, we found with the management of people’s medicines. Although regular audits were taking place, these were not effective at highlighting the shortfalls and we found continued breaches of regulation during this inspection.

Systems in place were not effective enough to support the safe management and administration of medicines. This resulted in some medicines running out of stock and documentation connected to medicines was not always accurate. This placed people at risk of harm from unsafe practices in relation to the management of medicines.

Processes and systems in place to oversee the safety of the home were not always effective. The provider failed to ensure the home’s three passenger lifts received their recent examination due to outstanding essential checks not taking place. The provider decided to suspend the passenger lifts until the works had been completed.

Sufficient numbers of staff continued to meet people's individual safety and support needs. A small number of agency nurses worked at the home, whilst two new permanent nurses awaited their final employment checks to be completed.

The provider carried out checks before staff commenced employment to ensure their suitability to work with people. People received support from a consistent staff team who knew them well.

Risks relating to infection prevention and control (IPC), including in relation to COVID-19 were assessed and managed. Staff followed good infection, prevention and control (IPC) practices. They had access to the required personal protective equipment (PPE), and they used and disposed of it safely.

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 1 January 2020). At the last inspection we issued the provider with a warning notice for Regulation 12. At this inspection we found persistent issues connected to the homes medicines and the home remained in breach of regulations 12 and 17. At this inspection improvements had not been sustained and the provider was still in breach of regulations. The service has deteriorated to inadequate.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in December 2019. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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

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 continued breaches in relation to the management of medicines and good governance.

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

Follow up

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

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 six 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.

Nazareth House – Manchester is a care home registered to provide nursing and residential care for up to 66 older people. At the time of inspection 58 people were using the service. People of all religious faiths are welcomed.

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

At our last inspection medicines were not always managed safely. Quality assurance systems were not robust. At this inspection we found ongoing issues with medicines management and the governance of the service.

Although we identified continued concerns around the safe management of medicines and good governance, we identified other key areas in which improvements had been embedded and sustained. We found improvements to the environment, training and staff deployment had been made.

We found shortfalls in the homes approach to safety. An electrical conditions report completed in March 2016 highlighted the electrical wiring systems needing to be replaced. We found this work had not been completed. During the inspection we were provided with high level assurances from the provider this work would take place in January 2020.

People's care plans did not always contain sufficient or accurate information for staff to be able to support them. End of life care plans were not always in place for people. We recommend the provider develops end of life care planning for people.

Complaints were dealt with in accordance with the organisation's complaints procedure, people said they knew how to complain. People were supported to engage in activities in the home and in the community.

Incident and accidents were recorded and dealt with appropriately. However, the service needed to develop systems that analysed patterns and trends in order to reduce the likelihood of such events occurring in future.

Staff were supported through induction, training and supervision. The management team had identified gaps in staff training at the last inspection and clear timescales were provided for when this would be completed.

Staff knew how to safeguard people from abuse. Staff were recruited using systems which reduced the risk of unsuitable candidates being employed.

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. Staff sought consent from people when assisting them.

The management team had been responsive to feedback from health professionals and commissioners, however, the provider had not been pro-active in identifying the issues raised themselves. The provider's audit systems were not always robust enough to monitor, assess and improve the safety and quality of the service in all areas.

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 3 July 2019).

Enforcement

At our last inspection we served requirement notices for Regulations 11, 12, 17 and 18. Although improvements had been made in certain areas, this did not reflect a sustained approach. At this inspection we have identified breaches for Regulations 9, 12 and 17.

Why we inspected

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 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.

People’s experience of using this service:

At this inspection we found four breaches in the Regulations. This related to staffing, safe medicines management, risk management, staff training and supervisions, people’s lack of participation in developing care plans, leadership and management, quality assurance and record keeping, including food and fluid charts and arrangements for consent to care and treatment.

The service was not well managed. We found shortfalls in the leadership and management of the service. Several managers had been running the home on a day to day basis since March 2018 none of whom had registered with us. The area manager supported us throughout this inspection.

During our inspection the home had recruited a new manager who was registered with us at another service which had achieved a good rating. This person had confirmed their appointment and was waiting to take up the role of home manager.

The providers quality assurance audits and systems had identified the shortfalls we found. However, they had not addressed these shortfalls in a timely way to ensure people were kept safe and the good governance of the service.

Many of the records and information we requested to see could not be located by the area manager. Poor record keeping played an important part in determining the quality rating of the service.

We spent time with the new recently appointed chief executive officer (CEO) who was to become the nominated individual (responsible person) for all the providers services. The CEO had a good understanding of the regulatory requirements the provider must meet and demonstrated a commitment to continuing to drive forward improvements.

We had concerns about staffing support afforded to people to ensure they receive safe, effective, responsive and dignified support. High levels of agency staff were and had been being used. However, feedback received by us was that the staffing situation had recently improved.

Systems in place did not ensure that people received their medicines in a safe way.

It was not always clear from people’s care records if all their identified risks had been assessed and a risk assessment put in place to help guide and support staff to mitigate such risks. We found several low level environmental risks during our inspection visit.

Staff had not received all the training and supervision they needed to support people effectively.

People who were able told us they were always asked for their consent before personal care tasks were carried out. It was not clear on people’s records whether a mental capacity assessment had been carried out to determine if they could make a specific decision when they needed to.

People told us they enjoyed their food. However, hostesses, who had previously taken time to assist, monitor and then record people’s food and fluid intake, had been replaced by putting an additional member of staff in the kitchen.

People where supported by staff who had been safely recruited. Staff knew what action to take if they thought someone was at risk of harm.

People spoke highly about the staff supporting them and said they were treated with dignity and respect. People appeared well cared for. The atmosphere was friendly, calm and quiet.

Rating at last inspection: The service was last inspected in October 2016 and had received a good rating

Why we inspected: This was a planned comprehensive inspection in line with our methodology.

Enforcement: Action we told provider to take can be found at the end of full report.

Follow up: We have requested an action plan from the service to tell us how they intend to make improvements. We will inspect the service again within six months.

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

Nazareth House is registered to care for up to 62 people who require nursing or residential care. People of all religious faiths are welcomed. It is a purpose built home that is attached to the convent of the Sisters of Nazareth. The home is situated in large well-kept gardens within easy reach of public transport and the motorway network. There is plenty of car parking and the home is only a short distance from Prestwich Village. There is level access to the front of the home, a lift to both floors and wide corridors allowing wheelchair access.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures (the reporting of unsafe and/or poor practice).

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

We saw people looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected. People’s care records contained enough information to guide staff on the care and support required. The records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans.

People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

The activities provided were varied and people who used the service told us they enjoyed taking part. We saw that people's religious, cultural and dietary needs and beliefs were respected.

Procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. All areas of the home were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in.

We saw that appropriate environmental risk assessments had been completed in order to promote the safety of people who used the service, members of staff and visitors. Systems were in place for carrying out regular health and safety checks and equipment was serviced and maintained regularly. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

The medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and there was always a choice of meal.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities, such as resident/relative meetings and satisfaction surveys for people to comment on the facilities of the service and the quality of the care provided.

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, speaking with a relative, speaking with management and from looking at records.

Is the service safe?

We saw that systems were in place to protect the rights of people who lacked the capacity to make decisions about their own treatment, care and support. Senior staff were able to fully demonstrate that they had a good understanding of capacity and consent. and knew the procedure to follow in the event of a Deprivation of Liberty Safeguard being required.

Systems were in place to ensure that management and staff learnt from any complaints made.

Is the service caring?

People we spoke with were complimentary about the care provided. We were told, 'Lovely, all very nice' and 'Very good, no problems here'. A relative we spoke with told us, 'The care is marvellous. It is really excellent'.

All staff were trained in The Six Steps to Success programme which aims to enhance 'end of life care' for people.

Is the service effective?

People were assessed before they were admitted to the home to ensure their needs could be met.

People's health was regularly assessed and monitored to ensure that their health and welfare was protected.

Specialist equipment was in place to aid comfort and help in the prevention and treatment of pressure ulcers.

Is the service responsive?

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people using the service.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

Is the service well led?

There were a number of quality assurance systems in place to ensure people were cared for safely.

The service worked in partnership with other organisations to support care provision and service development.

We also spoke with seven members of staff.

The atmosphere was relaxed and homely; we observed staff interacting with people who used the service and it was clear that there were good relationships between them.

There were large gardens with seating and parking. There was an accessible entrance and a lift. Accommodation was provided in three units over two floors and we saw that rooms were light, clean and personalised with people's belongings. Each unit had a separate dining area and a lounge area, although we observed that most people stayed in their rooms. A room was available for families to stay if necessary.

There was a chapel and we were told that Mass took place every day.

We saw that a range of activities was provided and we heard how these were designed to stimulate, for example, to promote hand/eye co-ordination, sensory stimulation and mental stimulation. Staff told us that visitors were encouraged to engage in activities with their relative and we saw a list of suggestions, which included the benefits to be gained, displayed in the home.

A variety of information was displayed around the home, such as complaints, the home's core values and named dignity champions.

We observed people being treated in a dignified way. People's records showed that personal choices had been taken into account in the way their care was delivered.

The people we spoke with were very complimentary about the home, the staff and their care. Their comments included 'I'm so lucky being here. All the staff are so genuine and caring', 'I couldn't ask for more. This place is absolutely brilliant and the care I get couldn't be better' and 'All the staff are excellent. They do everything I need them to do'.

The home was spacious and well maintained, and regular checks were carried out to ensure it was safe.

Staff received regular training that was monitored by the Manager. They had an annual appraisal meeting with their manager and staff told us they felt well supported at work.