Acacia Bank Care Home

The Beeches Care Home is a care home providing personal care to older people, some of whom were living with dementia. The service is registered for 60 people, at the time of our inspection there were 23 people living at the home. The home has two floors however the provider had moved all people to the first-floor unit, with the ground unit remaining empty.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

Risks were not being well managed for people, and where risks had been identified staff were not keeping contemporaneous care records. We were not assured the provider had effective systems for safeguarding vulnerable people. Recruitment processes were not consistent and staff deployment was not safe or effective. Medicines were not well managed, and the provider's governance systems had not identified the shortfalls we found on inspection.

People and relatives told us they felt safe in the service but they often had to wait for support and staff did not have time to spend with them. One person told us, “Most staff are alright, some can be short with me if I don’t do things quickly enough.”

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

We were assured staff and the provider were following and promoting safe infection prevention and control practices.

Right Care:

Care plans were inconsistent in detail. Some lacked relevant information such as appropriate risk assessments, and some care plans failed to capture people’s choices, wishes and preferences. The provider did not have effective oversight of personal care records which did not capture when people had received baths or showers. Nutritional requirements were not being well managed and care staff failed to keep accurate records of people’s food and fluid intake, in line with their requirements.

People’s feedback regarding the provision of food and snacks was mixed. Some people told us they had cooked dinners and enough fluids. Other people told us the quality of the food varied and not everyone reported receiving offers of snacks between meals.

The provider was working well with other professionals such as GP’s district nurses, occupational therapists, relatives confirmed the involvement of these professionals in people’s care.

Right Culture:

The provider did not have effective systems to monitor the quality of the care provided and therefore had failed to drive improvements. There had been inconsistent leadership and management in the service which had resulted in poor governance and oversight. Despite activity coordinators being employed, and some activities taking place, during both days of inspection we found there were many examples of missed opportunities for staff to meaningfully engage with people outside of a planned activity.

People told us staff did not have time to engage with them, and one person told us, “I think they could do with more staff. The staff are always busy.”

Staff felt supported by the new manager and provided positive feedback for being approachable and supportive.

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 19 June 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve promoting dignity and respect and good governance. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 4 and 6 April 2023. A breach of legal requirements was found. We initially undertook this focused inspection on safe, caring and well led, to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there was a concern with adhering to the principles of the Mental Capacity Act 2005, and person-centred care planning, so we widened the scope of the inspection which included the key questions of effective and responsive.

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

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

Enforcement

We have identified breaches in relation to person centred care, safe care and treatment, safe administration of medication, nutrition and hydration, good governance and staffing at this inspection.

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

Follow up

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

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 time frame 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.

The Beeches Care Home is a care home providing personal and nursing care to older people and people living with dementia. The service accommodates up to 60 people over 2 floors in 1 building. At the time of the inspection there were 37 people living at the home.

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

Serious shortfalls were identified which impacted on the safety and quality of care people received. We raised specific issues at the last inspection relating to medicine management which had not been addressed. The registered manager had been seconded to another role overseeing other services and a new manager had recently started in post. There was a lack of effective leadership at provider level and governance arrangements had failed to identify the significant issues we found at this inspection.

Medicines were not managed safely which exposed people to the risk of harm. People were at risk of harm as systems were not in place to effectively assess, monitor and review risks relating to people’s health, safety and welfare. The recruitment process was ineffective and as a result there were gaps in recruitment forms and incomplete processes. The provider had a dependency tool in place to assess the number of staff required. However, staff deployment around the home was ineffective and often meant people were not supported in a way that met their needs and requirements.

Feedback from relatives was generally positive however the feedback from people living in the service was mixed. We observed multiple occasions where people were not treated with dignity and respect, and there was an overwhelming lack of choice given to people. We saw staff were often unaware of the importance of being available for people and responding at times of their distress. A closed culture among staff was observed in the home which contributed to the shortfalls identified at this inspection.

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

The provider was responsive to inspection findings and provided assurances they would make the required improvements to improve the safety and quality of care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 December 2021), and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 21 October 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there was a concern with promoting people’s privacy, dignity and choice, so we widened the scope of the inspection which included the key questions of caring. This report only covers our findings in relation to the Key Questions safe, caring and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safe medicine management, privacy, dignity and choice, staffing 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

If the provider has not made enough improvement within this time frame 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.

The Beeches Care Home is a care home providing personal and nursing care to older people and people living with dementia. The service accommodates up to 60 people over two floors in one building. At the time of the inspection there were 26 people living at the home.

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

Improvements were needed to make sure medicines were managed safely.

People felt safe at The Beeches. When we asked people about this one said, “I’m really well looked after.” A relative of a person living at the home said “Yes (person) is (safe). The care staff are very good.”

Risks to individuals were appropriately assessed and managed and people were safeguarded from the risk of abuse.

There had been considerable improvements in the standards of cleanliness and management of infection control. We were assured that systems were in place and guidance being followed to minimise the risk of spread of infection within the home.

Recruitment was managed safely, and rotas indicated there were enough staff on duty to meet people’s needs safely. Some of the people we spoke with felt there had been occasions, particularly at weekend, when there were not as many staff available.

People who used the service, relatives and staff provided good feedback about their experience. People said they felt safe and staff were caring and kind.

There had been changes in the management team at The Beeches. Environmental improvements were taking place and the new manager had taken steps to involve people who lived at the home and staff in the development of the service.

Systems to monitor and check the service had been improved. The manager used auditing to learn lessons about what had gone wrong and where improvements could be made.

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 30 April 2021) and there were breaches in the regulations 12 and 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve At this inspection we found some improvements had been made and the provider was no longer in breach of regulation 17, although remained in breach of regulation 12.

This service has been in Special Measures since April 2021. During this inspection the provider demonstrated that improvements had 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 was a planned inspection based on the previous rating.

We carried out an unannounced focused inspection of this service on 17 February and 16 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beeches Care Home 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 a breach of regulation12 (Safe Care and Treatment) in relation to safe management of medicines.

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

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 Beeches Care Home is a care home providing personal and nursing care to older people and people living with dementia. The service accommodates up to 60 people over two floors in one building. On day one of the inspection, 29 people were using the service. On day two of inspection, 28 people were using the service.

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

People were not safe. On the first day of inspection we had serious concerns regarding the inadequate systems and processes which failed to protect people from the risks of infection. On the second day of inspection, we found infection prevention and control had significantly improved throughout the home.

Risks to individuals were not appropriately assessed and managed. Medicines were not always managed safely.

Staff we spoke with told us there were enough staff to meet people’s needs. However, during the COVID-19 outbreak and as staff were taking their annual leave, due to the end of the leave year, there were times when staffing was stretched. Health professionals involved in people’s care told us delays in staff reporting important updates about people’s health status in a timely way presented difficulties in accessing the support they needed.

Staff were recruited safely. The management team understood how to report safeguarding concerns. People we spoke with mostly felt their relatives were safe but some raised concerns about staffing levels.

Systems and processes for monitoring quality and safety of the service were not effective. There was a lack evidence of action taken in relation to issues identified in order to promote safety and drive improvement.

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

Rating at last inspection

The last rating for this service was good (published December 2017).

Why we inspected

We received concerns in relation to infection control and management of risk. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beeches Care Home 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 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.

Special Measures:

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

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection took place on 16, 24 August and 22 November 2017. The first two visits were unannounced, and the last was announced. The previous inspection took place on 8 and 9 March 2016 where we rated the service as ‘Requires Improvement’ overall and found one breach of regulation relating to complaints. At this inspection we found the provider was no longer in breach of that regulation.

At the early stage of our inspection the service had a manager who was going through the registered manager’s process. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. On our third visit we found the manager had registered with the CQC on 11 September 2017.

The home looked well maintained, clean and tidy, and checks were carried out to make sure the premises and equipment were safe.

Although people who used the service and their relatives told us they felt the service was safe, initially we observed care and support was not always delivered safely. For example, we saw some people were prescribed topical medicines such as creams and ointments. However, in some instances there was no indication to show how frequently the cream or ointment should be applied. In the case of one person, the cream prescribed should have been applied to their wrists and or hands. However, records clearly showed that staff on several occasions had applied the cream to the person’s hands and knees and sometimes only to their knees. On the last visit, we saw evidence the new registered manager had addressed earlier concerns regarding topical medicines.

Staff responded to people’s individual needs and delivered personalised care. People’s care plans and other records showed their needs had been assessed and care was usually planned. However, during the first inspection visit, we found some care plans had not always been updated when staff had noted significant changes in people’s needs as part of their monthly review. The manager had already identified care plans as an area for improvement and action was being taken to improve them. On the last visit we saw positive changes had been made which addressed people’s care plans and these had been regularly reviewed.

There were sufficient staff with the right level of skills and experience and several staff told us the staffing arrangements had improved. Appropriate checks were carried out before staff were employed.

People who used the service and their relatives told us they were happy with the staff that provided care and support. Staff we spoke with said they felt well supported and received training that ensured they knew how to do their job well. They said they understood their role and responsibilities. Staff we spoke with understood their responsibilities around how they should support people with decision making.

People told us they enjoyed the food, and had plenty to eat and drink. During the early part of the inspection the service was not always found to be acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Some senior staff did not know the people who had a DoLS in place and if conditions were attached. However, we found evidence on the last visit that the registered manager had held meetings with staff and discussed DoLS. Staff were all aware of who had a DoLS in place and any conditions attached.

People told us they were well cared for and visiting relatives told us the service was caring. We observed staff supported people in a calm, compassionate and sensitive way. Staff were cheerful and friendly. When staff assisted people to move and transfer they explained what was happening and reassured them throughout. Systems were in place that ensured people accessed healthcare services.

People told us they would talk to staff and management if they had any concerns; and complaints had been responded to in an acceptable manner which resolved the issue where possible in a satisfactory way. We saw several written compliments had been received.

We received positive feedback from people about the manager. Several relatives described them as “welcoming” and several staff described them as “supportive”. Resident and relative meetings as well as staff meetings were held. We saw from meeting minutes that people had the opportunity to discuss the service and were informed of planned events.

Audits and checks were undertaken on the service. At the initial inspection visit, some audits did not seem sufficiently robust as they had not identified some of the issues we brought to the attention of the manager. However, by the last visit, audits had improved and those undertaken were more rigorous showing action taken when issues were identified.

The Beeches Care Home is a purpose built home situated in the Wibsey area of Bradford. It is registered to provide personal care with nursing care for up to 60 older people. The home has a lift which provides easy access to all floors. The home is on a bus route and there is ample car parking.

The service did not have a registered manager in place. The service had not had a registered manager since June 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living in the home told us they felt safe and well cared for. We found there were enough staff to support people effectively. The staff were knowledgeable about the individual needs of the people and knew how to recognise signs of abuse.

The acting manager and provider followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. People were supported with their medicines in a safe way. Bottles of medicines were not always labelled with the date of opening.

The premises and equipment were appropriately maintained and we noted safety checks were carried out regularly. Risks to people's health and safety had been identified, assessed and managed safely.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people's rights were protected and they were encouraged to make decisions for themselves.

People had their nutritional needs met and were offered a choice at every meal time. People were offered a varied diet and were provided with sufficient drinks and snacks. People with specific nutritional needs received support in line with their care plan.

Most staff were not always able to maintain and develop their skills by on-going training. Although staff spoken with told us they had access to range of learning opportunities and said they were well supported by the acting manager and the provider. We found large numbers of staff had not completed all training courses.

We saw staff were caring, positive, encouraging and attentive when communicating and supporting people. Visitors were made welcome in the home and people were supported to maintain relationships with their friends and relatives.

Care records and risk assessments were person-centred and were an accurate reflection of the person's care and support needs. The care plans were written with the person, so they were able to influence the delivery of their care.

Care plans included people’s likes and preferences and were reviewed regularly to reflect changes to the person's needs and circumstances. People had good access to healthcare professionals.

People knew how to raise concerns and complaints if they needed to. However appropriate action was not always taken to address issues that were raised. People's views of the service were sought and responded to appropriately.

There was an open and friendly atmosphere in the home, which showed the staff and acting manager had good relationships and knew people well. We observed staff treating people with respect whilst assisting them to maintain their independence.

All people, most relatives and staff spoken with had confidence in the acting manager and felt the home had clear leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people living in the home and their relatives.

We found one 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 report.

We reviewed the records that were kept at the home and looked at the way they were stored and managed.

We saw that care plans were clearly indexed and information about the needs of people living at the home was therefore easy for staff to access. We saw reviews of care plans had taken place and were fit for purpose.

We looked at people's daily records which were kept by the home. These provided a detailed and accurate record of people's daily routines, activities they had participated in and any information relating to their health and well-being. We saw that each care plan held evidence of audits being completed on a six monthly basis..

We saw that assessments regarding people's hydration and nutritional needs were translated into daily charts to record food and fluid intake. Where needed, these records were supplemented by monthly weight checks.

We saw that all the necessary documentation and supportive evidence was available to enable the requirements of the Mental Capacity Act 2005 to be met when Deprivation of Liberty Safeguards (DoLS) authorisations were being sought.

Maintenance records and safety certificates were readily available for us to inspect.

Was the service caring?

Was the service responsive?

Was the service safe?

Was the service effective?

Was the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Was the service safe?

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

We found evidence that people were not always protected from the risks of unsafe or inappropriate care and treatment as the care provider did not maintain accurate and relevant records in relation to the care and treatment provided to people. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to records.

We spoke with five people who used the service and they told us they were pleased with the standard of care and felt respected by the staff. One person said, "Everyone should have staff like these" and another person said, "Staff are like friends here."

The provider told us they were familiar with the requirements of the Mental Capacity Act 2005 (MCA) and was aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

Was the service effective?

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

The home had a good working relationship with other health care professionals and followed their guidance and advice. The input of other health care professionals involved in people's care and treatment was clearly recorded in their care plan.

We saw all staff completed a comprehensive induction programme which took into account recognised standards within the care sector and was relevant to their workplace and their roles.

Was the service caring?

People who used the service told us they were very happy with the care and facilities provided at The Beeches. One person said, 'Staff are very nice.' Another person told us, 'I try to do as much as I can and the staff respect this.'

We found the staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. They felt confident the service provided to people who lived at the home was good and they encouraged them to remain as independent as possible.

We found the atmosphere within the home was friendly and welcoming and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Was the service responsive?

People's needs were assessed and care and support was planned and delivered the majority of the time in line with their care plan. Care records contained good information about how care and support should be delivered.

Wherever possible people who used the service and/ their relatives were involved in discussions about their care and the risks associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

People knew how to make a complaint if they were unhappy and were confident if they made a complaint it would be investigated thoroughly and action taken if appropriate. There was evidence that learning from incidents/investigations took place and appropriate changes were implemented.

Was the service well led?

We saw there was a quality assurance monitoring system through audits that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

The staff we spoke with confirmed they were well supported by the manager and seniors and said they could contact them at any time if they had concerns. This ensured the needs of people who used the service were met in line with their agreed support plan.

Their comments included: "You get good care here", 'They are all very nice' and 'I am very well looked after here'.

We found the home had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw evidence there was an appropriate system in place for listening to and acting on people's comments and concerns.

We spent time observing the lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

All the interactions we saw between carers and people who used the service and visitors were respectful. We saw some people engaged in activities with members of staff such as 'Happy Hour', singing, watching TV and arm chair exercises. The Activities Coordinator told us various activities were delivered on a daily basis.