Archived: Melrose Residential Home

Melrose is located in a residential area of Leyland, close to the town centre. The home is on three floors, with passenger lift access. Accommodation is provided in single rooms for up to 26 adults, who need assistance with personal care. At the time of this inspection there were 16 people who lived at the home. There is easy access to local amenities, such as shops, supermarkets, pubs and churches. Some parking spaces are available at the front of the home and on road parking is also permitted. There are garden areas to the front and rear of the premises.

The last inspection of this location was conducted on 27 and 28 February 2018. At that time, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care, safe care and treatment and good governance. We served two warning notices against the regulations of safe care and treatment and good governance, because these were continued breaches. Due to these failings a rating of ‘Inadequate’ was awarded to the domain of ‘safe’ and therefore the home remained in ‘special measures’. This means that the service was kept under review, and was inspected again within six months of the inspection report being published. The key questions of ‘effective’, ‘responsive’ and ‘well-led’ were rated as, ‘requires improvement’, with the key question of ‘caring’ being rated as ‘good.’

Following the last inspection, the provider developed an improvement plan to confirm how and when they were going to make improvements, in order to improve the key questions of ‘safe’, ‘effective’, ‘responsive’ and ‘well-led’ to at least ‘good.’

This inspection was unannounced, which meant that people did not know we were going to visit the home. It was undertaken on 15, 16 and 18 October 2018. At the time of the inspection there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

At this inspection we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment and good governance. We also found three additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to need for consent, safeguarding people from abuse and improper treatment and staffing. A breach of regulation 18 of the Care Quality Commission (Registration) regulations was also identified, as the provider was failing to send notifications of reportable events to the Care Quality Commission.

People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible. However, systems in the service did not always support this practice, as assessments had not always been conducted in order to determine if people had the mental capacity to make decisions and to give consent for their care and support.

We found risks to people’s health and safety had not always been identified and mitigated, in order to safeguard people from harm. There were also some safety issues noted during our tour of the premises. We found people’s needs were not always met and people’s safety was being compromised. The staffing levels were not adequate to meet the needs of those who lived at the home. This was evidenced by the excessive number of unwitnessed falls experienced by those who lived at Melrose.

We found infection control practices had improved. The environment was, in general clean throughout. Some refurbishment had been completed since our last inspection, which enhanced the environment for those who lived at Melrose.

We found some improvements had been made to the planning of people’s care. However, assessed needs had not always been incorporated into the care planning process. This meant that people may have not always received the care and support they required. We made a recommendation about this.

Policies in relation to equality and diversity had not been introduced. We made a recommendation about this.

We found people who lived at the home were treated with respect and their privacy and dignity was consistently promoted. People looked happy and comfortable in the presence of staff. We observed some lovely interactions by staff members with those who lived at Melrose.

At this inspection we found that medicines were not managed safely. We assessed the systems for monitoring the quality of service provided. We found there was little oversight and leadership of the service. Quality monitoring, governance and oversight systems were not effective.

We looked at the personnel records of three staff members who were employed at Melrose. We found that recruitment practices adopted by the home could have been better. We made a recommendation about this.

Although induction programmes and a variety of training had been provided for the staff team, records showed that supervision and appraisal sessions were sporadic and not structured. We made a recommendation about this.

We found the home had not always shared appropriate information with the relevant authorities and statutory notifications had not always been submitted to the Care Quality Commission.

Meals looked appetising and were well presented and we observed a pleasant dining experience for those who lived at the home.

We found that equipment had been serviced in accordance with the manufacturer’s recommendations, to ensure they were fit for use.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received.

People we spoke with were complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. Most we spoke with expressed their satisfaction about the home and the services provided.

We did not see much evidence of the provision of leisure activities and people who lived at the home felt this was an area which could be improved. We made a recommendation about this.

At this inspection, although we found the plans of care to be better, further improvements were still needed. People were not always involved in planning their own care and support. We made a recommendation about this.

This service remains 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 so that 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

Melrose is located in a residential area of Leyland, close to the town centre. The home is on three floors, with passenger lift access. Accommodation is provided in single rooms for up to 26 adults, who need assistance with personal care. There is easy access to local amenities, such as shops, supermarkets, pubs and churches. Some parking spaces are available at the front of the home and on road parking is also permitted. There are garden areas to the front and rear of the premises.

The last inspection of this location was conducted on 27 and 30 June and 10 July 2017. At that time we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; requirements relating to registered managers; person centred care; dignity and respect; need for consent; safe care and treatment; safeguarding service users from abuse and improper treatment; good governance and fit and proper persons employed. We also found a breach of the Health and Social Care Act 2008 (Registration) Regulations 2009 in relation to notifications of other incidents. Due to these failings an overall rating of ‘Inadequate’ was awarded at that time and therefore the home was placed in ‘special measures’. This means that the service was kept under review, and would be inspected again within six months of the inspection report being published.

Following the last inspection, we met with the provider to confirm what they would do and by when, in order to improve all five key questions to at least good. Due to the significant on-going failings of this service we also served a notice of proposal to cancel the registered manager’s registration. Representations received from the registered manager were not upheld.

This inspection was unannounced, which meant that people did not know we were going to visit the home and it was conducted by two adult social care inspectors from the Care Quality Commission.

This inspection was undertaken on 27 and 28 February 2018. The new manager was on duty at the time of our inspection. She had been in post for four months and was in the process of applying to the Care Quality Commission to become the registered manager of Melrose Residential Home. 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 of the Health and Social Care Act and associated regulations about how the service is run.

At this inspection we found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care; safe care and treatment and good governance.

We were told by the manager that no-one who lived at the home was being deprived of their liberty. People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible. However, systems in the service did not always support this practice, as assessments had not always been conducted in order to determine if people had the mental capacity to make decisions and to give consent for their care and support. We made a recommendation about this. Staff we spoke with had little knowledge around the area of advocacy. We made a recommendation about this.

We found risks to people’s health and safety had not always been identified and mitigated, in order to keep people safe from harm. There were also some minor safety issues noted during our tour of the premises.

We found infection control practices were better, although some areas were still in need of improvement. The environment was clean and hygienic throughout, except for the catering facilities, which were in need of a thorough clean.

We found the management of medicines to be poor. This put people at risk of harm, due to unsafe medicine practices.

We found some improvements had been made to the planning of people’s care. However, assessed needs had not always been incorporated into the care planning process. This meant that people may have not always received the care and support they required.

We found people who lived at the home were treated with respect and their privacy and dignity was consistently promoted.

We assessed the systems for monitoring the quality of service provided. We found the quality monitoring, governance and oversight systems had improved since our last inspection, although further improvements were still needed.

We looked at the personnel records of three staff members who were employed at Melrose. We found that recruitment practices adopted by the home were satisfactory. All relevant checks had been conducted and required documentation obtained. This helped to ensure that new employees were deemed fit to work with vulnerable people.We found some improvements had been made and the new manager was working towards a more structured approach around staff support mechanisms. We made a recommendation about this.

We found the home had shared appropriate information with the relevant authorities and statutory notifications had been submitted to the Care Quality Commission.

A new manager had been appointed, who had made some progress. However, further improvements were still needed.

At this inspection we found the environment to be warm throughout. However, the premises were in need of updating and modernising, as the environment was looking tired and worn. We made a recommendation about this.

People looked happy and comfortable in the presence of staff.

Meals looked appetising and were well presented, although the atmosphere was not conducive to an enjoyable dining experience. We made a recommendation about this.

We found that systems and equipment had in general been serviced in accordance with the manufacturer’s recommendations, to ensure they were fit for use, although there was no record available to show the hoist slings had been appropriately serviced. However, we were told the hoists were not being used by those who currently lived at the home.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received.

People we spoke with were complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the services provided.

We did not see much evidence of the provision of leisure activities and people who lived at the home felt this was an area which could be improved. We made a recommendation about this.

At the last inspection the overall rating for this service was 'Inadequate' and the service was therefore placed in 'special measures'.

At this inspection we found some improvements had been made. However, although the overall rating is now ‘requires improvement’, the domain of ‘safe’ remains ‘inadequate’. Therefore, the service remains 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 so that 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

You can see what action we told the provider to take at the back of the full version of the report.

The last inspection of this location was conducted on 7 February 2017. An overall rating of ‘Requires improvement’ was awarded at that time. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at that inspection. These were in relation to person centred care, need for consent, safe care and treatment and good governance.

This inspection was unannounced, which meant that people did not know we were going to visit the home. It was initially a focused inspection undertaken on 27 June 2017, following concerns raised by the local authority safeguarding team. However, additional breaches were identified in other areas and therefore a full comprehensive inspection was undertaken. The two adult social care inspectors inspected the home again on the 30th June and 10 July 2017 to gather further evidence required, in order to complete the comprehensive inspection.

The registered manager was on duty at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

At the last inspection we found the provider had not ensured that the care planning process always accurately reflected people’s needs and was always person centred.

At this inspection we found that four people who had lived at the home for several months did not have any care plans in place and another person did not have short term care plans around recent surgical procedures. Therefore, no guidance was provided for staff about the specific needs of these people and how these needs were to be best met. These people were therefore at risk of receiving unsafe or inappropriate care and support.

At the last inspection we found that the provider had not ensured that consent to care and treatment had always been sought from people who were assessed as having the capacity to make decisions.

At this inspection we found that the provider had not sought any consent from four people who lived at the home and who had not been assessed as lacking capacity to make decisions. The consent forms for many of the other people had only been partially completed. Therefore, people were receiving care and support, which they had not formally consented to.

At the last inspection we found that the provider had not always ensured that assessments had been conducted in order to mitigate potential risks to the health, safety and welfare of those who lived at the home.

At this inspection we found that four people did not have any risk assessments in place and the provider had also failed to fully protect others who lived at the home, as the risk management process was insufficient.

We found that steps had not been taken to assess people’s ongoing needs and plans of care or risk management plans had not been developed in order to keep them safe. This did not promote people’s safety and therefore they were potentially at risk of harm.

At the last inspection we found that medicines were not always managed safely.

At this inspection we found the management of medicines was not robust and therefore people were at risk of medicine mismanagement.

At the last inspection we found that the provider had not ensured that effective systems had been established in order to assess and monitor the quality of service provided.

At this inspection we found that there were no effective systems in place to adequately assess and monitor the quality of service provided. Although surveys had been circulated to those who lived at the home and their relatives the auditing system was insufficient. The registered providers did not provide an oversight of the home in order to monitor the quality of service delivered. There were no meetings held between managers and providers, the staff team or for residents and their relatives, so that people could keep up to date with any changes and could discuss any topics in an open forum, should they wish to do so.

In addition to the continuous above failings we also found that recruitment practices adopted by the home were not always robust, in order to ensure that people employed were fit to work with vulnerable adults.

We found that training for the staff team was not sufficient to help them fulfil their roles in a competent and skilful manner. Supervision and appraisals for staff were not adequate to allow appropriate monitoring and support for those who worked at Melrose.

At this inspection we found the environment to be warm throughout. However, the premises were in need of updating and modernising, as the environment was looking tired and worn. We made a recommendation about this.

There were some safety issues noted during our tour of the premises, such as easy access to domestic chemicals and poor infection control practices. We noted two fire doors were propped in the open position and a third was prevented from closing by the carpet pile. This presented a fire risk for the people who lived in these rooms. Some fire records were not up to date.

People looked happy and comfortable in the presence of staff. Meals were being well managed.

The service had not always reported safeguarding concerns to the relevant authorities. Records showed that the principals of the Mental Capacity Act 2005 ad the Deprivation of Liberty Safeguards were not being sufficiently implemented and people's privacy and dignity was not consistently respected.

At the last inspection we found that systems had not been appropriately serviced or maintained, in accordance with the manufacturer's recommendations. At this inspection we found that systems and equipment had been serviced in accordance with the manufacturer’s recommendations, to ensure they were fit for use.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received.

People we spoke with were complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the services provided.

We did not see evidence of the provision of leisure activities and people who lived at the home felt this was an area which could be improved. We made a recommendation about this.

We found multiple breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care; dignity and respect; need for consent; safe care and treatment; safeguarding service users from abuse and improper treatment; good governance; staffing and fit and proper persons employed. We also found a breach of The Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents.

Management Review meetings were held on the 27, 30 June 2017 and 07, 10 July 2017. These were decision making processes about risk, impact and the level of concern of each of the breaches. Discussions were also held to decide how the Care Quality Commission could mitigate risks to ensure people living at Melrose Residential Home could be kept safe.

The overall rating for this service 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 so that 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 last inspection of this location was conducted on 11 June 2015. An overall rating of ‘Requires improvement’ was awarded at that time. We did not find any breaches of the previous Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. However, we did make some recommendations.

This inspection was conducted on 07 February 2017 and it was unannounced, which meant that people did not know we were going to visit the home.

The registered manager was on duty at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations about how the service is run.

We found that new staff had been appropriately appointed and therefore people who lived at Melrose were protected by the recruitment practices adopted by the home.

We found that a varied training programme had been provided for the staff team, which helped them to keep abreast of current practices and any changes in legislation. Supervision sessions and appraisals for staff were being conducted, but these were on an ad hoc basis and were not structured.

At this inspection we found the environment to be warm and comfortable throughout. However, we noted a fire door was propped in the open position. We made a recommendation about this. We observed staff members interacting well with those who lived at Melrose. People looked happy and comfortable in the presence of staff and were enjoying their company.

Records we saw did not demonstrate that potential risks to people’s health, safety and welfare had been assessed and actions implemented to mitigate such risks, in order protect people from harm. Conflicting information was sometimes provided within the records we saw.

Systems within the home had not always been serviced in accordance with the manufacturers’ recommendations. During the course of this inspection we assessed the management of medicines and found that on this occasion these were not being well managed.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided information about how people needed to be assisted from the building, should the need arise. Records showed that equipment and systems within the home had not always been serviced in accordance with the manufacturer’s recommendations.

Records showed that Mental Capacity Assessments had been conducted, but these did not demonstrate how the level of capacity had been determined. We made a recommendation about this.

People's privacy and dignity was consistently respected.

The service had, in general reported safeguarding concerns to the relevant authorities and suitable arrangements were in place to ensure that staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. A range of health and safety training was provided for the staff team.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received.

The service worked well with a range of community professionals. This helped to ensure that people's health care needs were being appropriately met. Meals were, in general being well managed.

People we spoke with were complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the services provided.

Regular meetings were not held for the staff team. This would enable those who worked at the home to discuss topics of interest in an open forum. Residents and relatives meetings had not been held either at regular intervals. This would enable the managers of the home to pass on any important information and would enable people and their relatives to discuss any areas of concern, which they may have.

We did not see evidence of the provision of leisure activities and people who lived at the home felt this was an area which could be improved. We recommend that the provision of activities be assessed and tailored to the wishes of those who live at the home.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, need for consent, good governance and person centred-care.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, staff supporting them and from looking at records. We also consulted two community professionals and the local authority commissioning team.

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

Is the service safe?

Individual risks to people who used the service, in areas such as falling or developing pressure ulcers, were not properly assessed. In some cases we found that people were at very high risk but there were no care plans in place to help keep them safe.

People's medicines were not always managed safely. We found that people did not always receive their prescribed medicines, which meant their health and wellbeing was placed at unnecessary risk.

A lack of safe systems for the prevention and control of infection meant that people were at increased risk of acquiring infectious diseases.

Procedures for the safe maintenance of equipment were not always followed, which compromised the health and safety of people who used or worked for the service.

People's needs were not always taken into account when deciding staffing levels for the home. There were not always adequate numbers of staff on duty to support all the people who used the service in a safe manner.

Following the inspection we shared our findings with a number of other agencies to help ensure the health, safety and wellbeing of people who used the service was protected. These agencies included the local safeguarding authority, the local fire service, the community infection control team and local authority commissioners.

Is the service effective?

There was a lack of understanding in relation to the legal rights of people who did not have capacity to consent to their care. This meant people's rights under the Mental Capacity Act were not always upheld.

Staff didn't receive training in all the necessary areas to carry out their roles effectively. For example training in mental capacity and infection control had not been provided to any staff at the home.

Is the service caring?

People who used the service spoke highly of staff and the registered manager. People felt they were treated with kindness and respect. We observed staff going about their duties and interacting with people in a pleasant and patient manner.

Is the service responsive?

There was a lack of understanding about some people's individual needs and preferences because care planning was of a poor standard. In some cases, people's care plans didn't contain any information about their personal needs or wishes, or the things that mattered to them.

There was no activities programme at the home and people were not provided with support to pursue their interests or hobbies. There were no trips out of the home made available to people who used the service.

Is the service well led?

Systems for identifying risk and monitoring quality were not effective. This meant that people were sometimes at unnecessary risk because no actions had been taken to keep them safe.

Audits were not regularly conducted which meant that opportunities for improvement were often missed.

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.

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

Equipment was not always maintained.

We looked at the MARs and found them to be generally in good order. However, we did find that one signature was missing within the records relating to one person. The registered manager was made aware of this and advised us she would speak to the individual staff member responsible for this omission. The service provider should take action to ensure all staff who handle medicines at the home follow the correct procedures so that records are properly maintained.

We were informed that in recent months, a legitimate visitor to the home had been let in by a visiting relative. The service provider should take note that security of the home is properly maintained to ensure that people's health and wellbeing is promoted and protected.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People's needs were taken into account with signage and the layout of the service, enabling people to move around freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People at the home said that they felt their needs were very well met by the staff. One relative said that the staff were very helpful, and knew their relative very well. They added that the staff were quick to respond to requests for help.

We observed the staff work with people in positive ways, giving them time to think, treating them with care and respect, and responding to their requests for help and support. People living at the home said that they felt safe and secure. One person said that they knew they could always turn to a staff member for help and reassurance. A relative said that they believed their loved one lived in a very safe and caring environment.

Is the service responsive?

People completed various activities in and outside the service. People knew how to make a complaint if they were unhappy. The registered person did not always protect service users, and others who may be at risk, against the risks associated with the effectiveness of some equipment in the home, and the deployment of staff working in the home. There were not always enough qualified, skilled and experienced staff to effectively meet people's needs.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system in place. Staff had a good understanding of the ethos of the home and wanted to ensure it was implemented.

People had care plans that promoted a person centred approach to their care. We observed staff were attentive to peoples request for assistance and spoke to people respectfully. Staff knew how to care for people at risk of falling, developing pressure ulcers or may not eat enough.

Visiting arrangements were very good. 'I have plenty of visitors. Staff will give them a cup of tea, well it's like being in your own home, the first thing you do is put the kettle on. We have a good life considering'.

People were cared for by staff who had character checks to ensure they were fit, trustworthy, qualified and able to do their job.

The provider regularly visited the service and asked people about the service they received, the staff and their accommodation.

Visitors to the home sent written comments such as 'Thank you and your staff for the excellent way that you all cared for him'. And 'I visited the home regularly and saw for myself how caring, considerate and friendly all the staff were in their dealing with the residents'.