Archived: Marquis Court (Tudor House) Care Home

Marquis Court (Tudor House) Care Home is a nursing home providing personal and nursing care to up to 52 people. The service provides support to older people some of whom are living with dementia. The care home accommodates people across two separate floors in one building each with their own separate facilities. At the time of our inspection there were 17 people using the service.

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

Significant improvements had been made to assessing people’s risks, but further improvements were required to ensure all risks were escalated when needed. For example, risk assessments did not contain sufficient guidance regarding escalating concerns around people’s continence needs. Risk assessments were updated when needed but quality checks did not always ensure other related documentation was also amended to ensure guidance for staff remained consistent. Systems in place to review daily records did not always identify concerns. Where one person’s dentures had broken, this had been documented by staff but not escalated. Audit documentation was not always completed in full, so it was not clear when actions had been addressed.

People told us they felt safe and staff understood how to manage their risks. People were supported by a sufficient number of staff to meet their needs safely. People received support with repositioning or wound care in line with their care plans. Improvements had been made to the storage of medicines and medicines were now stored safely. Protocols had been put in place for ‘when required’ medicines and these were administered safely. The home was clean, and measures were in place to reduce the risk of infection. Where things went wrong, the provider had taken action.

People’s needs assessments were holistic and considered their likes, dislikes and preferences. People’s diverse needs had been considered in their assessments such as how they would like their religious needs met. People were supported by well trained staff who had the skills and competence to meet their needs. People were supported to eat and drink in line with their care plans. People’s nutritional and fluid intake and weights were monitored when needed. The provider was proactive in referring to health professionals to ensure people received the care they needed. People had personalised their bedrooms and the home had been adapted to support people with their orientation around the home. 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 were supported by staff who treated them with kindness. Relatives told us staff were caring and knew people well. Staff respected people’s privacy and dignity. Staff promoted and encouraged people’s independence where possible.

People had choice over how their needs were met, and care was delivered in a personalised way. People were supported by staff who knew them well. People had personalised care plans in place that were regularly reviewed. Complaints were addressed in line with the provider’s complaints policy and relatives told us they were satisfied with how the provider addressed complaints.

People had end of life plans in place. An activities programme was in place and people told us there was enough for them to do. People were supported by staff who understand how to communicate with them to maximise their understanding.

The manager was new to their role, but people and relatives knew who they were and spoke positively about them. The manager was well supported by the registered manager and regional manager and the management team were clear about their roles. Quality monitoring systems at the home had improved significantly. Systems had been implemented to improve clinical oversight and these were effective. People and relatives were encouraged to provide feedback regarding the home and action was taken on this. The provider worked closely with other professionals and with the local authority to make improvements.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 20 January 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service is now rated requires improvement. This service has been rated either requires improvement or inadequate for the last 9 consecutive inspections. Despite the repeated requires improvement ratings, significant improvements had been made at this inspection, but more improvements are required, and the provider needs to evidence these improvements can be sustained over a longer period of time.

This service has been in Special Measures since 20 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Follow up

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

About the service

Marquis Court (Tudor House) Care Home is a nursing home providing accommodation and nursing and personal care to a maximum of 52 older adults. People are supported over 2 floors at the home. At the time of our inspection 26 people lived at the home some of whom were living with dementia.

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

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

People had to wait for their care, as there were not enough staff to support them in a timely way. People did not receive the support they required around mealtimes, pressure care and wound care. This had resulted in people losing weight and the condition of their skin deteriorating. People experiencing periods of anxiety and distress did not have care plans to enable staff to meet these needs in a consistently safe and effective way.

People's dignity was not promoted. Staff used disrespectful language to describe people's needs. People had limited access to activities and personalised care in line with their needs and preferences. People and relatives were not happy with social activities available to occupy their time. People were not safeguarded from potential harm as they were not receiving the care and support they required.

People were not supported in a safe environment as doors were left open to rooms containing harmful substances. People did not have end of life care plans in place which comprehensively explored their needs and wishes at the end of their lives. We have made a recommendation about supporting people in line with their preferences at the end of their lives.

Although people and their relatives knew how to complain, complaints were not always acted upon. Governance systems were ineffective as they had not identified the concerns found at this inspection. Leadership at the home was inadequate and improvements had not been identified or embedded to ensure people experienced good quality care and support. The home had not received a rating of good overall since they registered with us in 2014.

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 September 2019) and there was a breach of regulations. 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 regulation and further breaches had been identified. This service has been rated requires improvement for the last 9 consecutive inspections.

Why we inspected

This inspection was prompted by information being shared from external partners that the home had improved since our 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 changed to inadequate based on the findings of this inspection.

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 found a repeated breach in relation to the governance and oversight at this inspection. We have also found further breaches in people's safe care and treatment, person centred care, nutrition and hydration care and staffing. Please see the Safe, Effective, Responsive and Well-led sections of this full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marquis Court (Tudor House) Care Home on our website at www.cqc.org.uk.

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

Marquis Court (Tudor House) Care Home is a nursing home providing personal and nursing care to 28 older adults. Care is provided on two floors. Some of the people are living with dementia. The service can support up to 52 people.

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

Marquis Court (Tudor House) Care Home continues to be rated as requires improvement. The provider had identified areas of improvement and continued to work through these actions. People felt there could be more to do and activities on offer could be improved. Care records and documentation did not always have the detailed information staff may need.

People were safe and happy with the care they received. Risks to people were considered and reviewed. There were enough staff available for people. Medicines were managed in a safe way. Infection control procedures in place and followed. Lessons were learnt when things went wrong.

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 support this practice. People had access to health professionals when needed. They were supported to maintain healthy diets. Peoples needs were assessed and considered. There was a complaints procedure in place.

People were supported by staff they were happy with. People were encouraged to remain independent, offered choices and their privacy and dignity was maintained.

Audits were carried out in the home, so improvements could be identified. Feedback was sought from people and relatives who used the service. We were notified of significant events as needed.

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 (6 December 2018).

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 all regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding’s. A decision was made for us to inspect and examine those risks. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to good governance, as the home has continued to be rated as requires Improvement.

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.

Marquis Court Tudor House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 52 people in one adapted building, arranged over two floors. There is a floor for residential care and a floor for nursing care. At the time of our inspection, there were 31 people living there, some of whom were living with dementia. There is a communal lounge and separate dining room on each floor and a small garden area to the front and side of the home.

There was a registered manager in post. They were unavailable during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection we asked the provider to take action to make improvements to staffing within the home. At this inspection the provider has not made the necessary action.

There were not enough staff available for people and they had to wait for support. We raised this as a concern at our last inspection and the provider has not taken the necessary action to comply with this regulation. This is the fifth consecutive time this service has been rated as requires improvements.

The lack of staff in the home meant people were not always encouraged to be independent or supported in a kind and caring way. This was because staff were rushing and did not always have time to spend with people to ensure they received the support they needed. This included a condition of one person’s DoLS authorisation not being met. We also found people’s capacity had not always been assessed when needed. At this inspection people are not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice

People felt there could be more to do in the home and there was not always the opportunity for people to participate in activities they enjoyed. People did not always receive care that was responsive to their needs and care records were not always accurate completed.

People were happy with the staff that supported them and the provider had ensured they were suitably recruited. Staff understood safeguarding and how to protect people from potential harm. People were encouraged to make choices and their privacy and dignity was considered. People were happy with the food and drink that was available. There were infection control procedures in place and these were followed.

Risks to people were considered and reviewed and medicines were managed in a safe way. Staff received an induction and training that helped them support people. The home was decorated in accordance with people’s needs and preferences.

Staff offered consistent care and knew people well. When people complained they were happy with the outcome, there were complaints procedures in place that the provider followed. People were supported to access health services when needed. Staff felt listened to and knew who the registered manager was. Relatives and friends could freely visit the home. The provider worked jointly with health professionals who came into the home. The provider was displaying their rating in line with their requirements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

We carried out an unannounced inspection at Marquis Court Tudor House on 20 March 2018.

Marquis Court Tudor House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 52 people in one adapted building, arranged over two floors. At the time of our inspection, there were 30 people living there, some of whom were living with dementia. There is a communal lounge and separate dining room on each floor and a small garden area to the front and side of the home.

The service had a 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service has been rated as ‘requires improvement’ at the four comprehensive inspections carried out since 2014 and there have been repeated breaches of the regulations. Our last comprehensive inspection of this service was on 22 February 2017. We found the provider was not meeting the regulatory requirements because people were not always protected from the risks associated with their care, there were insufficient staff to support people in a timely way and people were not always treated with dignity and respect. The provider’s quality assurance systems were not effective in identifying shortfalls and ensuring that regulatory requirements were met. We rated the service as ‘requires improvement’. Following the comprehensive inspection, we issued a warning notice and told the provider to take action to ensure people received safe care and treatment by 24 April 2017. The provider sent us an action plan saying how and by when they would meet the legal requirements. On 15 May 2017, we undertook an unannounced, focused inspection to check that they had followed their plan and taken the relevant action needed to meet the requirements of the warning notice. We found that the required improvements had been made to the way risks were managed and that people were protected from avoidable harm. This meant the warning notice had been met.

At this comprehensive inspection, we checked that the provider had met the remaining legal requirements and had improved the key questions of safe, effective and well-led to at least ‘good’. We found some improvements in the management and oversight of people’s care and we saw significant improvements in the staff culture, reflected in people’s views that staff were consistently kind and caring. However, further improvements were needed to ensure people received timely, personalised care and that systems to monitor the quality and safety of the service were effective in ensuring the service is consistently well led and meeting all legal requirements.

We found there were not enough staff to support people in a timely, person centred way that promoted their dignity at all times. Systems used to set staffing levels were not effective in ensuring there were sufficient staff available to meet people’s individual needs and preferences at all times. People were protected from the risk of abuse and staff knew what actions they should take to minimise the risks associated with people’s care. However, we could not be assured there were sufficient staff to support people to stay safe at all times.

People did not always feel involved in planning their care and people’s individual needs were not always identified and met. People were not always supported to access activities that interested them and were relevant to their needs and preferences. We have recommended that the provider seeks guidance in this area to ensure people are supported to have choice and control over how they receive their care. People and relatives were asked for their feedback on the service but we could not be assured that the systems used were always effective in identifying concerns and areas for improvement.

Most people enjoyed a positive mealtime experience but the availability of staff meant people were not always supported to manage their dietary needs. People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording, storage and disposal of medicines.

The provider followed safe recruitment procedures to ensure they were safe to work with people. Staff received training and ongoing support to fulfil their role. The provider monitored this to ensure they provided care in line with best practice.

The provider followed legal requirements when people lacked the capacity to make certain decisions. People were supported to have maximum choice and control of their lives and staff did supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring and encouraged them to have choice over their daily routine. People had access to their GP and other health care professionals when needed. People were encouraged to maintain relationships with family and friends and visitors were not restricted.

There was an open, inclusive atmosphere at the service. People and their relatives felt able to raise any concerns and complaints with the registered manager and staff. Staff felt supported by senior staff and the registered manager.

The registered manager had notified us of important events that occurred in the service, as required by their registration with us.

We found continued breaches of the regulations. We have asked the provider to send us a written report setting out how they plan to improve the quality and safety of the service and the experience of people using the service. They must send this to us by no later than 28 days after receipt of our request. We will continue to monitor the service and may take enforcement action if we are not satisfied with their progress.

We carried out an unannounced comprehensive inspection of this service on 22 February 2017 and found four breaches of the legal requirements. On 14 March 2017 we issued a warning notice to the provider in Regulation 12 HCSA (RA) Regulations 2014 Safe care and treatment. This was in relation to the management of risks to the health, safety and wellbeing of service users. We told the provider to take action before the 24 April 2017. After the warning notice was issued, the provider wrote to us to tell us what action they were taking.

We undertook this focused inspection on 15 May 2017 to check that they had followed their plan and taken the relevant action needed to meet the requirements of the warning notice. This report only covers our findings in relation to those requirements set out in the warning notices. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court Tudor House on our website at www.cqc.org.uk

There was a 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the focused inspection on 15 May 2017, we found that the required improvements had been made to the way risks were managed. Where risks to people’s health and safety had been identified, plans were in place to guide staff on the actions they should take to minimise these risks. We saw staff followed the guidance to protect people from avoidable harm.

The provider had increased staffing levels and we saw that people received timely support. However, further action was needed to demonstrate that the provider had acted on all the concerns raised at the last inspection to demonstrate there were sufficient, suitably trained staff available at all times. This meant there was a continued breach of the legal requirements.

People were safe because the provider followed recruitment procedures to ensure staff were suitable to work in a caring environment. Staff understood their responsibilities to protect people from the risk of abuse. Systems were in place to audit medicines to ensure any errors could be identified and rectified.

Marquis Court (Tudor House) provides accommodation for up to 52 people who require nursing or personal care, divided into a nursing and a residential unit over two floors. Some people have complex medical conditions and some people are living with dementia. On the day of our inspection visit, 28 people were living at the home. We had previously inspected the home in September 2016 and rated the home as Requires Improvement overall with specific concerns about the management of risks associated with people’s care and medicines and that people were not always treated with dignity.

We received an action plan from the provider in October 2016 which said the improvements would be made by January 2017. At this inspection, we found some improvements had been made but further action was still needed to ensure the legal requirements were being met. We also found improvements were needed to ensure there were sufficient, suitably qualified staff available to meet people’s needs and the effectiveness of the provider’s quality assurance systems.

There was a registered manager who had started working at the service in October 2016 and had registered with us in February 2017. 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 improvements were still needed to ensure risks associated with people’s care were always managed safely. The registered manager had made improvements to ensure medicines were administered, stored and recorded safely. However, there were insufficient, suitably qualified staff and people’s medicines were sometimes delayed and people’s care needs were not always met in a timely fashion. Staff were busy which meant interactions with people were limited and at times, staff did not always treat people with dignity and respect. People were not always supported to have an enjoyable mealtime experience and some people’s individual needs were not met. The activities co-ordinator had been absent from the service for some time and people were not always offered opportunities to join in social activities and follow their hobbies and interests

People and their relatives had told the provider on a number of occasions that there were insufficient staff to meet their needs. However, the provider had failed to act on their feedback and had not effectively assessed, monitored and mitigated risks to ensure there were sufficient suitably qualified staff to meet people’s needs at all times. Quality assurance checks were not always effective in identifying shortfalls and driving improvements in the service.

Improvements were needed to ensure staff received effective training and support to meet the needs of people they cared for. The provider followed procedures to ensure staff were suitable to work in a caring environment.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. People accessed the support of other health professionals when needed and were encouraged to keep in contact with family and friends. Visitors were able to visit without restriction. Relatives felt involved in people’s care and were kept informed of any changes.

The registered manager and staff understood their responsibilities to support people to make their own decisions as much as possible. Where people lacked the capacity to make decisions for themselves, decisions were made in people’s best interests which followed legal guidance. Where people were being restricted of their liberty in their best interests, the registered manager had applied for the required legal approval.

People felt confident raising concerns and complaints. The provider was open and transparent and kept people informed about things that were happening in the service.

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

This inspection took place on 20 September 2016 and was unannounced.

Marquis Court (Tudor House) provides accommodation for up to 52 people who require nursing or personal care, divided into a nursing and a residential unit over two floors. Some people have more complex medical conditions and some people are living with dementia. On the day of our inspection visit, 36 people were living at the home.

We inspected the home in November 2015 and rated the home as Requires Improvement overall with specific concerns about the sufficiency of staff to meet people’s needs and the effectiveness of the systems used to assess, monitor and improve the quality of the service. We received an action plan from the provider which said the improvements would be made by July 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed in the administration and management of people’s medicines and the risks associated with people’s care.

There was a registered manager but they had recently left their employment with the provider and were no longer working at the service. 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. The management of the service was being overseen by the regional manager and a nurse consultant, who had been brought in to deliver improvements at the service. The regional manager told us the provider was arranging for an interim manager whilst a permanent manager was recruited.

At the last inspection we asked the provider to ensure there were sufficient staff to meet people’s needs at all times. At this inspection we found there were sufficient staff to meet people’s needs but further action was needed to ensure staff were effectively deployed to provide timely support to people in communal areas and during mealtimes.

At the last inspection we asked the provider to make improvements to their quality assurance systems to ensure the quality and safety of the service was maintained. In the absence of the registered manager, some of the systems being used to monitor the quality and safety of service provided were not up to date and we found shortfalls in the management of people’s medicines and the systems used to monitor the accuracy of care records. We found there was a lack of management oversight which meant that some people did not receive their medicines as prescribed and staff did not always take action when people’s needs changed. Risks associated with people’s care were not always well managed and some people did not receive care and treatment that met their individual needs and ensured their safety and wellbeing.

Whilst some staff were observed to treat people in a kind and compassionate manner this was not always demonstrated by other staff, who did not always treat people with dignity and respect. Staff did not always interact with people when they were supporting them. Staff and they encouraged people to make choices about their daily routine to promote their independence.

People told us they had enough to eat and drink but some people weren’t happy about the quality and variety and meals and this was being addressed by the provider. People told us they received the support of other health professionals when needed.

Staff told us they received an induction and training to fulfil their role and the provider was taking action to ensure staff received all the training they needed to provide effective care. Staff felt supported by the management team overseeing the service but were concerned that the improvements that had been made would not be sustained.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, the required legal authorisations had been applied for.

People were provided with opportunities to join in social activities and were encouraged to follow their hobbies and interests. People were encouraged to maintain important relationships and visitors were made welcome.

People felt able to raise concerns and complaints but did not ways feel action was taken. People told us they had given their feedback on the service but were not aware of any changes that had been made to improve the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We are changing how we inspect services in the future and also making changes in how we report our findings. Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that Marquis Court (Tudor House) was a good place in which to live and the staff cared and supported them well.

Sufficient staff were provided to deliver people's care needs and they received the training they needed to provide the necessary care and support.

There were systems in place to analyse accidents and incidents in the home, to ensure lessons were learned and improvements were made to protect people.

Is the service responsive?

People's health, social and support needs were assessed and reviewed at regular intervals.

The service had a complaints procedure for people to use where they were unsatisfied with the care provided. People told us and we saw the manager took all concerns and complaints very seriously and acted swiftly to resolve issues.

Is the service caring?

People told us they were happy and liked living at Marquis Court (Tudor House). One person told us: 'It is very good here; staff do all they can to help. We have plenty to eat and drink. I have no concerns it's lovely'.

People who were unable to comment or did not wish to speak with us looked comfortable, well groomed and cared for.

Is the service effective?

People's health and care needs were assessed, recorded and reviewed, but people and/or their representatives were not always included. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us they received the support they needed.

Is the service well led?

People who used the service and the staff we spoke with all told us that the current manager was supportive, approachable and friendly.

We previously had concerns about the monitoring of the quality and safety of the service. We saw that some improvements had been made. The provider must now continue with sustaining and further improving the service to ensure a quality service is provided.

The majority of people said that they were treated with respect and had their privacy and dignity promoted. One person said: "They are always respectful and ask me before they do anything". Another person said: "They are very good about making sure they respect your privacy. They always knock and wait to be invited to come in".

The majority of people we spoke with told us they received care when they requested and needed it. One relative said: "She is always clean and tidy whenever we come". There was a need to ensure that people consistently received timely care, support and treatment to maintain their health and wellbeing.

We found the home was clean although this will be further improved when the updating and replacement of the carpets had been completed. There were appropriate systems in place to reduce the risk of cross infection. People who lived or visited the home told us they found the home to be clean. One person told us: "It's always been alright here in my book, good home, very clean and good carers'.

People generally told us that staff were caring. One person said: "I can't knock the girls here- I call these girls my family". A relative said: "All the staff are warm and welcoming and take time to talk to us when we visit. We found that improvements were needed to ensure that staff were appropriately supervised and people were protected against inappropriate care.

There were systems in place to assess the quality of the service provided, however these systems were not always effective.

We spoke to two people who lived at the home and one relative. People we spoke with told us that they or their relative received the care they needed. One person told us, "It's ok here, and better than where I was before".

People were consulted about how and where they spent their day. One person said that they got up and went to bed when they choose. They told us that their friends and relatives were able to visit them.

We found that additional staff had been recruited and were available since our previous inspection. We found that additional monitoring was needed to check that there were sufficient staff to provide care and support to people on an ongoing basis.

We found that the home had made improvements which demonstrated that it was compliant with the regulations we assessed.