Chamberlaine Court

Chamberlaine Court is a residential care home providing accommodation and personal care to up to 38 people, including people with dementia. At the time of our inspection there were 30 people using the service. Care is provided across two floors. A communal lounge and dining area are located on each floor. People's bedrooms were ensuite and there were further communal bathroom facilities located on each floor.

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

At this inspection, there continued to be a lack of effective oversight to ensure standards and regulations were maintained. Some areas previously identified as a concern remained, and new areas of concern were identified.

Chamberlaine Court has not achieved an overall rating of good for the last four inspections dating back to November 2020. The home has continued to fall short of the expected minimum standards of care, people living in care settings should receive.

At our last inspection, we issued a warning notice because the provider had not adequately assessed risks and done all that was practicable to mitigate any such risks. The warning notice had been met in part, however, further action was needed to ensure people received safe care and treatment. Risks to people's health had not always been identified, assessed or monitored to ensure staff provided safe care and treatment.

Prior to our inspection we received concerns about insufficient numbers of staff. We found there were enough staff to keep people safe, but staffing numbers did not always ensure care was delivered in a timely way which promoted people’s dignity and emotional well-being. Although we received some positive feedback, most people and relatives told us there were not enough staff.

Despite our findings, we found some improvements had been made. Risks related to skin breakdown had been identified, assessed and mitigated and people who required support, assistance and encouragement to maintain good hydration and nourishment, received effective support. The cleanliness of the home had improved, and we received positive feedback about the improvement in infection control processes.

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.

The staff culture was positive and staff were working together to make the required improvements. The manager at our last inspection was now registered with the CQC and was aware improvements were required at the home. They had completed a monthly action plan following our last inspection so we could monitor the progress of the home in line with our regulatory functions.

We received positive feedback about the registered manager from people, relatives, staff and other healthcare professionals who agreed the home was on an improvement trajectory.

The home was being supported by the local authority and a variety of healthcare professionals to make improvements to the home. This support was ongoing and had been welcomed by the registered manager.

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 01 August 2022) and there were breaches of the 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.

This service has been in Special Measures since 07 June 2022. During this inspection the provider demonstrated that some 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

We carried out an unannounced focussed inspection of this service on 31 May 2022. 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. In addition, we had received further concerns in relation to staffing numbers and poor-quality care. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

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 from inadequate to requires improvement based on the findings of this inspection. We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to governance and safe care and treatment at this inspection. 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, which will help inform when we next inspect. 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.

Chamberlaine Court is registered to provide accommodation and personal care for up to 38 people, including people with dementia. At the time of our inspection visit there were 36 people living at the home. Care is provided across two floors. A communal lounge and dining area are located on each floor. People’s bedrooms were ensuite and there were further communal bathroom facilities located on each floor.

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

At our last inspection, we found concerns related to the management of health, welfare and environmental risks, infection control practices and limited and ineffective oversight of the service, meant it did not meet the regulations. In response to our last inspection the provider sent us an action plan telling us how they had strengthened their audit processes, introduced regular daily and manager checks and improved the cleanliness and food hygiene practices at the home. The provider also said the management team was strengthened to provide more oversight at the service to ensure standards were improved and then sustained.

At this inspection, there continued to be a lack of effective oversight to ensure standards and regulations were maintained. Some areas previously identified as a concern, remained. Environmental and health audits now introduced, were either not completed or they were ineffective when completed, in identifying where improvement was needed. Several improvement actions we found during our visit had not been identified through any provider checks at the service. When the manager was away from the home, there was no policies or process to ensure those quality checks continued to be completed. The provider’s response to our last inspection and their own action plans had not been fully implemented or effectively followed through.

Environmental risks such as fire safety required improvement. One fire door marked as ‘fire door’ did not close at all, while another fire door closed at varying speeds. Some first-floor window restrictors did not have tamper fixings in line with recommended guidance. Some of those restrictors could be not as secure as required.

Food hygiene and cleanliness in communal kitchenettes continued to fall short of expected standards, despite additional checks being put in place. Other risks such as cleaning products and hot and exposed surfaces had potential to put people at unnecessary risk. Doors to these rooms were to be locked, yet we saw these doors were open and there was no staff presence to protect people from risks.

Lessons had not always been learned because the same issues remained from the previous inspections.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. Infection control systems implemented during a pandemic were in place. However, as health professional visitors, on the first day, we were not checked to ensure we were negative of COVID-19 and temperature checks were not completed. This was completed on the second day. Staff told us face masks were worn when providing personal care and staff wore masks when they supported people around the home. However, we saw occasions when staff did not wear their face mask correctly.

People’s overall feedback to us was mainly positive of a service they received that they felt met their needs. However, we found care plans, care plan reviews and risks associated with people’s care were either not recorded, inaccurate or where not followed or consistently understood by the staff team. Staff conversations about the people they looked after and how they needed to be cared for, were inconsistent.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse. There were enough staff on duty to support people, however staff said on the first floor they worked on occasions with one less staff member. We were not confident the dependency tool used to predict staffing hours was accurate as it was based on people’s assessed risks which we found were not always accurate. We asked the manager to review staffing hours and the management and deployment of the shift to ensure it met people’s expectations. The provider’s own audits of call bell times showed in excess of 200 calls per month were in excess of 20-minute delays. From work undertaken by the new manager, we noted call waiting times had recently reduced.

At this inspection, there was another new manager in post so day to day management of this home over the last year or two had seen a number of management changes and instability. It was clear from the conversations with the new manager and the staff team, clear, honest and constructive ways forward were needed to improve people’s experiences at the home. The culture and atmosphere of this home was quite negative and from our conversations, a blame culture was noticeable. This is the fourth inspection where the home has achieved the same rating and the culture, ethos and willingness to do the right thing has not yet become embedded in everyday practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 April 2022) and there were breaches of regulation. The provider had received warning notices following the last inspection and they had to be compliant with these. The provider was also required to send us an action plan telling us how they would improve and by when. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

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 Safe, Effective 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 not changed. 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 Chamberlaine Court 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 COVID19 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 three breaches in relation to safe care and treatment, person centred care and good governance. We found the provider failed to meet the warning notice we issued at the last inspection.

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

Follow up

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.

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.

Chamberlaine Court is registered to provide accommodation and personal care for up to 38 people, including people living with dementia. At the time of our inspection visit there were 37 people living at the home. Care is provided across two floors. A communal lounge and dining area are located on both floors. People’s bedrooms were ensuite and there were further communal bathroom facilities located on each floor. Some of these bathroom facilities were being used as an area for staff to safely put on and remove, personal protective equipment.

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

At our last inspection, we found concerns that the management of risks, infection control and management and oversight of the service, did not meet the regulations. At this visit, we found some improvements had been made but further improvement was needed.

In response to our last inspection the provider told us a deep clean of the home and improved food hygiene had been undertaken as well as improvements to their quality assurance systems and processes. However, we found a continued lack of ownership and oversight to ensure standards were maintained. Some areas previously identified as a concern, remained.

Cleaning tasks were not consistently effective because some communal areas of the home were not regularly cleaned. Despite assurances of a deep clean throughout the home, standards of cleanliness expected were not maintained. Food trollies and an upstairs kitchenette remained dirty, with unopened food stored in cupboards that were not clean.

In the main kitchen and the first-floor kitchenette, some food items continued to have passed their ‘use by date’ whilst other food items were left out uncovered. Some refrigerated items had a sticker but there was no date to show when the item was opened or when it had to be consumed or discarded.

Some improvements to risk management were seen, however, records and staff knowledge to manage and monitor risks continued to be inconsistent. The provider told us following the last inspection, people identified at high risk of falls now had a falls prevention plan. For those people we saw at high risk of falls, there was no such plan. People who needed their food and fluid monitored, incomplete recording did not provide an accurate picture that would help other health professionals and staff to help keep the person hydrated and nourished. The quality of completed records remained limited and there were no effective checks to identify where improvements were required.

Quality assurance system had been improved however some audits were not effective in driving improvements. Audits such as medicine management, infection control and the manager’s daily walk around had not identified the issues we found or where they had, there was no action taken to make those improvements. The provider’s response to our last inspection and action plans had not always been implemented or followed through.

Medicine records also lacked detailed information to confirm safe management. Staff understood their responsibility to report any concerns to protect people from the risk of abuse. There were enough staff on duty to support people, and people told us they felt safe living at the home.

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 25 December 2020) and there was a breach of regulation 12 safe care and treatment and regulation 17 good governance. The provider completed a monthly action plan after the last inspection to show us how they would improve and by when. At this inspection we found the provider remained in breach of regulations.

Why we inspected

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 Safe 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 not changed. 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 Chamberlaine Court on our website at www.cqc.org.uk.

The inspection was also prompted in part by reviewing statutory notifications we had recently received indicating a high number of unwitnessed incidents. We also received some information related to a death that may have arisen from a suspected fall. A decision was made for us to inspect and examine those risks.

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

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 COVID19 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 in relation to safe care and treatment and a breach related to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chamberlaine Court is a residential home providing accommodation and personal care for up to 38 people aged 65 and over, at the time of the inspection 35 people were living there, some people were living with dementia or a cognitive impairment.

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

The provider’s systems and processes did not always ensure risks to people were known and managed safely. Individual risks relating to health conditions were assessed, however, when changes had occurred, those risk assessments did not always reflect the person’s current support needs. Inconsistencies in how people were cared for and how records were written, meant staff did not always have clear and current information to enable them to support people correctly.

Where people required monitoring of their foods and fluids, records were not descriptive enough to ensure the person got the help and support they needed. Actions identified during clinical checks and audits were not always implemented, which meant the provider failed to make identified improvements. We found people had fallen, yet care records, falls assessments, incident forms and falls analysis were incomplete. When we asked staff for some people’s daily health records, we were told they were inaccessible. We found there was poor filing and storage of records we asked for. This meant the provider could not be assured they had accurate or up to date records, and there was a lack of oversight to ensure people’s daily needs were being met in accordance with their care plans. There was no effective system to accurately record what had happened and the actions taken to seek the necessary health interventions.

The service was inspected during the COVID-19 pandemic. The provider's infection prevention and control measures were not always effective, so people were not consistently protected from the risks of cross infection. Clinical waste was not always disposed of, or stored, safely. Some personal protective equipment (PPE) had not been disposed of correctly into clinical bins. Clinical waste and general waste bins did not always have a foot pedal which meant staff and people had to use their hands to open the bins, which presented a risk of cross contamination. Cleaning schedules were in place but were not consistently effective because some areas of the home were not regularly cleaned. Overall cleanliness and limited managerial oversight meant current infection control and government guidelines were not followed.

Poor leadership and oversight of the service had impacted on the quality of care and treatment people received. The provider’s systems to monitor the quality and safety of the service, were not always effective and had not always identified areas for improvement. The management had not identified the concerns that may arise through poor infection control, poor record keeping and a lack of consistency in recording and managing people’s needs that changed over time.

Relatives felt staff did their best to help support people, yet communication with managers and staff was a barrier for them to understand their relative’s current health and support needs, especially during the COVID-19 pandemic. A relative was not told about the COVID-19 outbreak and was allowed entry to deliver a gift, against the provider’s policy and government guidance.

We communicated our urgent concerns to the provider after our inspection visit. The provider responded to our concerns stating that they would work to improve the service within tight timescales through their own robust action planning and closer scrutiny of the service.

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 good (published 09 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about risks related to moving and handling, food and fluid monitoring and people at risk of falling. We were also notified that the home had an outbreak of COVID-19. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures. We looked at the IPC practices the provider has in place.

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

We reviewed the information we held about the service. No immediate 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.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chamberlaine Court 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 COVID19 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 and management of the home.

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

Follow up

At the time of this inspection, an investigation into a serious incident remained on-going. We will continue our investigation into the serious incident.

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chamberlaine court is a care home. It is registered to provide personal care, accommodation and nursing support to up to 38 older people, including people with dementia. At the time of the inspection visit the home supported 36 people over two floors.

People’s experience of using this service:

People felt safe using the service and staff understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People had risk assessments in place and risk mitigation plans, so that staff knew how to support people safely.

People received support from staff when needed and they were supported to have their medicines as prescribed.

The provider and the registered manager worked in partnership with outside agencies to improve people’s support when required. There were checks in place to ensure good standards of care were maintained.

Rating at last inspection and update: The last rating for this service was Good (published 9 August 2018). At this inspection we found the provider had maintained their rating of Good.

Why we inspected:

This was a focussed inspection to follow up on concerns raised with us regarding the quality of care people received. The inspection was also prompted in part by a specific incident following which a person using the service sustained an injury. This inspection examined the management of risks to people at the home. We undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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 not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this report.

Follow up:

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

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

There was an experienced registered manager in post at the time of our inspection visit. A requirement of the service’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and the associated Regulations about how the service is run.

We last inspected in May 2017, when we rated the service as ‘Requires Improvement’ overall. At that inspection the key areas of Responsive and Well-led were rated as ‘Requires Improvement’ because improvements were needed in how people were supported to maintain hobbies and interests, and audit procedures did not always identify where improvements were required at the home. At this inspection we found improvements had been made and have rated the service as ‘Good’ in all areas.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals, and received support with their nutritional needs. This assisted them to maintain their health.

People told us there were enough staff to keep them safe and we saw there were enough staff during our inspection visit to ensure people were cared for safely. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with people who lived there. People were supported by a staff team that knew them well.

Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People were consulted about their wishes at the end of their life.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The registered manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people who were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.

Quality monitoring procedures identified areas where the service needed to make improvements. Where issues had been identified in checks and audits, the registered manager and provider acted to address them to continuously improve the quality of care people received. The provider and registered manager worked with other organisations and external professionals to improve and develop the quality of care.

Chamberlaine Court is a residential home which provides care to older people including some people who are living with dementia. Chamberlaine Court is registered to provide care for up to 38 people. At the time of our inspection there were 37 people living at the home.

Chamberlaine Court was last inspected in April 2015 and was rated as ‘Good’.

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

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

Staff encouraged people to make daily choices in how they lived their lives. For people who lacked capacity to make decisions, staff continued to prompt and offer people visual choices so people continued to have input in how their support was provided.

People were supported to pursue various hobbies and leisure activities and although there were a variety of interests for people, improvements were needed. A number of people told us other than planned activities, there was not much else to keep them stimulated.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided. However, we saw examples where a person’s drinks were out of reach and staff were not always attentive to notice when a person’s drinks were untouched.

People were encouraged and supported by a caring staff team and people were encouraged to maintain relationships and keep in touch with those people who were important to them.

People told us they felt safe living at Chamberlaine Court and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. The registered manager knew what action to take if concerns regarding people’s safety were brought to their attention.

People had their medicines administered by trained and competent staff but the management of medicines required improving to ensure people received their medicines as prescribed, in line with pharmacist guidance.

Infection control measures when identified were not effectively managed within the home which had potential to place people and staff at unnecessary risk.

Some senior staff were not always clear of their roles and responsibilities which meant the shift and staff were not effectively managed to ensure people received their care and support needs in a timely and responsive manner.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. Improvements were needed because we found the provider’s systems did not always identify and rectify improvements and some records did not demonstrate what actions had been taken.

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

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

Is the service safe?

People were cared for in an environment that was well maintained and fit for purpose. We found it was clean and tidy with no unpleasant odours.

Relatives and visitors told us they felt their relatives were well looked after. We were told, "We couldn't ask for any more from a care home."

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and a call bell system that people could use to call for assistance.

We identified concerns during our visit with regards to the number of staff available on the first floor of the home. Staff on this floor also raised concerns with us about the numbers of staff available and the impact it was having on people's care and welfare.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The manager understood their responsibilities in relation to this legislation.

Is the service effective?

People and relatives we spoke with told us they were happy with the care provided. They told us, "They are looking after me very good", "They have catered for all Nan's needs" and "I think it's really nice."

We found that some of the care plans we looked at were not reflective of people's needs. We saw care plans were evaluated monthly, but were not always updated with any changes to care needs.

Is the service caring?

People were supported by staff who were kind and attentive. Relatives we spoke with said, "It seems very nice and friendly" and "The staff are lovely, very caring."

Interactions we observed between staff and people who lived in the home were positive and friendly.

Staff we spoke with on the first floor told us they felt they were not able to always provide the care they wanted to because of the numbers of staff available. They said, "People go without the care. We used to sit and talk to them, chat with family. It's impossible to do this."

Is the service responsive?

Systems and processes were in place to monitor and manage complaints, accidents and incidents.

People and relatives we spoke with told us they were able to approach the manager and staff freely to discuss any concerns or worries they had.

Is the service well led?

There were processes and systems in place to monitor the service provided. The manager used the information gathered through these processes to assess and improve the quality of service for people.

Staff had mixed views regarding the management of the home. Some staff we spoke with on the ground floor told us they felt well supported and able to approach the manager. They said, "X's (the manager's) door is always open and she is available for support." Other staff, working on the first floor told us they rarely saw the manager. We were told, " I get no support from the manager" and "Very rare seniors come up. They don't support us."

Staff did not received regular one to one supervision to enable them to discuss issues, concerns or ideas or personal development.

The majority of relatives we spoke with told us that they were satisfied with the care and support their family members received. Comments such as, "X is well looked after, well fed and well kept, what more could we ask for?' and "Mum has been here a while now and we are very happy with the care she gets." Two relatives raised concerns with us, some of which we were aware of. The concerns we were not aware of were directed to the manager to follow up.

People who lived in the home were complimentary about their care and the staff, commenting, " it's lovely here and very clean' and 'The staff are lovely, I can get up and go to bed when I like.'

Some people living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences. We saw that staff treated people with kindness and compassion and when people approached the staff they stopped, listened and spoke with them even if they were busy doing something else.

We looked at the storage of medicines, medicine administration records and some care plans.

We spoke with the new manager who it was acknowledged had been in post for two weeks. We also spoke with two members of staff and two people living in the service. The two people we spoke with were not able to discuss their medicines with us but one person told us 'everybody is lovely'.

We found that improvements had been made to ensure that medicines were managed safely.

In this report the name of a registered manager, Carol Jones, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register for this service at the time.

During our visit we spoke with four people who used the service, two relatives, the manager and five staff on duty. Some people we met were not able to speak with us because of their complex needs. We saw that people appeared comfortable and relaxed in their surroundings and with the staff.

People we spoke with, which included visitors to the home, told us that they were satisfied with the care provided. "I'm satisfied with how they look after me, I like it here" and "Mum's been here since it opened, I've no complaints about how she's cared for" were comments made.

Care records were clear and provided staff with enough information to care for people. Daily records were being completed in line with people's care plans. People's healthcare needs were being addressed, with relevant healthcare professionals being called out in a timely manner as necessary.

The safe handling of medicines was assessed by a CQC pharmacist inspector. We found that improvements in medicine management would be necessary in order to ensure the safe handling of people's medicines.

We found that records were well ordered and easy to follow. All records were located and produced promptly when requested.