Mill River Lodge

Mill River Lodge is situated in Horsham, West Sussex. It is a residential ‘care home’ providing care for up to 70 people in one adapted building. People residing at the home may be living with dementia, physical disabilities, older age or frailty as well as up to 20 people who may require nursing care. At the time of inspection there were 63 people living at the service.

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

Since our last inspection it was evident that the managers of the service and staff had continued their work to improve the standard of care people received and the overall governance of the service. Quality assurance and monitoring systems had been revised and embedded. Support from external organisations and health professionals had been utilised effectively and recommendations implemented to address the concerns raised about Infection Prevention and Control (IPC) and managerial oversight of people’s care.

IPC practice had significantly improved and was in line with current government guidance. People and their relatives told us they felt safe and were cared for by staff who knew them well. People told us staff wore Personal Protective Equipment (PPE) when providing care and ensured that visitors to the home completed a lateral flow test for COVID-19 before they entered the building.

Risks to people’s health and safety were assessed and people were supported to stay safe. Care plans were person-centred and provided staff with clear guidance on how to support people. Staff were aware of their safeguarding responsibilities and knew how to report and escalate concerns. Accidents, incidents and safeguarding concerns were appropriately investigated with actions taken to reduce the risk of reoccurrence.

Medicines were managed safely. People received their medicines in line with the prescribers requirements from staff who were trained and competent in the task. People who were prescribed medicines to be administered ‘as and when required’ (PRN) had detailed care plans to guide staff when PRN medicine should be administered.

People and their relatives told us staffing levels had improved and there were enough staff to meet their needs. Staff were recruited safely and had the skills, training and competence to provide safe and effective care. Staff had regular supervision where they received feedback about their practice and opportunities for development.

People received care in accordance to their needs and had access to healthcare services and support. One relative told us, “They [staff] always take time to help any resident who needs it. They don’t get impatient and they help in a gentle way.” 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 culture within the home was positive, person-centred and promoted good outcomes for people. People and their relatives felt involved in their care and were complimentary about how the home was managed. A relative told us, “I think the home is very good and I have recommended it to people. I feel very confident with my [person] being there.”

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 07 April 2020). There was one breach of regulation relating to the leadership and governance of the home. The provider completed an action plan to show what they would do and by when to improve. A targeted inspection was held on 10 November 2020 (published 08 April 2021) to follow up on this breach and look at concerns raised at the time about people’s care. The provider had not met all of their action plan and there was a further breach of regulation relating to infection prevention and control and people’s care. The home had failed to make enough improvements and remained Requires Improvement. The provider was served a notice to impose conditions on their registration. The provider was required to submit monthly reports to CQC to demonstrate their quality assurance and monitoring systems were effective and utilised to improve people’s care.

At this inspection enough improvements had been made and the provider was no longer in breach of regulation 12 (safe care and treatment), and regulation 17 (good governance).

Why we inspected

We undertook this focused inspection to check the provider had complied with the conditions imposed on their registration. We also needed to ensure that actions submitted in their monthly reports were embedded and confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements. The rating from the previous comprehensive inspection for the key question not looked at on this occasion was used in calculating the overall rating at this inspection.

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

The overall rating for the service has changed from Requires Improvement to Good. 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 Mill River Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to work alongside the provider and local authority to monitor progress. 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.

Mill River Lodge is situated in Horsham, West Sussex. It is one of a group of services owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ providing care for up to 70 people who may be living with dementia, physical disabilities, older age or frailty as well as up to 20 people who may require nursing care. At the time of inspection there were 60 people living at the service.

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

Risks to people had not always been mitigated to help ensure their safety. We found concerns in relation to infection prevention and control practice. The registered manager and provider had not ensured staff were provided with correct and current guidance on infection prevention and control (IPC)practices or the appropriate use of personal protective equipment (PPE). They had failed to identify that staff were working in a way that increased the risk of exposure and spread of infection for people and themselves. When our concerns in relation to IPC practices were immediately fed back to the registered manager and provider, they did not respond in a timely way to help ensure risks to staff and people were minimised. This further increased the risk of harm to both people and staff.

Two people had not always received care that met their assessed needs and preferences in relation to personal and oral hygiene and following health professional's guidance. Shortfalls in infection control identified during the inspection had not been identified by the provider's quality assurance processes. This raised concerns about their effectiveness.

Improvements had been made regarding the quality and oversight of most people's healthcare. Staff’s competence had been assessed to provide assurances their practices were safe when supporting people to move and position or when administering medicines. Risk in relation to people’s hydration, nutrition, falls and specific healthcare needs were well-managed and people had received effective care.

People were complimentary about the care they received. They told us staff made them feel safe and they were happy living at the service. Staff told us they felt well-supported and valued by the registered manager and the leadership of the service had improved.

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 (Report published 7 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection improvements of the oversight of people's care had been made. The provider had not met all of their action plan that was sent to us after the last inspection. They had not ensured that the quality assurance systems they had introduced were always effective in identifying the shortfalls found in relation to oral and personal hygiene and the implementation of health professional's guidance.

Why we inspected

We undertook this targeted inspection to check whether the Requirement Action we previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to see if the concerns found at the last inspection had improved. We also looked at the care people had received in response to concerns that had been raised to us since the last inspection. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on enforcement action or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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 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 leadership and management at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added after any representations and appeals have been conducted.

Follow up

Immediately after the inspection, we worked with the local authority and clinical commissioning group to seek assurances about the provider's infection prevention and control practices. This helped ensure improvements were made to reduce the risk of the transmission and spread of infection for people and staff.

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

Mill River Lodge is situated in Horsham, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 70 people some of whom are living with dementia, physical disabilities, older age and frailty and may need support with their nursing needs. At the time of the inspection there were 62 people living in the home.

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

Newly implemented systems and processes had helped decrease risks to people’s care. These were yet to be fully embedded and sustained in practice to ensure there was enough oversight of all people’s care. There was a lack of guidance to inform staff of some people’s preferences and needs and some people had not been supported according to their assessed needs. Audits had not always identified the shortfalls that were found at the inspection.

Lessons had not always been learned when incidents had occurred. Since the last inspection, outcomes from the local authorities safeguarding enquiries as well as our own, had sometimes found people had not received safe care and treatment.

There was a lack of oversight to ensure all agency staff were assessed as competent before they started to support people and we found three occasions when agency staff had not ensured people’s needs were met. Two people had not always been consistently supported with their oral hygiene. Two people’s emotional needs had not been fully considered.

We recommended that the provider continued to ensure all people who required assistance with communication were provided with information that was accessible to them.

There were enough staff to meet people’s needs. Staff had received appropriate learning and development opportunities to meet people’s needs and knew how to minimise the risk of abuse. People told us they felt safe and were happy at the home. Most risks in relation to people’s care were managed well. Medicines management was safe. Infection prevention and control was maintained.

People told us they enjoyed the food and had enough to eat and drink. People received support from external health professionals when needed and staff worked with them to ensure a coordinated approach to people’s care. Changes and improvements had been made to the environment to ensure it met all people’s needs. 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.

A new manager was in post who had been instrumental in making improvements to people’s care and ensuring that risks decreased. The provider and manager had worked with external health and social care professionals to seek advice and guidance.

The manager and staff placed an emphasis on providing more person-centred care for people and ensuring that people had access to stimulation and activities that were meaningful. People told us they had access to a range of activities, and they enjoyed those provided. If people were unhappy with their care, they and their relatives told us they felt comfortable raising concerns with staff. People were able to plan for care at the end of their lives to ensure their preferences were known and their comfort maintained.

People told us staff were kind, caring and compassionate and our observations confirmed this. People were encouraged to be involved in their care and in decisions relating to it. Independence was promoted and people were able to retain their skills. When people did require assistance their privacy and dignity was maintained.

Rating at last inspection and update

The last rating for this home was Requires Improvement (Supplementary inspection report published 14 September 2019). There were three breaches of regulation in relation to people’s safety, person-centred care and the leadership and management of the home. We served two Warning Notices and the provider was also required to complete an action plan to show what they would do and by when to improve. During this inspection, the provider had demonstrated some improvements had been made and they had met two of the regulations. Some improvements needed to be further embedded and sustained in practice to provide continued assurance about the leadership and management of the home. The home has been rated as Requires Improvement and had now been rated as Requires Improvement at the last seven consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We had planned to undertake a focused inspection to check the improvements made since we had served Warning Notices at the last inspection for breaches of two Regulations. We found improvements in some of the key questions had been made and therefore undertook a comprehensive inspection.

Enforcement

We have identified a breach of Regulation in relation to the leadership and management of the home 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 the intelligence we receive about this home. We will work alongside the provider and the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Mill River Lodge is situated in Horsham, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 70 people some of whom are living with dementia, older age or frailty. Some people also require support with their nursing needs. At the time of the inspection there were 63 people living in the home.

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

The provider had learned from concerns that had been found during inspections at some of their other services and had implemented training to increase staff’s awareness and skills. Systems and processes had been introduced to help minimise potential risk. However, people had not always been protected from the potential risk of harm. People requiring modified diets had sometimes been given foods that had the potential to cause them harm. People did not always have enough fluids to ensure their remained hydrated. Infection control was not always well-maintained. Systems and processes had not always identified the concerns found as part of the inspection. Improvement to systems that had been introduced were yet to be fully embedded and sustained in practice. The manager took immediate action to address the concerns raised and ensure risk was minimised.

One person had not always been treated in a caring or dignified way. Once identified, appropriate and robust action was taken by the manager and provider. Some people were, at times, at risk of social isolation. Some people spent large amounts of time unoccupied with little stimulation or interaction with others.

Information had not always been provided in the most accessible format. People who were living with dementia did not always have access to an environment that met all their needs. We have recommended that the provider seeks support from a reputable source in relation to this.

Staff were not always appropriately deployed to ensure people’s needs were met in a timely way. People sometimes had to wait for support if they needed assistance to eat and drink. Some staff were observed to be task-focused and there was sometimes missed opportunities to interact and engage with people. People provided mixed feedback about staff’s skills. They told us that permanent staff had the skills to meet their needs, yet they felt some agency staff lacked the necessary skills and understanding.

People’s needs were assessed, and staff were provided with guidance to help inform their practice. 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, relatives and staff complimented the efforts that the manager had made to make improvements. There was a friendly and relaxed atmosphere. Staff told us they felt valued and well-supported by both the manager and provider.

People told us they were happy. One person told us, “Overall, I’m happy with the care here and the staff, who do the best they can.”

Rating at last inspection

At the last comprehensive inspection, the home was rated as Requires Improvement. (Published 12 September 2018). At a focused inspection on 3 December 2018, the overall rating remained the same. (Published 29 January 2019). The home has been rated as Requires Improvement on six consecutive occasions.

Why we inspected

The inspection was prompted in part due to concerns received about people’s hydration, pressure area care, the responsiveness of staff and the leadership and management of the home. Although an inspection was planned based on the previous comprehensive inspection rating, a decision was made for us to inspect sooner and examine risks. We have found evidence that the provider needs to make improvements. Please see all the sections of this full report.

Enforcement

We have identified three breaches in relation to people’s safety, person-centred care and the leadership and management of the home. You can see what action we have asked the provider to take at the end 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.

The manager took prompt action after the inspection, to ensure that risks were lessened.

Follow-up

We will continue to monitor the intelligence we receive about this home. 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 plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Mill River Lodge is situated in Horsham in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Mill River Lodge is registered to accommodate 60 people. At the time of the inspection there were 57 people accommodated in one adapted building, over three floors which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs. The home also contained an unregulated day service facility where people could attend if they wished; however, this did not form part of our inspection.

Since the previous inspection on 15 May 2018, the registered manager had left. A registered manager is a ‘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 home is run. The management team consisted of an acting manager, an acting deputy manager and team leaders. A registered manager from one of the provider’s other homes managed the home three times per week. This provided clinical oversight for the registered nurses and people who received nursing care. An operations manager also regularly visited and supported the management team.

We carried out an unannounced comprehensive inspection on 15 May 2018. The home was rated as ‘Requires Improvement’ for a third consecutive time and a breach of legal requirements was found. This was because there was a lack of person-centred care. Not all people had access to activities or sources of stimulation to occupy their time. Quality assurance audits were not always conducted. Records to provide guidance to staff, as well as document their actions, were not well-maintained and were sometimes illegible. The registered manager and provider lacked oversight of the shortfalls that had been found as part of the inspection. Notifications, to inform CQC of specific incidents or events had not been submitted. There was a risk that because of this we would were not aware of incidents and did not have sufficient oversight to ensure the appropriate actions had been taken. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mill River Lodge on our website at www.cqc.org.uk. Following this inspection the overall rating remains 'Requires Improvement'.

At this inspection we found that some improvements had been made. The provider had arranged for a registered manager, who was also a registered nurse, from one of their other homes, to manage the nursing floor three days per week. This ensured that there was clinical oversight of people’s nursing needs and of the nursing decisions taken by staff. Quality assurance processes were conducted. When areas for improvement had been identified these were monitored and actioned. The management team acknowledged that progress had been made and told us that further improvements were planned.

There were concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. The provider’s quality assurance processes were not always effective. Shortfalls that were found at the inspection had not been identified by the management team or provider. Records, to document staff’s actions and provide guidance for staff were still areas of concern. Some records were illegible. This made it difficult for staff to know what was required of them. Staff did not always document their actions. It was not apparent if people had been provided with the required care to meet their needs or if staff had failed to document their actions. The provider had not learned from concerns that were found at inspections of their other services and had not shared this learning to ensure that improvements were made across all their services. These were areas of concern.

People, a relative and staff were complimentary about the changes to the leadership and management of the home. Staff told us that they felt valued and supported. People and a relative told us that they felt involved and part of people’s care. Notifications to CQC had been submitted.

Partnership working and links with external healthcare professionals ensured that staff did not work in isolation and good practice was shared.

Person-centred care had improved. People’s personal preferences were respected. They told us that when they requested a gender of staff to support them with their personal care needs, that staff respected this. People could plan for their end of life care. People’s wishes were acknowledged and respected when they did not feel comfortable discussing this.

People’s access to interaction and stimulation meant that people were not socially isolated. They told us that they enjoyed the activities and that there was sufficient interaction to occupy their time. One person told us, “Staff are kind, they talk to me. I like living here. I have things to do and friends to see."

People and their relatives were involved in contributing to plans about their care. Regular reviews ensured that the care people received met their current needs.

People were aware of their right to comment or complain about their care. Residents’ and relatives’ meetings, as well as surveys, provided people with an opportunity to do this. When feedback had been provided and suggestions had been made, these had been listened to and acted upon.

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

Mill River Lodge is situated in Horsham, West Sussex. It is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Mill River Lodge accommodates 70 people across seven units, each of which have separate bedrooms with en-suite facilities, a communal dining room and lounge. There are also gardens for people to access and a hairdressing room. The home provided accommodation for older people, those living with dementia and people who required support with their nursing needs. At the time of our inspection there were 62 people living at the home.

The home had a registered manager. A registered manager is a ‘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 home is run.

At the previous inspection on 26 August 2016 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns regarding the oversight of the service. Quality assurance audits, to identify areas for improvement, had not been completed. Actions resulting from the provider’s audits had not always been addressed. The provider lacked oversight of the systems and processes within the home. Other areas identified as needing improvement related to the deployment of staff to meet people’s needs in a timely manner. At this inspection the sufficiency and deployment of staff had improved. However, we continued to have concerns with regards to the managerial oversight and the provider was found to be in continued breach of the regulations. This is the third consecutive time the service has been rated as 'Requires Improvement'.

Systems and processes were not sufficiently monitored, nor action taken, to ensure that the service was to the standard people had a right to expect. The registered manager had not completed all of the provider’s audits to monitor the service. It was not always evident if actions required by the provider had been completed. The provider had conducted their own audits and these demonstrated that the failure to conduct audits and comply with required actions was a consistent and on-going issue. Records to document people’s care and treatment, as well as those to monitor the service, were not always completed in their entirety. The registered manager and provider had not ensured that the service people received continued to improve. These areas of practice were of concern.

People and their relatives told us that staff were kind and caring. One person told us, “The staff are very kind”. Most people were treated with respect and dignity. However, not all people were treated in this way and person-centred practice was not always evident. People’s needs, preferences and abilities had been documented in care plans. These informed and guided staff’s practice to enable them to meet people’s needs in a way that people preferred. Despite this specific and person-centred information, staff did not always ensure that people’s expressed needs and beliefs were respected. This related to a person’s beliefs as well as their preference for female care staff. This was an area of concern.

The provider and registered manager had not always notified us of events and incidents that had occurred at the home. This did not always enable us to have oversight to ensure people were safe.

Risk assessments identified possible risks to people’s safety. Staff were aware of how to safeguard people from harm. Staff supported people appropriately to ensure their safety. A reflective culture existed when incidents had occurred or care had not gone according to plan. Although most people received appropriate support to ensure their safety, staff had not always considered the impact of some people’s behaviour on others. Staff had not always considered their safeguarding policies and procedures when people demonstrated behaviour that challenged others or when one person had sustained an injury.

People provided mixed feedback with regards to their access to activities and stimulation to occupy their time. Most people told us that they enjoyed the activities and people were seen enjoying the musical entertainment that was provided. They were smiling, laughing and dancing. Some people, however, felt that there wasn’t enough to occupy their time.

An area in need of improvement related to gaining people’s consent when there were restrictions on their freedom to move around and out of the building. People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible, however, staff had not always considered if applications to the local authority, to deprive people of their liberty, were required.

People had confidence in staff’s abilities. Their needs were assessed and their healthcare needs met by registered nurses as well as external healthcare services. There was a coordinated approach to ensure people’s health and they received medicines to meet their health needs. People received appropriate end of life care to ensure their comfort. Safe practices maintained infection control and ensured that people were not at risk of cross contamination.

People spoke highly of the food and had a positive, social dining experience. One person told us, “There is a good choice and it is quite a social occasion”. Another person told us, “The food is lovely”. People had access to an environment that met their needs. People could spend time on their own or with others and had access to the garden. Signs and themed hallways ensured that people were supported and able to orientate around the building.

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

This comprehensive inspection took place on the 24 August 2016 and was unannounced.

The accommodation was arranged over three floors. The upper floors were accessed by a shaft lift or flight of stairs. There was level throughout and access to a secure garden. There is limited allocated parking at the location and car park passes are available to visitors.

The service had 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 2008 and associated Regulations about how the service is run.

At the last focussed inspection in September 2015 the provider was heavily reliant on agency staff and that on two nights in the months leading up to the inspection the service had operated without a registered nurse. This was an area of practice we identified as needing to improve. At this inspection we found the service had always operated with a nurse on duty and the provider had recruited more care staff. People told us they felt safe in the service however the deployment of staff in one area of the service was an area of practice we identified as needing improvement.

There was a comprehensive quality assurance system in place to monitor quality and identify areas for improvement however this was not being effectively implemented. Therefore opportunities to identify and rectify shortfalls in the quality of the service and drive improvement had been missed. At the last comprehensive inspection in February 2015 we assessed the provider needed to make improvements in relation to recording people’s involvement in meaningful activities and reviewing of their care however these improvements had not been made.

People were supported to eat and drink sufficient amounts and enjoyed the food. Special diets were catered for and drinks and snacks were freely available throughout the day. People were provided with appropriate levels of support at meal times.

People’s privacy was protected and people were treated with dignity and respect by kind and caring staff. A relative told us “The staff are very helpful and very friendly, so far mum is very happy”. Another relative told us “Staff know her, they understand her”. Visitors were welcomed and had the opportunity to attend ‘family meetings’ at which they could give their views on the running of the service and make suggestions for improvements. People were able to personalise their rooms and bring their own furniture and thought had gone into making the environment dementia friendly and assist people with orientation around the service and to their rooms. .

People’s health care needs were met and professional advice and support was sought from health care professionals such as GP’s and district nurses as and when needed. People were supported by competent staff who received the training and support they needed to undertake their role and effectively meet people’s needs. One person told me “They know their jobs”.

People received their medicines on time and they were administered by staff who were trained to do so. Measures were in place to reduce the risk of harm occurring and protect people from abuse. Accident and incidents were recorded, collated and analysed to identify and themes and trends so the provider could take steps to reduce the risk of reoccurrence. Staff understood the need to gain consent and worked in accordance with the Mental Capacity Act (MCA).

There were processes in place for complaints to be responded to. People told us they would speak with a member of the care staff team if they had any concerns or wanted to make a complaint and one person commented “They listen to me”.

Recruitment procedures were robust and included identity and security checks were completed before staff were deployed. All new staff completed an induction to the service and were introduced to people before they worked unsupervised.

People and staff felt supported by the management. The registered manager was aware of their legal responsibilities and kept up to date with good practice by attending management meetings.

There was one area where the provider was not meeting the requirements of the law. You can see what action we have asked the provider to take at the back of the full version of this report.

We spoke with one person. They told us that 'The staff order their medicines for them and each month they received them. They keep their medicines in a locked draw in their room to which they have a key. Each day they transfer the medicines they need to a pill reminder'.

We spoke with four members of staff and the manager. One member of staff told us, 'When the people require blood tests to check the effectiveness of their medicines the dates are put in the diary and on the board in the clinical office". The manager said, 'Before we can look after people with more complex needs the staff will require additional training and competency assessments". We also observed the administration of medicines at lunch time on the first floor.

Concern had been raised with CQC relating to the management of medicines within the service. Therefore, this visit was carried out by a specialist pharmacy inspector who looked at the use and management of medicines within the home.

You can see our judgements on the front page of this report

People were protected against the risks associated with medicines because the provider does have appropriate arrangements in place to manage medicines.

'They look after us well and the food is quite good.'

'I like it here because I have company. I never feel lonely.'

We also spoke with the manager, an administrator, the unit manager for the dementia care unit, two nurses, and four care staff.

Some people using the service had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private. Staff were discreet when explaining to people the tasks they were undertaking to support their care needs.

We spoke with the acting manager and four staff. The home has been going through a period of change as it had lost two managers since out last inspection. The staff felt supported through this change. One staff member told us the management "involves staff in the changes"

We spoke with two relatives on the telephone. Both were happy with the care offered in the home and feel they are communicated with well. One did tell us that they felt the garden had not been well maintained this year. The other told us that there had been many improvements in the home of late and that it "was much more like a home now". We spoke with the district nursing team who told us that communication was much improved in the home. They have met with the acting manager and have proposed ways to make their regular visits twice a week more efficient. People we were told were referred appropriately and promptly to the team.