Willow Tree Lodge

Willow Tree Lodge is a residential care home providing accommodation, personal and nursing care to up to 34 people. The service provides support to older people, some whom live with dementia. At the time of our inspection there were 27 people using the service. Care is provided in one adapted building over three floors.

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

People and their relatives were positive about the service and the support they received from staff. One person said, “I am happy here. I wouldn’t want to go anywhere else.” A relative said, “I am happy with the care home. They are all friendly and attentive.”

Staff knew how to protect people from the risk of abuse. If concerns arose, they were reported and investigated appropriately. Action was taken following incidents and lessons were learnt to reduce the risk of re-occurrence. There were risk assessments in place to guide staff on how to support people to remain safe. Staff were aware of the risks to people and were supporting people safely. There were sufficient staff to support people and people told us they got support when they needed it. Medicines were managed safely to ensure people received them as prescribed. People were kept safe from the risk of the transfer of infection, such as the risk from COVID.

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. Staff followed best interest processes where people needed this support for decisions. Where people could make choices, people told us staff supported this.

The service had continued to improve since the last inspection and previous improvements had been imbedded. Regular checks were undertaken on the quality of the service. Where the registered manager had identified actions were needed, these had been undertaken or were in progress. The registered manager understood the importance of being open and transparent should incidents occur. Staff were kind to people and were supported by the registered manager who worked alongside them. There were systems in place to ensure people, their relatives and staff could provide feedback about their care. People told us they were listened to.

The service had complied with legal obligations such as displaying their rating and notifying CQC of important events. The service had worked in partnership with other health and social care providers to improve outcomes for people and learn best practice.

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 (Published 02 December 2019). Since the last inspection the service has changed their name from High Meadow Nursing Home to Willow Tree Lodge. There were no breaches of regulation found at the last inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of 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 Willow Tree Lodge on our website at www.cqc.org.uk.

Follow up

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

High Meadow Nursing Home is a ‘care home’ and at the time of this inspection was providing personal care, nursing care and accommodation to 22 people. Most of the people using the service were older people with varying needs including dementia. No new people had been admitted to the home since our last inspection, the home is registered to support up to 34 people. The home is a large detached and extended house. Accommodation was split over three floors with lift access to each floor.

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

People and visitors were positive in their feedback. Their comments included, “I would recommend this home, I feel its turned the corner, it’s much better now,” and, “I am happy, comfortable and contented.” A relative, speaking about their mother, told us, “There are always staff around. She has all new furniture. She’s always clean and everything is together and nice, her clothes are always clean and washed.” Another relative told us,” The staff have been amazing, we think they are fantastic.”

The service had improved considerably since our last inspection. There were enough staff to provide the care people needed, care staff were deployed on each floor and were attentive to people’s needs. No new people or staff had joined the service since our last inspection; staff were familiar with people and knew their needs well.

The laundry was appropriately staffed, there were supplies of clean bedding and towels, many of which were recently renewed.

People were safeguarded from abuse, staff showed a good understanding of what was meant by abuse and knew how to report any concerns. The registered manager worked closely with people and their relatives and encouraged them to report any issues or concerns. The complaints process was updated and accessible.

Risks to people were known, assessed, up to date and well managed. There was clear guidance for staff to follow. Improvements to the environment had been made, it was safe and regularly maintained, problem flooring had been replaced and dementia friendly improvements made. Equipment had been serviced and maintained, where needed people had their own wheelchairs and lifting slings.

There was always a nurse on duty at the service. People received their medicines on time and as prescribed. When people were unwell or needed support from a health and social care professional they received this. People were supported to eat and drink safely. Where people needed support to maintain their weight or eat a specialist diet, this was in place.

Staff worked hard to support people to maintain their dignity, this had improved with revised staffing availability. The support people received was personalised, people and their relatives were positive about the support they received and told us it met their needs. People and relatives were complimentary about the activities offered at the service and the enthusiasm of staff.

Staff understood people had the right to make choices about their care. Where people were not able to make decisions, these were made in their best interests. 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.

Staff had the skills and experience they needed to support people well. They were more positive about the training they received and felt well supported by the registered manager.

People and relatives told us they found the registered manager, nursing and care staff dedicated, approachable and friendly. Improvements had been seen across the service since our last inspection. The provider, registered manager and staff had worked hard to make sure people received better quality care and support.

Management systems to provide ongoing oversight of the service had improved, records evidenced where follow up action had been taken as the result of checks and audits. However, due to the extent of change and history of decline after inspection, management systems needed time to embed to ensure they were fully effective to continuously monitor and improve the quality 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, following a full inspection, for this service was Inadequate (published 02 May 2019). There were eight breaches of regulation. The provider had failed ensure safe care and treatment was provided. The provider had failed to ensure there were enough staff on duty to provide service users with the support they needed to meet their needs. The provider had failed to ensure the building was properly maintained and suitable for the purpose for which it was being used. The provider had failed to ensure the quality and safety of the service provided was appropriately assessed monitored and improved or that improvements made were sustained. The provider had failed to ensure care was person centred and that care provided reflected service users preferences. The provider had failed to operate an accessible system for identifying, receiving, recording, handling and responding to complaints. The provider had failed to ensure notifications had been submitted to CQC submitted without delay. The provider had failed to ensure service users were treated with dignity and respect.

An additional focussed inspection also rated this service as Inadequate (published 26 July 2019). The focussed inspection did not look at each key question and was carried out in response to concerns received about the service. This inspection found there was one new breach and three continued breaches of regulations. The provider had failed to protect service users from abuse and improper treatment because systems and processes were not established and operated effectively to prevent abuse. The provider had failed to ensure there were sufficient numbers of staff to meet people's needs. The provider had failed to take reasonable steps to mitigate known risks to people. The provider had failed to effectively assess, monitor and improve the quality and safety of the service.

The provider completed an action plan after both inspections to show what they would do and by when to improve, they provided updates to this action plan each month.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations

This service has been in Special Measures since 02 May 2019. 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 was a planned inspection based on the previous rating.

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.

High Meadow Nursing Home is a ‘care home’ registered to provide accommodation and nursing care for up to 34 people. At the time of the inspection, the service was supporting 24 people. Most of the people using the service were older people living with dementia. The service is a detached house situated on the outskirts of Canterbury. Accommodation is split over three floors, access to each floor is by lift or stairs.

People’s experience of using this service:

There were not always enough staff to provide the care people needed. Staffing was reduced in the afternoon and evenings and people had to wait for the support they needed at times. Some people slept in beds without duvet covers or pillow cases because there were not enough housekeeping staff to do the laundry. These concerns, which would have been evident to staff, were not reported by them or escalated to the extent that they could be investigated or resolved

Some risks to people were not mitigated or well managed because there was no clear guidance for staff to follow. This included how people’s hydration should be monitored. Aspects of the environment were not well maintained or designed or adapted to support people living with dementia.

The service was not well-led, this had an impact on the care people received. Feedback about the registered manager and staff was positive, but feedback about the provider was less positive. Concerns about staffing, management and the environment of the home raised with the provider had not been effectively addressed.

People and visitors told us they enjoyed the activities available. There was a daily choice of food which people told us they enjoyed. Medicines were managed safely and people told us they received the right medicine at the right time. People and relatives told us they found the registered manager, nursing and care staff approachable and friendly.

The service did not meet the standard of Good in any key area and there were also three breaches of the regulations.

Rating at last inspection:

At the previous inspection (published on 2 May 2019) the service was rated as Inadequate and placed into special measures.

Why we inspected:

The inspection was prompted in part due to concerns received about the environment of the home, insufficient staffing and a safeguarding matter, together with concerns about the management of the service. A decision was made for us to inspect and examine those risks.

Enforcement:

You can see what action we told the provider to take at the back of the full version of the 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 remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this 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.

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

High Meadow Nursing Home is a ‘care home’ and was providing personal care, nursing care and accommodation to 24 people at the time of the inspection. Most of the people using the service were older people living with dementia. The service was set in a large detached house in a street with similar houses. The accommodation is split over three floors with access to all floors by lift or stairs.

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

People’s experience of using this service:

• There was not enough staff to support people’s needs. This had an impact on the quality of care that people received and there were times when people were left waiting for support. Staff were extremely busy and did not have time to stop and chat to people or take their full breaks.

• The environment that people lived in was not designed for people who lived with dementia, it was not well maintained and was not always safe.

• Risks to people from their health conditions were not always mitigated, nor were risks to people from equipment.

• Most of the staff had worked at the service for a long time and had the skills and experiences they needed to support people well. However, staff were not positive about the training they were offered, and it did not promote best practice. We made a recommendation about the training staff were offered.

• The support people received was not always personalised and people and their relatives were not always positive about the activities at the service.

• Staff worked to support people to maintain their dignity. However, the care people received was not always dignified due to the design of the service and the lack of staffing.

• The service was not well-led and this had an impact on the care that people received. People, relatives and staff were all positive about the registered manager. However, they were less positive about the provider. People’s relatives told us that they had raised concerns with the provider but that they had not felt listened to. When relatives had raised concerns about the maintenance it had not been recorded as a complaint and the complaints process was not always accessible.

• An audit undertaken by a consultant on behalf of the provider identified a number of the concerns we identified during this inspection. However, these had not been addressed.

• There was a nurse at the service at all times and people received their medicines on time and as prescribed.

• When people were unwell or needed support from a health and social care professional they received this.

• People were supported to eat and drink safely. Where people needed support to maintain their weight or eat a specialist diet this was in place.

• Staff understood that people had the right to make choices about their care. Where people were not able to make decisions, these were made in their best interests.

The service did not meet the standard of Good in any area and there were a number of breaches of the regulations.

Rating at last inspection:

At the previous inspection (published on 5 April 2018) the service was rated Requires Improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

You can see what action we told the provider to take at the back of the full version of the 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 six months to check for significant improvements.

High Meadow Nursing Home 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.

High Meadow Nursing Home is registered to provide accommodation and personal care for a maximum of 34 people. The home provides care to older people, people who are frail and some people living with dementia as well as a range of health and support needs such as diabetes, epilepsy and catheter care. At the time of our inspection there were 25 people living in the service. At the last inspection on 1 and 2 March 2017 we asked the provider to take action to make improvements. Six breaches of regulation were found and the service was rated as Inadequate in the key questions of safety and leadership. It was rated as Requires Improvement for the remaining key questions of effective, caring and responsive. This was because the provider had failed to ensure actions designed to minimise risk were always adequate in practice. These related to diabetes and pressure wound management and the risks of people being isolated and unable to use call bells to summon staff. Staff were sometimes neglectful of people’s need to use the toilet, asking them to wait for up to 30 minutes while other tasks were completed. There were not enough staff on duty to meet people’s needs, and staff training needed improvement in some areas. Dietician advice was not always followed to ensure people received adequate nutrition and staff were not aware of target fluid intake for individuals. Records about food and fluids were filled out in retrospect and were sometimes inaccurate. Staff were not consistently caring; some had become desensitised to people’s calls for assistance. There was not enough interaction or stimulation for people who stayed in bed every day. Quality assurance processes had not picked up and addressed these issues. Following the last inspection, the service was rated as Inadequate overall and placed into Special Measures. The provider sent us regular updates about improvements they were making.

When we completed our previous inspection March 2017 we also found concerns relating to people’s hopes and wishes for their end of life care. At this time, this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Responsive. Therefore, for this inspection, we have inspected this key question and also the previous key question of Caring to make sure all areas are inspected to validate the ratings.

At this inspection significant improvements had been made and the legal requirements of the previous breaches had been met. However, we identified some areas where further improvements could be made, these related to a formal review and resolution of an adhoc way in which some nursing needs were covered, for staff to always ensure that call bells were within people’s reach, for choice to be offered and an understanding about how people preferred to receive their medication and an enhancement to the way in which the size of wounds were recorded. The registered manager met with people and carried out an in-depth assessment of their needs and wishes before they came to live in the service; to ensure these could be appropriately met. Potential risks to people’s health and welfare were assessed and there was detailed guidance for staff to follow to mitigate those risks; for example, in relation to diabetes, epilepsy, wound, pressure and catheter care.

People had been asked about their end of life wishes and these had been recorded to ensure people’s these were respected. Staff had received training appropriate to their role, including end of life care. Staff received one to one supervision and appraisal to discuss their role and their training needs. There were sufficient staff on duty to meet people’s needs, staff were recruited safely. People’s medicines were managed safely and people received their medicines when they supposed to.

Staff worked with health and social care professionals to ensure people received the support they needed. Staff monitored people’s health and people were referred to specialist healthcare professionals when required.

People were protected from abuse and discrimination. Staff knew how to recognise signs of abuse and knew that they should challenge colleagues if people were being discriminated against. Staff knew how to report concerns and felt confident they would be dealt with appropriately. Accidents and incidents had been recorded and analysed, action had been taken to reduce the risk of them happening again.

The building had been adapted to meet people’s needs. People were protected from the risk of infection, staff wore protective clothing when required and kept the building and equipment clean.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The service was meeting the requirements of the Deprivation of Liberty safeguards and Mental Capacity Act 2005.

People knew how to complain. Any complaints received were investigated and action taken to prevent incidents from happening again. People and their relatives were encouraged to provide feedback about the quality of the service and any suggestions they may have. These were acted upon by the registered manager and people and visitors told us any concerns had been acted on immediately.

People were treated with dignity and respect. Staff had developed caring relationships with people; they were aware of and sensitive to their needs. Staff encouraged people to be as independent as possible. People’s confidentiality and privacy was promoted by staff. There was a wide range of activity available to people who enjoyed meaningful entertainment and individual sessions. The service had established links and were involved in the local community and church.

There was an open and transparent culture within the service. People, relatives and staff were positive about the leadership at the service and said there had been changes for the better. The registered manager attended local forums to keep up to date with best practice. Staff understood their roles and responsibilities.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service, so we could check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service is rated Requires Improvement. This is the second time High Meadow Nursing Home has been rated as Requires Improvement.

High Meadow is registered to provide nursing and personal care for up to 34 people .There were 28 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, Parkinson’s, catheter care, dementia; and people who needed support to be mobile. Many people were nursed in bed.

High Meadow is a large detached premises situated on the edge of the city of Canterbury, Kent. The service had a very large communal lounge/dining room; with armchairs and a TV for people and a separate, quieter conservatory. Bedrooms are situated over three floors; with a passenger lift available.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

High Meadow was last inspected in January 2016. At that inspection it was found to require improvement. There were a number of breaches of Regulation and we issued requirement actions about these. The provider sent us an action plan showing that all of these areas had been improved. At this inspection however, we found that none of the Regulation breaches had been fully addressed. In addition, other issues had emerged, resulting in further breaches of Regulation.

Assessments had been made about individual risks to people but actions designed to minimise these were not always adequate in practice. This related to diabetes and pressure wound management and the risks of people being isolated and unable to use call bells to summon staff.

Staff were sometimes neglectful of people’s need to use the toilet, asking them to wait for up to 30 minutes while other tasks were completed. There were not enough staff on duty to meet people’s needs, and staff training could be improved in some areas.

Dietician advice was not always followed to ensure people received adequate nutrition and staff were not aware of target fluid intake for individuals. Records about food and fluids were filled out in retrospect and were sometimes found to be inaccurate.

Staff were not consistently caring and some had become desensitised to people’s calls for assistance. There were scant records about people’s hopes and wishes for the end of their life. There was not enough interaction or stimulation for people who stayed in bed every day.

Quality assurance processes had not picked up and addressed the issues we found during this inspection. Effective action had not been taken following our last inspection to make positive changes and provider oversight had been inadequate. A poor culture had developed in which staff had become desensitised to people’s needs.

Medicines were well-managed and safely administered by staff. The service was maintained to a good standard and all equipment was routinely safety checked.

People’s consent had been sought formally and verbally for day-to-day care tasks. Staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and worked within its principles. The registered manager had made applications for deprivation of liberty safeguards (DoLS) and received authorisations for some of these.

Staff received regular supervision and appraisal. There was a robust recruitment system in operation and all necessary checks had been made prior to taking on new staff.

There was a system for recording all complaints and people and relatives knew how to raise concerns. Feedback was sought through a variety of sources.

The registered manager was respected by staff who described good teamwork.

We recommend that the provider obtains from a reputable source; information about first aid during and after seizures.

We recommend that the provider seeks professional advice about best practice guidelines for people’s individual fluid intake.

We recommend that the provider ensures that people’s hopes and wishes for the end of their life are individually discussed and documented wherever possible.

We found a number of breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

High Meadow Nursing Home provides accommodation with personal and nursing care for up to 34 older people, some of whom are living with dementia. There are 28 single rooms at the home and 27 people were living at the home at the time of inspection. The accommodation is over three floors and bedrooms can be accessed by a passenger lift. People share a communal lounge/dining room and a conservatory. There is an accessible and secure garden to the rear of home. This contained a summer house, which had been turned into a tea room for people to use in the warmer weather.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were stored safely and administered by qualified nurses. However, there was not always clear guidance in place for them to follow to ensure they gave people medicines prescribed to be given ‘as required’ appropriately and consistently.

Although people’s personal care needs were met, there were not sufficient numbers of staff available to interact with people so they received stimulation and emotional support. Information had been gained about people’s likes, preferences and past history. However, this information was not effectively used to plan and deliver an individual and group activities programme. An activities coordinator was available for six hours a day. Staff did not have time to sit and talk to people, but chatted to them about their interests and families when supporting them with their personal care. External entertainers visited and special occasions were celebrated such as people’s birthdays.

Quality assurance systems were in place, but where shortfalls had been identified the action taken to address them had not always been reviewed to ensure that it was effective.

Checks were carried out on all staff at the home, to ensure that they were fit and suitable for their role. Staffing levels ensured that people’s physical and personal care needs were met, but were insufficient to meet people’s social needs.

Assessments of risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Staff knew how to follow the home’s safeguarding policy in order to help people keep safe. Accidents and incidents were monitored.

People had their health care, nutritional and fluid needs assessed and monitored and professional advice was sought as appropriate. People were offered a choice at mealtimes, and where appropriate support was provided and people were not rushed.

New staff received an induction which included shadowing new staff. Staff were provided with training in the areas necessary for their role, and this was refreshed on a regular basis. All staff had received training in the Mental Capacity Act 2005 and staff understood the principles of the Act and how to apply them. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

The environment had been adapted for people living with dementia and people had memory boxes with information and photographs that were important to them. However, these boxes were not accessed on a regular basis.

People’s care, treatment and support needs were assessed before they moved to the home and a plan of care developed to guide staff on how to effectively support people’s individual needs. Clear guidelines were in place for staff to follow for people who became anxious or distressed or whose behaviours may challenge themselves or other people.

The views of people and their relatives about the quality of care provided at the home were regularly sought. Relatives felt able to approach the registered manager or staff if they wished to discuss a concern. The service had received a number of compliments.

The registered manager was a visible presence in the home and led a staff team who were clear about the aims and values of the service. Relatives said they would or had recommended the service to other people.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Below is the summary of what we found. The summary is based on our observations during the inspection, speaking to people using the service, their relatives, the staff supporting them and from records in place.

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

Is the service safe?

We saw that people were treated with respect and dignity by all of the staff. People spoken with told us they felt safe. Staff were aware of the whistleblowing procedure. Policies were in place and had been signed as read by all of the staff. Systems were in place to follow up accidents, incidents and complaints, in order to see if any improvements could be made. We found evidence that all of these were followed up by the manager and action plans were put in place when required. Care plans included mental capacity assessments where they were needed. Some people had documents in place for Do Not Attempt Resuscitation (DNAR), and we saw that the person, or their family members had been appropriately consulted by the health professionals completing the forms. This showed that people's individual wishes were safeguarded.

We saw evidence that the home's equipment was well maintained and routinely serviced. The environment had been improved since our last visit and recently redecorated. The home was seen to be clean and tidy and well cared for. This showed that the provider ensured the people were safe from risks.

The manager ensured the staffing was sufficient and each shift had a good mix of experienced staff members to ensure that all the people living at the home were well cared for. The manager also ensured that staff were fully trained and proficient in their roles by the use of staff supervisions and direct observations. This ensured that all of the people's needs were being met at all times.

Is the service effective?

People's health needs were monitored routinely by trained nursing staff and professional support was requested as a matter of urgency when required. People were monitored monthly for their blood pressure and skin integrity to ensure their safety and well being. Amendments were made to care plans as changes were found. This showed that the service was effective at meeting the needs of the people living at the home. Part of the communal areas had been adapted to promote memory links for those with dementia. We found that this area was highly popular with people living at the home and family members that we talked with. Family members said that they felt welcome and were made to feel at home at each visit. People’s family and friends could visit them in their own rooms or in one of the communal rooms, according to the person’s own choice.

Is the service caring?

We observed that people living in the home were treated respectfully by the staff, and their privacy and dignity were maintained. A family member stated that their father was more than happy with the support they received and felt 'at home'. People's family members were invited to take part in care review meetings if this was applicable. We found that there was an open chain of communication between the management, the staff, and people living at the home, which promoted a relaxed atmosphere. We saw that people were very involved in the running of the home, and were able to take part in tasks, such as baking and gardening to enable them to keep as active as possible.

Is the service responsive?

The home employed an activities co-ordinator to enable people to be active on a daily basis in line with their personal preferences. Activities seen included gardening and baking. The people living at the home assisted in the newly opened sweet shop. The cook was actively involved with the people living at the home and talked with them regularly to ensure that changes to their likes and dislikes were acted upon quickly. The cook also acted quickly to provide menu changes to meal presentation when requested by the person or by health professionals.

Is the service well led?

The manager and two other staff members had been trained as 'dementia-champions'. This aided the home to be proficient in the care of people with dementia and to work proactively with them.

The home had systems in place to monitor the quality of the service provided and action plans were put in place to address any requirements. We found that any actions required were carried out quickly. The staff were very committed to the ethos of the home to provide best practice at all times. The introduction of the memory lane cafe and sweetshop had been welcomed by people living in the home. We saw that the manager was active in hands-on care on a daily basis and was in touch with the staff team. All of the staff that we spoke with said they were happy working in the home and felt supported. Relatives that we spoke with also stated their confidence in the manager and the staff team and said they particularly liked the recent improvements to the premises.

People told us that staff treated them with dignity and respect; they said they felt listened to and were supported to remain as independent as possible. We saw staff speaking and responding to people in a gentle and respectful manner. We found records to show how people's health needs had been assessed before they came to live in the home. These included information from health and social care professionals to make sure the home could provide the care people needed.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people. Systems were in place to monitor the service that people received and suitability of the premises to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.