Archived: Highcliffe House Nursing Home

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

The inspection took place on 14 January 2019 and was unannounced. During our last inspection on 25 April 2018 we found breaches to Regulations 17 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found that improvements had been made. There was still improvement needed, which was underway and the service was no longer in breach of regulation.

Following our last inspection in April 2018, the overall rating for this service was 'Inadequate' and the service was put in 'special measures'. The service was kept under review and was inspected again within six months. Because, during this inspection we found the service had made sufficient improvement to be rated requires improvement, this service is no longer in special measures.

Highcliffe House Nursing Home is a 30-bedded residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 19 people living at the service.

At the time of our previous inspection in April 2018, the registered manager was also a director of the registered provider. Soon after that inspection the registered manager stepped down and a new manager had been appointed who had started the process of becoming registered. 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.

Highcliffe House a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates people in one adapted building close to the sea in Felixstowe.

During our last inspection in April 2018, we found that not all internal doors that had signage to say, 'keep locked shut' for people's safety were kept locked. During this inspection we found that these doors were locked, keeping materials that could be harmful to people safe and steps had also been taken to ensure that access to the cellar was monitored when staff were in the kitchen to ensure people were safe from falling down the stairs, but this gate needs to be kept locked at all times.

Improvements had been made in the quality of people’s care plans and the way that risks were identified and measures put in place to help protect people from harm. But the standard was not consistent throughout people’s care plans and we found that a piece of equipment mentioned in a risk assessment that was essential for the person’s safety was not in working order. This was rectified immediately.

People where protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and knew how to report any incidents they witness or suspected. Improvements had been made since our previous inspection and appropriate safeguarding referrals had been made.

People were protected by staff that had been safely recruited.

Medicines were managed in a way that ensured that people received them safely and at the right time. There were also appropriate infection control practices in place to help protect people, visitors and staff from infectious disease.

Staffing levels were sufficient to keep people safe on the day of our inspection. We saw evidence that lessons were learnt and improvements made when things went wrong.

The way the service was managed had improved since our last inspection and the provider and manager had made a positive move towards improving the service. There were systems in place to monitor the quality of service the providers offered people, however there were still some inconsistency in records and in identifying the concerns including those we identified during this inspection.

Improvements had been made in the culture of the service. Staff told us that things had improved and the service was a better, happier place to work in. People and staff told us the manager was open, supportive and had a good, caring attitude in the way they believed people and staff should be supported.

The service had worked in partnership with other agencies whilst working to make improvements to the quality of care offered to the people they support.

Since the last inspection in March 2017 we have prosecuted the registered provider and registered manager (who is also a Director of Highcliffe House Ltd) for an offence under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12(1) refers to failure to provide safe care or treatment resulting in avoidable harm to person using a service, or exposes a service user to a significant risk of exposure to avoidable harm. A person fell from a window at the service and died. The registered provider and registered manager pleaded guilty and were fined at Magistrates court in January 2018. Immediately after the incident in 2016 we took urgent action to safeguard others using the service including ensuring window restrictors were fitted through-out the service. The 2014 Regulations make it a criminal offence to fail to comply with Regulation 12(1) where the failure to provide safe care or treatment results in avoidable harm to a service user or exposes a service user to a significant risk of exposure to avoidable harm. The 2014 Regulations took effect on 01 April 2015 and coincided with a transfer of enforcement responsibility for health and safety incidents in the health and social care sector from the Health and Safety Executive and local authorities to CQC.

The last inspection of Highcliffe House in March 2017 found that improvements had been made and the rating increased from Inadequate to Requires Improvement. However, there were still breaches in regulation and concerns about the overall governance and quality assurance.

Highcliffe House Nursing Home is a 30-bedded residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 23 people living at the service.

There was a registered manager who was also a Director of the registered provider. 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 this inspection, we found a lack of consistency in the way the service was managed. The leadership, governance arrangements and culture in the service did not always support the delivery of high quality care. There remained an inconsistent approach to reporting and (where appropriate) investigating of incidents and safeguards. This was identified at our previous inspection and continues to place people’s safety, health and welfare at risk. It also means there continues to be missed opportunities to improve care and mitigate risks.

This included continued lack of action following the death of the person who fell from a window. There had been no formal debrief, learning or review of what went wrong from the provider. It is important those affected by such incidents, such as friends, family and others are informed of the actions taken to improve practice and reduce the risk of such events happening again. The Nominated Individual representing the provider stated they would now be implementing an internal investigation. We also identified the provider and registered manager had not adhered to their responsibilities under Duty of Candour. They had not formally written to the person’s relevant representative, providing an explanation or apology for the incident. This did not demonstrate caring values, behaviours and transparency regardless of the outcome of the prosecution.

At our previous inspection in March 2017 we identified risks in relation to people’s continence management, dehydration and pressure wound care. Whilst we found improvements to manage the risks to people in these areas, we found further risks to people that had not been identified and managed to keep them safe. This included choking, further environmental risks including unlocked doors intended to be locked to protect people from the risk of harm from unsupervised access.

Staff had received a variety of training relevant to their roles, however they remained unclear of the strategies in place to support people whose behaviour can be challenging. Staff lacked understanding about how to recognise when restraint of any form was being used and escalate if it was not appropriate or thoroughly assessed.

We continued to receive concerns about the numbers and quality of staffing and management. The registered manager could demonstrate action taken to manage employment issues, specifically around bullying and poor performance when it was reported to them. Despite this, concerns remained about bullying and blame culture in the service. The provider had not explored the reasons why this continued to be an issue to effectively address and identify the root causes.

The volume of information in people’s care plans made it difficult for staff to access information in relation to people’s specific care needs. Missing/incomplete information and inconsistencies continued to place people at risk of not receiving the care they needed. We have made a recommendation about improving care plans to ensure information about people’s needs is easily accessible and up to date.

Despite these concerns people were positive about the care and support they received and that there were enough staff. We saw staff were intuitively kind, caring and compassionate towards people who lived in the service. Staff had developed good relationships with people.

People were supported to eat and drink according to their dietary needs, choices and preferences. People were supported to access ongoing healthcare support and significant improvements had been made to promoting healing of pressure wounds. Systems were in place to prevent the risk of cross infection, but on occasions essential elements of cleaning were missed. People were positive about the decoration and design of the premises, they liked living there because it was comfortable, felt like home and not clinical. People were protected from isolation and were involved in a range of activities that reflected previous lifestyles and current interests, including access to the local community.

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 act 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 act 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.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Highcliffe House Nursing Home is a 30 bed residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 20 people living at the service.

There was a registered manager who was also the registered provider. 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 our previous inspections in May, July and August 2016, we found evidence of major concerns in relation to the clinical oversight of the service, insufficient monitoring of people with complex nursing needs and the overall quality and safety monitoring of the service. The service was rated as ‘inadequate’.

We formally notified the provider of our escalating and significant concerns and placed a condition of the provider’s registration to stop them admitting any further people to their service. We notified our stakeholders which included the Local Safeguarding Authority and the Clinical Commissioning Group (CCG).

At this comprehensive inspection, we found that with the support provided to the service from the local authority and the CCG, improvements had been made.

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 provider had implemented systems to improve their quality and safety monitoring of the service including the clinical oversight of people with complex health care needs. However, further improvements were required in the monitoring of people at risk of malnutrition and wound management.

At two inspections carried out in the last year, May 2016 and August 2016 we found, ongoing concerns in relation to the management of people’s medicines. At this inspection we found significant improvement with the implementation of improved systems for auditing and response to medicine administration errors.

There were systems and processes in place to minimise the risk of abuse and staff had received training in protecting people from abuse. However, not all incidents and accidents had been recorded and investigated according to local safeguarding protocols and the provider’s safeguarding policy.

Whilst we found some improvements, further work was required to ensure that the care planning for people who presented with distressed behaviours and the monitoring of catheter care, skin tears and wounds was effective at mitigating the risks to people’s health, welfare and safety.

The service was clean and there were regular audits and systems in place to prevent the risk of cross infection. Environmental risk assessments had been updated to include regular safety checks of window restrictors, exposed pipework, bedrails and slip, trips and falls hazards.

Staff and the manager understood their roles and responsibilities with regards to the Mental Capacity Act 2005. Staff had received a variety of training relevant to their roles.

People’s nutritional needs were assessed and they were supported to eat and drink according to their dietary needs, choices, and preferences. People were supported to access ongoing healthcare support. There were systems in place to ensure important information about people’s health, welfare and safety needs were shared with the staff team.

People had access to clear information about how to raise concerns and complaints. There was a written procedure visible on noticeboards throughout the service . There was a suggestion box in the reception area, available to enable people to log any suggestions and concerns easily and anonymously if they chose. Annual surveys were carried out to ascertain the views of people and their relatives.

We observed some very caring interactions between staff and people living at the service. Relatives were positive about the improvements they had observed and in the culture of the staff group. Staff were observed to be kind and respectful in their approach towards people.

Auditing arrangements had been strengthened but further improvements were needed to the oversight of clinical care and accidents.

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

At our previous inspections in May 2016 and July 2016, we found evidence of major concerns in relation to the clinical oversight of the service and the quality and safety monitoring of the service.

Our urgent focused inspection carried out on 15 July 2016 was in response to concerning information we received in relation to a serious incident that had occurred the day before resulting in a fatality. We found that the provider had continued not to take action to assess the risks to people’s health, welfare and safety and regularly monitor the quality and safety of the service. Staff had not been provided with the required health and safety training, including assessment of risk and had not been provided with procedural guidance to guide them in steps they should take to protect people from the risk of harm. This meant that the health safety and welfare of people using the service was a t risk and the provider was failing to provide a safe service.

We formally notified the provider of our escalating and significant concerns following our urgent, focused inspection 15 July 2016 and ongoing emerging risk shared with us by stakeholders. We placed a number of conditions on the provider’s registration which required them to take urgent action to protect people from the risk of harm.

We carried out this unannounced focused inspection on the 10 August 2016.

Highcliffe House Nursing Home is a 30 bed residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 26 people living at the service.

At this focused inspection 10 August 2016, we found the provider had taken some action in responding to assessing the risks to people’s safety in relation to the environment and action to arrange for staff to be provided with training in health and safety, including risk management. However, we continued to have major concerns regarding the overall clinical leadership of the service, the lack of action taken by the provider to safeguard people in the management of their medicines, monitoring to ensure people were sufficiently hydrated, pressure ulcer prevention and the lack of monitoring to ensure their complex nursing needs were being met. This meant that the health, safety and welfare of people with complex nursing needs, continued to be at risk. The provider was not meeting the requirements of the law as they did not monitor effectively the health and nursing care needs of people and identify people at risk of receiving care or treatment that was inappropriate or unsafe.

There was a registered manager who was also the registered provider. 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. However, as this is a care home with nursing we found that there was no clinical lead with overall responsibility for clinical governance of the service.

We found continued, on going, major concerns in relation to the management of people’s medicines and the overall clinical governance of the service in meeting the nursing needs of people with complex health care conditions. There was a lack of clinical oversight and review of daily health and welfare monitoring records.

People were not receiving appropriate nursing care and monitoring which placed them at increased, serious risk of harm. For example, people assessed as at high risk of developing pressure ulcers were not being repositioned to alleviate pressure to skin. There was a lack of monitoring to ensure people received adequate support to maintain adequate nutrition and hydration to prevent ill health. People were not effectively monitored for pain or receiving adequate pain relief medicines as prescribed.

We found a lack of sufficient measures in place to ensure the safety of people during procedures where staff were required to support people with their moving and handling transfers.

People with swallowing problems and at risk of choking were not always provided with food and drink that was at the correct, prescribed consistency, to protect them from the risk of harm. Care plans for people with dysphagia and at risk of choking did not refer to clinical guidance and correctly detail the required consistency of food and fluid.

People had not been supported by staff to be repositioned, placing them at risk of skin breakdown, stiffness and pain. This demonstrated a significant lack of effective clinical oversight which directly increased the risks to people of not having their care and treatment needs being met and action to mitigate the risks to people’s health, welfare and safety of people.

We noted that some people using the service had been assessed as having mental health support needs such as depression and suicidal tendencies. However, there was a lack of sufficient, clear guidance for staff in how these people were to be appropriately supported.

Immediately following this inspection we issued an urgent action letter formally requesting the provider take urgent action to mitigate the risks to people’s health, welfare and safety.

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.

This report only covers our findings in relation to this, focused inspection. You can read the report from previous inspections, by selecting the ‘all reports’ link for ‘Highcliffe House Nursing Home’ on our website at www.cqc.org.uk

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

We carried out this focused inspection to look at concerning information in response to a serious incident that had occurred the day before resulting in a fatality.

Following our previous comprehensive inspection in May 2016, we asked the provider to take action to make improvements as we found evidence of major concerns in relation to a lack of regular, effective quality and safety monitoring of the service. The provider’s audits were found to be sporadic, irregular and did not identify the shortfalls we found in relation to qualified nurses management of people’s medicines and inadequate medicines management policy. There was no clear, established system of clinical governance in place and operated effectively with regularity which would ensure regular assessment and monitoring of risk in relation to the regulated activity which included nursing care.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Highcliffe House Nursing Home is a 30 bed residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia.

There was a registered manager who was also the registered provider. 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. However, as this is a care home with nursing we found that there was no clinical lead with overall responsibility for clinical governance of the service.

During this urgent, focused inspection 15 July 2016, we found a continued failure to ensure that service users were protected from the risks associated with improper operation of the premises, with a failure to assess the risks to people’s welfare and safety. We found that the provider had made no attempt to carry out any environmental risk assessments and no individual assessments in relation to people with access to windows without appropriate window restrictors in place.

We also found a lack of action to assess the risks to people’s welfare and safety as the provider had made no attempt to carry out any environmental risk assessments and no individual assessments in relation to people’s exposure to the risks associated with contact with hot surfaces such as unprotected radiators.

An external health and safety audit was carried out in February 2015, commissioned by the registered person. Recommendations for action following this audit included; accidents and incident statistics should be reviewed and outcomes with actions recorded on a formal basis. The audit report also highlighted the need for health and safety training to be provided for all staff including risk assessment and that suitable and sufficient risk assessment for all activities where there is a risk of injury should be carried out. Target dates for signatures to evidence actions taken were not completed. The registered person was not able to show that actions had been taken in response to this audit.

This meant that the safety and welfare of people using the service was at risk and the provider was failing to identify risks and provide a safe service. The provider was not meeting the requirements of the law as they did not protect people against the risks of receiving care or treatment that was inappropriate or unsafe.

This report only covers our findings in relation to this urgent, focused inspection which we carried out in response to having received concerning information. You can read the report from our comprehensive inspection carried out 3 May 2016, by selecting the ‘all reports’ link for ‘Highcliffe House Nursing Home’ on our website at www.cqc.org.uk

During this inspection we identified a 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 this report.

Highcliffe House Nursing Home is a 30 bed residential and nursing care service providing care, treatment and support, including end of life and care and support for people living with dementia. On the day of our inspection there were 27people living at the service.

There was a registered manager who was also the registered provider. 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. However, as this is a care home with nursing we found that there was no clinical lead with overall responsibility for clinical governance of the service.

The provider’s medicines management policy which provided staff with procedural guidance for ensuring the safe administration of people’s medicines was brief in detail and failed to provide guidance to the level of detail required in line with current legislation including the National Institute for Clinical Excellence (NICE) guidance for managing medicines in care homes. There were shortfalls in the management of people’s medicines. These had not been identified by the provider’s medicine audits. This meant we could not be assured that people always received their medicines as prescribed.

There was a lack of regular, effective quality and safety monitoring of the service. The provider’s audits were found to be sporadic, irregular and did not identify the shortfalls we found in relation to qualified nurses management of people’s medicines and inadequate medicines management policy. There was no clear, established system of clinical governance in place and operated effectively with regularity which would ensure regular assessment and monitoring of risk in relation to the regulated activity which included nursing care.

The service was caring because people were treated with kindness, compassion and their rights to respect and dignity promoted.

People were provided with a variety of meals and supported to eat and drink sufficiently. Where support was required this was provided in a caring, respectful manner.

People’s needs had been assessed prior to their moving into the service. Within care plans people’s health care needs had been recorded and input from other healthcare professional described. However, further work was needed to ensure that care plans were reviewed and updated in a timely manner to reflect people’s changing needs.

The service was found to be clean and well maintained. People’s room were individual and people have some of their own personal items making the rooms homely. There were systems in place to protect people from the risk of acquired infection.

People said that they were supported to voice any concerns they might have and the manager had been supportive in listening to suggestions they had made to improve the service.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the management of people’s medicines. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection on 2 April 2014 we found that improvements had been made.

We spoke with six people who used the service. We also spoke with one person's relative. We looked at five people's care records. Other records we viewed included newly appointed staff recruitment records, health and safety checks and staff meeting minutes.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information we had gathered to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

People we spoke with told us they felt safe living in the service and that they would speak with the manager if they had any concerns.

We saw that two staff had recently been provided with training in understanding the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DOLS). The provider told us that they had plans in place to ensure that all staff would be provided with this training in the near future and that mental capacity assessments would be implemented.

We saw records which showed us that health and safety checks were carried out by the provider. This included regular fire safety, electrical appliance checks and contracts were in place to ensure that moving and handling equipment was regularly serviced.

Is the service effective?

People who used the service told us they had received a quality service which met their needs. One person told us, 'You cannot fault them. I prefer to stay in my room and they are always popping in and out to make sure I am alright. I am very satisfied with the service they provide.' Another person said, 'The food is excellent. They cannot do enough for you.'

Relatives we spoke with said they found staff to be approachable and had confidence in the manager to address any concerns they might have.

Our observations found that staff responded well to people's requests for assistance. We saw that people were supported on a 1-1 basis with trips out into the community for shopping and organised activities within the service.

Is the service caring?

We spoke with people who used the service and their relatives. One person told us, 'The staff are all very kind. There is not one person here who is not always professional, kind and caring.' A relative also told us, 'I am here most days and I am always welcomed. They are excellent and I cannot find fault. If I was not happy I would not hesitate to speak with the manager'

We observed how staff treated people and saw that staff were kind, respectful and attentive.

Is the service responsive?

People's care records viewed showed us that their individual physical, mental and social care needs were assessed prior to admission to the service. Daily records evidenced that in the main, where concerns about the health and well-being of people had been identified appropriate action had been taken to ensure they were provided with the support they needed. This included access to health care professionals such as a doctor or district nurse and chiropodists.

Is the service well-led?

Since our last inspection the provider had made improvements to their management of quality monitoring systems. The records we viewed showed that the provider had regularly reviewed the quality of care plans, daily records and the cleanliness of the environment. Review meetings had been organised to enable people who used the service and their relatives to express their views regarding the quality of the care they received and to contribute to their plan of care.

We looked at the care records of three people who used the service. We found shortfalls in the planning for the night time needs of people and the management of risk for people who had been assessed as prone to falls and the use of bedrails.

We found that care records were not being regularly reviewed and updated. This meant that people were at risk of receiving care and treatment that was inappropriate or unsafe.

During our inspection we found there had been several improvements to care plans. These had been updated and we saw up to date records for people who required 24 hour bed care including those people being cared for at the end of their life. This showed us that staff were provided with more robust guidance to meet the needs of people who used the service.

People were overall complimentary about the approach of staff who supported them. One person said, 'You could not want for a better place it is A1.'

Prior to our inspection we received a concern about the service not responding to people when they were requesting help from communal lounges. We looked at this during this inspection. We spoke with five people who used the service and a relative. We also spent time observing care and support provided to people.

We spoke with two relatives who told us they were pleased with the service their relative received. They told us if they had any concerns they would be confident that the provider would deal with any issues.

We observed the care provided to people who used the service and saw that the staff interacted with people in a caring, respectful manner.

We found that there were shortfalls in the management of people's medication. We found that care records were not being audited or reviewed on a regular basis to ensure that information to guide staff was current and accurate. This meant that people were at risk of receiving care and treatment that was inappropriate or unsafe.