St Michaels House

St Michaels House is a residential care home registered to support up to 13 adults with mental health conditions and/or people who misuse substances. There were nine people living at the home at the time of inspection.

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

People were satisfied living at the home and felt they received adequate care. However, there were continued failings in relation to the management, governance and oversight of the service.

The management team had failed to take sufficient action to make improvements from the previous inspection. The management team had been unable to implement effective governance structures to adequately review people’s care.

The management team had insufficient oversight of people’s care plans and risk assessments, and the audits that were in place were ineffective at identifying where improvements were required.

The management team did not ensure adequate records were maintained in relation to the care people received and had failed to audit key documents in relation to this.

The management team had an inadequate understanding of their role in ensuring, and reviewing, that people received the care they required. They failed to understand the requirements of how to run a Good service.

People did not have all the risk assessments they required to reduce their known risks. For example, one person at risk of malnutrition did not have a risk assessment in place giving guidance to staff to minimise this risk.

Since the last inspection the provider had introduced some personalised risk assessments however they were not regularly reviewed or updated when changes to people’s care needs had occurred.

Sufficient arrangements were in place to support people with their medicines and there were enough staff to support people safely. Adequate cleaning arrangements were in place.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 March 2020) with well led rated inadequate and the service placed in Special Measures.

At our last inspection we found breaches of the regulations due to our concerns about the leadership of the service and insufficient risk assessments in relation to people’s care. The provider met with us after the last inspection to tell us what they would do and by when to improve. In addition, they have been required to submit monthly reports to the Commission outlining the improvements they were taking.

Not enough improvement had been made at this inspection and the provider was still in breach of the regulations.

This was a continued breach of Regulation 17 (Good governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service remains in Special Measures.

Why we inspected

We carried out this focussed inspection to follow up on the action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions and therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the 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 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 found breaches in relation to insufficient risk assessments relating to people’s care and insufficient leadership, oversight and governance of the service.

We will update the end section of this report to provide information about CQC’s regulatory response to the breaches found. We will do this once any action has concluded.

What happens next?

We are continuing to keep the service in special measures as we have rated it inadequate in a single key question over two consecutive inspections. This means we will keep the service under review and if it is still operating, will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

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

St Michaels House is a residential care home providing personal care to 13 younger and older adults with mental health conditions and/or people that abuse alcohol or drugs. The service was full at the time of inspection.

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

People told us that staff treated them well and they usually felt safe within the home. However, there were significant failings in relation to the management, governance and oversight of the service. The provider and registered manager were unable to identify and embed adequate governance structures that effectively reviewed the service and ensured people received safe care and support.

People did not have adequate risk assessments in place that identified their known risks or gave sufficient guidance to staff about how to manage them.

Safeguarding procedures were not adhered to and there was insufficient action to report and investigate safeguarding incidents.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. The policies and systems in the service did not always support a practice which empowered and enabled people to have as much freedom as they required. People did not always have appropriate mental capacity assessments completed, or best interest decisions made. The registered manager was unable to confirm the status of people’s Deprivation of Liberty Safeguards.

Incidents and accidents were not always appropriately reviewed. There were missed opportunities to learn from previous events and prevent future occurrences.

Staff felt supported by the registered manager however supervisions were irregular, and staff were not given regular feedback about their performance.

Improvements were required to ensure people were supported to maintain their dignity and independence.

Care plans did not always contain sufficient information about people’s care needs and the support they required.

People were supported to maintain relationships that were important to them and carry out activities they enjoyed.

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 25 October 2018).

The service remains rated requires improvement. This service has been rated requires improvement or below for the last six consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this full report.

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

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

Enforcement

We have identified breaches in relation to insufficient risk assessments to keep people safe, and inadequate governance and oversight of the service.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Requires Improvement’ with the Well-Led section rated as ‘Inadequate’. Due to the nature of our concerns and the history of this provider, we have placed this service 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.

St Michaels House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Michaels House can accommodate 13 people in one adapted building. At the time of inspection, 9 people were living at the service.

Following our inspection in March 2018 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there, and ongoing breaches of regulation. The commission placed the service in special measures until they had improved the care provided. 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 provider demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. At the time of this inspection we found there had been improvements in the way that the home operated and in relation to the cleanliness of the environment and maintenance within the home. Therefore, this service is now out of Special Measures. However, the rating reflects that more time is required to evidence sustainability of the improvements made.

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.

People told us they felt safe, and staff understood how to recognise abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, and actions were taken to reduce risk where possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager.

Staffing levels were adequate to meet people's current needs, and rotas showed that staffing was consistent.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff attended mandatory training courses to ensure their knowledge was up to date. Staff were able to update their mandatory training with short refresher courses.

Staff supported people with the administration of medicines, however, there were improvements required in identifying risks and making sure people could take the medicines they required safely.

People were protected by the prevention and control of infection. The home had undergone decoration and renovation in many areas, and all areas were being regularly cleaned.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Consent forms were signed and within people’s files.

People were able to choose the food and drink they wanted and staff supported people with this, and people could be supported to access health professionals when required. All aspects of people’s health was documented within their files and updated regularly.

Care planning and risk assessments were personalised and mentioned the specific care each person required, including their likes and dislikes. Staff were aware of people’s preferences, and supported people in a person-centred manner.

People were involved in their own care planning as much as they could be, and were able to contribute to the way in which they were supported. People told us they felt in control of their care and were listened to by staff.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and provided their care in a respectful and dignified manner.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The people we spoke with knew how to use it.

Quality monitoring systems and processes were in place and comprehensive audits were taking place within the service to identify where improvements could be made.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and improvements were highlighted and worked upon.

St Michaels House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Michaels House can accommodate 13 people in one adapted building. At the time of inspection, 10 people were living at the service.

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

St Michaels House was inspected in April 2017 and rated as inadequate and placed into special measures. In August 2017 we inspected again, and whilst some improvements had been made, we found ongoing breaches of regulation. The service was rated as requires improvement, and remained in special measures. During this inspection in March 2018, we found that the provider had implemented improvements in some areas however; they remained in ongoing breach of regulation . There remained a poor quality of cleanliness within the home, lack of oversight to monitor and improve the quality and cleanliness. This meant there was a risk of harm posed to people due to the lack of cleanliness of the home. We found that there was not enough improvement to take the provider out of special measures. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The home was dirty and had continued to not be adequately cleaned. There were numerous areas throughout the home that posed a direct risk of harm through the allergens present in mould and the increased risk of infection associated with the ingrained dirt and general lack of cleanliness. This included the kitchen area and people’s bedrooms. The kitchen had many areas of ingrained mould and dirt, and food was being prepared in these areas. We found mould around several people’s basins, and serious damp and mould issues in one person’s bedroom. This was a risk to people’s health, including one person at a higher risk of developing respiratory infections due to a diagnosis of COPD.

We found that fire doors within the service had been propped open by chairs, thus creating a fire risk as the doors would not close in the event of a fire. People using the service smoked within their rooms. Risk assessments were in place to identify the potential risks of this behaviour, and people had signed agreements not to smoke in rooms. This did not stop people from smoking in their rooms, and no further actions had been taken by the service to address this.

The environment continued to be poorly maintained. A redecoration plan was in place, but this had failed to take prompt action in improving the environment.

A robust and detailed system of quality assurance to monitor the environment and key aspects of people's care and support had not been implemented. This had resulted in the shortfalls that we identified during this inspection failing to be identified or addressed by the provider. As a result of the last inspection, we were receiving monthly updates from the provider regarding the cleaning that was taking place and the environmental audits. We found that these were ineffective and did not reflect the state of poor cleanliness within the home. The registered manager had not taken prompt action to identify and address the problems with the environment.

Staff supported people in a positive manner and were caring in their day-to-day interactions with people. However, the overall ethos within the service required improvement in this area, due to lack of action taken to make sure people felt safe, comfortable and dignified in their environment.

At our last inspection, there was no evidence that people had been involved in capacity assessments and best interest checklists had not been completed. At this inspection, the service had begun to evidence people’s involvement in their own care plans, and best interest decisions were being carried out around specific areas of people’s lives. Where required, the use of advocacy services had been applied for to support people with their decision making.

A programme of activities had been introduced to increase people's sense of well-being. Improvements had been made in this area and detailed records were kept to evidence the different opportunities people were offered and when, and an evaluation of how successful this was.

People received their prescribed medicines safely. Staff had been recruited safely and received the training, support and supervision that they required to provide people's care and support.

People were supported to have enough to eat and drink and to access healthcare professionals when they needed to.

Care planning documents had improved since our last inspection. Person centred care plans were newly in place that included people’s likes, dislikes, skills and preferences.

The overall rating for this service is 'Inadequate' and the service remains 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.

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

There was a registered manager in post who was also the provider of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Following the last inspection of St Michaels House in April 2017 the provider was rated as inadequate and placed into special measures. During this inspection we found that the provider had implemented improvements in a number of areas however, these improvements required further development to ensure that they were sufficiently embedded into practice. There was a lack of oversight of people’s care and support from the provider and an appropriate system to monitor and improve the quality and suitability of care and support that people received had not been implemented. This had resulted in ongoing breaches of regulation and a risk of harm posed to people due to the lack of cleanliness of the home. This inspection found that there was not enough improvement to take the provider out of special measures and that the well-led domain remained inadequate.

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.

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.

The home was dirty and a number of areas on the ground floor including the laundry room were mouldy and posed a risk of harm to people. Throughout the home and in people’s bedrooms we found broken items of furniture that were in use, dirty carpets and the home was in need of redecoration and updating. The provider had submitted an action plan to CQC in August 2017 detailing the improvements that they intended to make to the environment however, appropriate and timely action had not been taken since our last inspection.

Although people’s care and support files contained assessments of their capacity showing that they lacked capacity to make decisions in relation to their care there was no evidence that people had been involved in these capacity assessments. Best interest checklists had not been completed and there was no evidence to show that the provider had explored less restrictive options when developing people’s plans of care.

A system of quality assurance to monitor the environment and key aspects of people’s care and support had not been implemented. This had resulted in the shortfalls that we identified during this inspection failing to be identified or addressed by the provider.

A programme of activities had been introduced to increase people’s sense of well-being. We have made a recommendation within the main body of the report in relation to how this programme of activities can be further developed.

People could now be assured that they would receive their prescribed medicines safely. Staff had been recruited safely and received the training, support and supervision that they required to provide people’s care and support.

People were supported to have enough to eat and drink and to access healthcare professionals when they needed to.

Staff knew people well and the engagement between staff and people had improved since our last inspection. However, the availability of staffing sometimes impacted detrimentally the engagement between staff and people living in the home.

People had plans of care in place describing their care needs however, these required strengthening to provide person centred guidance to staff on how to meet people’s care and support needs consistently.

At this inspection we found the service to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

St Michaels House provides accommodation for up to 12 people living with mental health needs. At the time of our inspection there were 9 people living in the home

We inspected this service in May 2016 and found identified that there was a breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was asked to submit an action plan to tell us how they would address these breaches however, did not submit this to us.

There was a registered manager in post who was also the provider of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The provider continued to fail to implement adequate quality assurances procedures since our last inspection. This had resulted in on going shortfalls in the service failing to be identified and resolved. We also found that the home had not been adequately maintained and the provider did not have plans in place to address the maintenance of St Micheals House.

The provider continued to fail to ensure that people received their prescribed medicines safely as there were insufficient processes in place to ensure that all prescribed medicines had been given..

People’s capacity to consent to their care and support had not consistently been considered by the provider. People were subject to some restrictions where their capacity to consent to the restrictions had not been assessed or processes followed to ensure that the restrictions were in their best interests.

People did not always experience positive interactions and relationships with staff. Staffing levels within the home were not always sufficient to facilitate activities or positive engagement with people.

Staff provided care that was based on mitigating known risks; however, this provided a negative culture as staff did not relate to people’s strengths, interests or implement proactive strategies to engage with people.

There was a breach of four regulations which included two continued breaches of 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.

St Michaels House provides accommodation for up to 12 people living with mental health needs. At the time of our inspection there were 10 people living in the home.

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

At the last inspection in March 2015 we asked the provider to make improvements to the way in which people’s medicines were managed as at times people’s medicines were not managed safely. During this inspection we found that people continued not to always receive their medicines safely. We also found that records were not always completed to show what medicines people had been administered. This constituted a breach of the regulation 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.

There were not effective systems in place to monitor and improve the quality of the service. Audits of the environment had not always identified areas that required improvements, and where they had been identified actions to improve the environment had not always been made. This constituted a breach of the regulation 17 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.

During our inspection in March 2015 we also asked the provider to make improvements to the way in which they supported people who did not have the capacity to consent to their care and support. At this inspection we found that these improvements had been made and staff and the manager understood their roles in supporting people who may lack the mental capacity to make decisions for them.

People felt safe and comfortable in the home and staff were clear about their roles and responsibilities to safeguard people from harm. People were protected from the risk of harm and staff understood how to recognise and respond to concerns. Risks associated with people's care needs were assessed and measures put in place to reduce the likelihood of harm occurring.

There were enough staff to meet people's needs in a timely manner. Staff were knowledgeable about people's needs and people told us staff cared for them in a kind and compassionate way.

Staff received regular training that equipped them with the skills and knowledge that they required to carry out their roles.

Staff worked closely with people’s allocated health professionals to ensure that they maintained good health. Where staff had identified that people were unwell they supported them to access appropriate healthcare services in a timely manner.

People were supported to eat and drink enough to maintain their health and well-being and were able to choose and participate in the preparation of their meals. People had individual plans of care in place that they had been involved in developing. People were involved in and supported to make decisions about their care and were supported to participate in a range of activities both with and outside of the home.

People had good relationships with staff within the home. Staff knew people well and were aware of how to support people to raise any concerns and complaints. People told us that the registered manager was visible within the home and that they felt able to approach her should they have any concerns.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. People's ability to manage their finances had been assessed and appropriate arrangements put in place.

No person in the home was subject to Deprivation of Liberty Safeguards. We saw no restrictions on people's liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements were needed in supporting staff through a structure of regular supervision and a system of appraisal.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff cared for them well and listened to them. One person told us, 'Staff are nice here ' they all help us'. Another said, 'I like it here ' it is the best home I've been in, everyone is very helpful'.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person's care. This helped staff provide care and support according to the person's needs and choices.

Is the service caring?

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People told us they were encouraged and supported by staff to take part in relevant daytime activities both in the home and in the community. This meant that the provider was promoting the wellbeing of people who used the service by taking account of all their needs.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system. We found that a range of internal quality checks were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

Improvements had been made in the maintenance of accurate and appropriate records since our last inspection.

We found that improvements had been made in the standard of cleanliness, and that refurbishment had taken place in parts of the home.

We found that people were well cared for and we saw that staff interacted well with people in a way that demonstrated that they were knowledgeable about their individual requirements.

We were concerned that weekly fire alarm tests and some care records had not been completed in a timely way. One care record had not been completed which would outline the steps for staff to take in order to keep people safe.