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Archived: Balliol Lodge Nursing Home

Overall: Inadequate read more about inspection ratings

58-60 Balliol Road, Bootle, Liverpool, Merseyside, L20 7EJ (0151) 933 6202

Provided and run by:
Mr Bharat Kumar Modhvadia and Mrs Jaya Bharat Modhvadia

All Inspections

5 & 6 November 2015

During a routine inspection

The inspection was unannounced and took place on 5 and 6 November 2015.

Balliol Lodge is a care home that provides nursing and personal care for up to 32 people. The care provided is for people with a diagnosed condition of dementia although some people have other enduring mental health needs. The home consists of two converted buildings over three floors. It is located very close to shops, local amenities and public transport links.

At the time of our inspection there were 22 people living at the home.

There was no registered manager in post. The previous manager had left the service shortly before our last inspection on 29 July 2015. An existing member of staff had taken up the role of manager shortly before this inspection. However, they had not applied to be registered. A registered manager is a person who has registered with the 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.

Following the inspection in July 2015, the home was rated ‘inadequate’ overall. This meant the home was placed into ‘Special Measures’ by the Care Quality Commission (CQC). The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve.
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in Special Measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

People living at the home were not protected from abuse. There were a large number of serious incidents between people living at the home, many resulting in injury. Effective risk management measures had not been put in place to minimise the occurrences of such incidents. Not all staff had received training in adult safeguarding. The home did not have an adult safeguarding policy.

Individual risk was not managed effectively. Individual risk assessments and risk management plans were either not in place or were poorly completed.

We found the staffing levels were inadequate to ensure people’s safety was maintained at all times. The staffing levels had been reduced since our inspection in July 2015 despite an increase in dependency levels and continual incidents between people living at the home. Staffing levels were insufficient to ensure the shared areas were supervised by staff at all times.

The approach to recruitment of staff was not robust. Character references were accepted and references from previous employers were not always sought. Induction was not role-specific. Staff supervision was taking place but staff were not up-to-date with training needed to fulfil their role effectively.

Medicines were not managed in a safe way. For example, there was either no information or insufficient information to guide staff when administering medicines that are given when needed. There was also insufficient information recorded to enable staff to apply topical medicines (creams) properly. People’s medicines were not always given as prescribed and no explanations for these omissions were recorded. No action was taken by nurses to review people’s medicines, or seek medical advice, when they refused the medicines on a regular basis.

We found that the home was not very clean, safe or well-maintained. For example, not all of the window restrictors had been replaced following our last inspection. A stair gate was broken which meant people at risk of falling could access the stairs. Merseyside Fire and Rescue Authority had been monitoring the home closely following an allegation of serious deficiencies under the Regulatory Reform (Fire Safety) Order 2005. As a result of the visit, a Fire Safety Inspection was carried out and appropriate action was being taken. Despite these concerns, we found that weekly visual checks of smoke detectors, emergency lighting, door self-closures and firefighting equipment had not taken place since the end of August 2015.

Families informed us that their relatives had access to healthcare services when they needed it. Care records confirmed this.

Adequate measures and support were not in place to ensure people received enough to eat and drink to meet their nutritional and hydration needs. Snacks and drinks were not provided between meals. Water was not routinely offered to people as a drink.

Mental capacity assessments were not being undertaken in accordance with the principles of the Mental Capacity Act (2005). This showed staff lacked an understanding of the Act. Staff had not received training in mental capacity. Deprivation of Liberty safeguarding (DoLS) applications had been submitted to the Council for the people who needed them.

We found that not all staff were kind or caring towards the people living at the home. We heard staff speak sharply to people and we saw a member of staff displaying a dispassionate attitude towards people on a number of occasions. Staff did not make sure that people’s privacy and dignity was maintained at all times.

Care was not person-centred. Care records concentrated mainly on people’s physical health care needs and contained minimal information about people’s personal history, preferences and interests. Preferred routines were not recorded for people.

We observed no meaningful recreational or social activities taking place throughout the inspection. There was no evidence in the care records of activities taking place. Families told us activities had not taken place since the activities coordinator left in August 2015.

A complaints procedure was in place and the manager provided details of a complaint that had been resolved to the satisfaction of the complainant.

Since the registered manager left the service in July 2015, another manager and a deputy manager had been appointed but they had both since left. A registered nurse working at the home had been promoted to nurse-manager with only 10 hours of managerial time negotiable with the owner each week.

Staff meetings and meetings for relatives were taking place. The provider was not acting on feedback from these meetings. For example, staff raised concern about the low staffing levels in August 2015 yet the staff levels were reduced after this.

Structures to monitor the quality and safety of the service were ineffective. Audits and checks of the service had not picked up on serious issues we identified, such as concerns with the safety of the environment and the management of medicines. The provider was not informing the CQC of all the events CQC are required to be notified about.

CQC used its urgent powers to remove the location so that Balliol Lodge was no longer registered to carry out the regulated activities.

29th July 2015

During a routine inspection

The inspection was unannounced and took place on 29 July 2015.

Balliol Lodge is a care home that provides nursing and personal care for up to 32 people. The care provided is for people living with dementia although some people have other enduring mental health needs. The home consists of two converted buildings over three floors. It is located very close to shops, local amenities and public transport links.

At the time of our inspection there were 23 people living at the home.

A registered manager was not in post. They had left the service shortly before our inspection. A new manager had started working at the home a week prior to the inspection and they intended to apply to CQC to register as manager. A registered manager is a person who has registered with the 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.

People told us they felt safe living at the home. There was variable understanding amongst staff about what adult safeguarding meant. Training records showed that the majority of the staff team were not up-to-date with safeguarding training.

People living at the home told us there were not enough staff on duty at all times. Visitors and staff said there were sufficient numbers of staff on duty at all times. From our observations there were enough staff and people’s needs were responded to in a timely way. An activities coordinator had recently been recruited.

Staff recruitment processes were not effective. All relevant recruitment checks had not been undertaken prior to staff starting work at the home. Arrangements to check the on-going fitness to practice of staff registered with a professional regulator was not robust.

Medicines that were given to people without their knowledge had not been undertaken in accordance with the home’s policy. There was no evidence to show that medicines given this way had  been agreed through a best interest discussion with the person’s doctor, family and with the involvement of a pharmacist.

The process to monitor staff training and supervision was not robust as there were conflicting messages between what staff were telling us and what the records showed.

People and visitors expressed mixed views on the quality of the food. There was a consistent view shared with us that there was insufficient choice at each meal time based on people’s preferences.

Staff sought consent from people before providing personal care. Staff had not received awareness training regarding consent and mental capacity. They had a limited understanding of how it applied in practice. Mental capacity assessments were completed in a generic way and were not specific to the decision the person needed to make. Five people were on a Deprivation of Liberty Safeguard plan but CQC had not been notified of these.

People had access to a range of health care practitioners when they needed it.

We observed staff supported people in a kind, caring and unhurried way. Personal care activities were carried out in private. A keyworker system was in place. People without someone to represent them regarding their care and support had not been referred to advocacy services.

A complaints procedure was in place but not all complaints raised had been dealt with in accordance with the procedure.

Arrangements to monitor the safety of the environment and equipment were not rigorous as we found a number of concerns with many areas of the environment. For example, lighting was not working and windows did not close properly in some rooms. We tested the shower water and initially it was scalding to touch. It took 15 seconds for the water to cool down. This meant there was a risk of scalding if a person was under the shower when staff turned it on. Some areas of the building and items of equipment were not clean.

Staff were not always using the hoist correctly to move people. Training records showed very few staff were trained in moving and handling.

Systems to monitor the quality and safety of the service were not robust. These included checks and audits, feedback systems and the analysis of accidents and incidents. This put people’s health safety and welfare at risk of being compromised.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

22 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection of Balliol Lodge Nursing Home. The home provides residential and nursing care for up to 32 people living with dementia or other enduring mental health needs. Accommodation is provided over three floors, with the dining room, lounges and some bedrooms on the ground floor. It has two passenger lifts and a garden to the rear of the building. The home is situated within walking distance of Bootle town centre. Twenty-one people were residing in the home at the time of our inspection.

A registered manager was in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People living at Balliol Lodge Nursing Home were receiving care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse and avoidable harm. Staffing levels were sufficient to meet the needs of people living at the home.

In the main, safe systems were in place for the management of medication. However, we did find ‘when required’ medications were not always managed in accordance with national guidance. We recommend that the service considers arrangements for the use of ‘when required’ medication to ensure it is working in accordance with the NICE guidelines on managing medicines in care homes.

New staff underwent recruitment checks to ensure they were suitable to work with vulnerable adults. An induction programme was in place and staff were supported through supervision and on-going training. Staff received an annual appraisal of their performance.

We found staff were caring and treated people with dignity and respect. The majority of concerns raised by families were responded to in a timely way.

The principles of the Mental Capacity Act (2005) were not always followed for people who lacked mental capacity to make their own decisions. For example, mental capacity assessments were generic in nature and just indicated that the person could make simple decisions but not complex decisions. This meant it was not clear what types of simple decisions people could make and the types of complex decision making they needed support with. We recommend that the service considers its approach to seeking the consent of people living at the home in to ensure it is working in accordance with the principles of the Mental Capacity Act (2005). 

The registered manager was new to the service and had made many positive changes. From listening to people’s views and discussions with staff, we established that the current leadership within the home was strong and effective. The quality monitoring systems had been developed and introduced by the registered manager so it was too early to determine their effectiveness and impact.

10 July 2014

During an inspection looking at part of the service

Our inspection was carried out unannounced. The inspection was very specific as it focused on the maintenance and monitoring of the environment of the home. The inspection helped answer two of the questions we normally review:

' Is the service safe?

' Is the service effective?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and 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?

We inspected Balliol Lodge to check specifically whether the provider [owner] had met the requirements of the warning notice we served following our last inspection in February 2014. The warning notice was served because of a breach of regulations to ensure the home was adequately maintained so that people living at Balliol Lodge could be supported in a safe and comfortable environment.

We found the provider had carried out the necessary work and the home was now safe and comfortable for people. The work previously identified had been mainly carried out and any further work was planned.

We also checked some of the home's safety certificates to ensure these were up to date. Those seen were up to date.

Is the service effective?

We asked how the provider checked to ensure standards would be maintained. We were shown various audits and checks made by the Registered Manager and provider. We also looked at some of the checks carried out by the maintenance person including fire safety, and routine checks to ensure safe standards in the home were being maintained.

People who lived at the home told us that they were pleased with the improvements and the work carried out had been effective in improving the home's environment.

The Registered Manager and maintenance person told us that a new maintenance schedule was being drawn up. This would include completion of existing work, planned times of future upgrading as well as a list of the audits and checks that would help ensure the home was adequately monitored in the future.

27, 28 February 2014

During an inspection looking at part of the service

We last inspected Balliol Lodge over two days in September 2013. We found that the provider was not meeting required outcomes for people in a number of key areas. We took enforcement action following this inspection which meant that the home can currently not admit any more people to the home. On this inspection we reviewed the issues of concern to see if improvements had been made.

We reviewed the care of people in the home and found that they did not always experience support that met their needs. There were improvements but some care was not being appropriately assessed or planned and monitored effectively. This included the keeping of care records in the home. Some information about care was not immediately available and some assessed care needs were not recorded as being carried out and lacked necessary detail. The current system of care planning had not been fully embedded with all staff in the home.

We looked at whether progress had been made regarding the maintenance of the environment of the home. Although some work has been completed to upgrade the home this remains incomplete after being identified since April 2012. There were some environmental hazards that had not been identified and could pose a risk to people using the service.

We found staffing was more consistent and stable on this inspection. There was, however, lack of appropriate steps being taken to assess ongoing and fluctuating nursing dependency for people. There was therefore a risk that appropriate staffing could not be maintained at all times.

We looked at how the provider [owner] monitored and assess standards of quality in the home. We found there was not effective systems to regularly assess and monitor the quality of service that people received. The provider did not have effective systems in place to Identify, assess and manage risks to the health, safety and welfare.

4, 5 September 2013

During an inspection in response to concerns

We inspected the home to check whether progress had been made towards meeting regulations and improving standards in the service.

We looked at the care people received and found that the nursing care of people with specific conditions such as diabetes and people who presented with more challenging behaviour was not being effectively assessed, planned or monitored.

We looked at the way people's monies were managed and found appropriate systems in place to ensure this was managed safely.

We looked at how the service managed infection control and whether they maintained good standards of cleanliness and hygiene. We found some improvements and the provider was able to show they had effective systems in place to ensure all areas were clean and hygienic and adequate standards would be maintained.

We looked at how the building was maintained and found that work was still on-going to upgrade the environment to make it comfortable and safe for people. The provider [owner] identified areas that still needed improvement.

Staffing levels in the home were not being maintained to meet people's care needs. There was an absence of assessment by the provider to ensure enough suitable qualified staff were available daily to support people's care needs.

People were not protected from the risks of unsafe or inappropriate care and treatment as people's personal care records were difficult to access effectively. Some information about care was not immediately available and some assessed care needs were not recorded as being carried out and lacked necessary detail.

The provider did not have robust and effective systems to regularly assess and monitor the quality of service that people received. The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare.

16 July and 2 August 2013

During an inspection looking at part of the service

We last inspected the home on 25 April 2013. At that time we judged the home as failing to meet key regulations and therefore keep people safe.

Following the inspection the acting manager for the home sent us an action plan advising us of the progress the home were making and how the service would meet the requirements. On this inspection we visited the home to check whether progress had been made towards meeting regulations and improving standards to keep people safe.

We looked at how the staff managed infection control and whether they maintained good standards of cleanliness and hygiene. We found some improvements but the staff failed to show us they had effective systems in place to ensure all areas were clean and hygienic and adequate standards would be maintained.

We looked at how the building was maintained and found people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

People were not protected from the risks of unsafe or inappropriate care and treatment as people's personal care records were difficult to access effectively. Some information about care was not immediately available and some assessed care needs were not recorded as being carried out and lacked necessary detail. The current system of care planning had not been fully embedded with all staff in the home to ensure the staff had the information they needed to provide care and support to people safely and effectively.

The provider did not have effective systems to regularly assess and monitor the quality of service that people received. The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who lived at the home.

25, 26 April 2013

During a routine inspection

People we spoke with and their relatives told us they were happy with the care and support they received. One person said, 'I think the care is good. The staff seem very caring and are always available', a relative commented, 'The staff contact me if there is anything to report ' such as if they need to get the doctor.'

We found that there were enough qualified, skilled and experienced staff to meet people's needs. Comments we received about staff were positive and we saw a lot of good care being provided.

We found people were placed at risk as there was a lack of effective management of the infection control in the home. We also found that the home was not being maintained as effectively as it could be. We have required the provider to improve in both of these areas.

We looked at the overall management of the home. We found the provider did not have effective systems to regularly assess and monitor the quality of service that people received or to identify, assess and manage risks to the health, safety and welfare. On this visit, we highlighted aspects of quality of care records, health and safety monitoring, infection control auditing, laundry standards that the manager and provider had not been aware of, or had not acted on.

18 October 2012

During a routine inspection

We spoke with people living at Balliol Lodge and also made observations of the care and saw how staff interacted and supported people.

People expressed their views and were involved in making decisions about their care and treatment. A visitor told us that the manager and staff keep them up to date with the care and any changes are reported so that they felt involved. They said, 'The staff do very well ' they support my relative well and always make me feel welcome.'

We spoke with five of the people who live in Balliol Lodge and they varied in their opinions about the care available. None were, however, dissatisfied with the staff and the way they were approached. People told us they were happy with the care and support they received. Their comments included:

'The staff are very good and make sure I am well looked after'

'The care is fine'

'I can see my doctor any time. I'm going for an appointment to hospital this week and one of the staff will take me'

'It's good here. Staff are OK. I would like to go out more ' nobody seems to go out now'

' I'm waiting for staff to come and put me in my chair [was in wheelchair at the time]. They use the hoist and are very good'

A relative said the staff were very good and 'Went out of their way' to provide help and care to people at the home. We had received some comments from the family of a person living in the home about the care organised around specific nursing needs. The family were said the staff organised things well and liaised with health care professionals when required.

5 April 2012

During an inspection looking at part of the service

We spoke with people living at Balliol Lodge, some of whom were able to give an opinion about life in the home and how they were cared for.

People expressed their views and were involved in making decisions about their care and treatment. A visitor told us that the manager and staff kept them up to date with the care and any changes were reported so that they felt involved.

People we spoke with on the day of our visit were very positive and told us that staff supported people well and gave good care. One visitor told us the home had 'done marvellous' and their relative had vastly improved since being at Balliol Lodge. Other comments were that the 'staff are lovely ' its home from home here.'

We spoke with one person living at the home who told us that, 'things were better now. I've moved to a new room and like it much more.'

One person who lived in the home told us that medicines were usually given on time, but were occasionally late. On one of our visits the morning medicines were all administered at an appropriate time. On the day the Pharmacist inspector visited however, the morning medicines were still being administered at 13:00 and medicines due at lunchtime were still being given at 16:00. This meant that people were not always getting their medicines at the right time.

We are still concerned about the impact the management of medicines may have on the health and wellbeing of people at Balliol Lodge. The Warning Notice we served following a previous visit has still not been met.

We spoke with people living at the home who said that generally the staff communicated well with them and asked for consent on a daily basis when they gave personal care. Visitors spoken with agreed with this and said that they had observed staff asking people and explaining care to them before they carried it out.

We spoke with two people who said that their cigarettes were rationed by the staff but this was OK and the manager had spoken with them about it.

We spoke with a person who did share a bedroom but had made a request for a single room. This had now been agreed and they had moved to the new bedroom.

People we spoke with were pleased with the way food was served and felt staff supported them well at meal times. One person commented on the way drinks were served from a drinks trolley and felt this was an improvement.

We spoke with people and they were generally satisfied with the way the home was maintained. Visitors commented positively on the standards of cleanliness. Some commented that the homes decor could be improved but were aware that this process was ongoing.

9 December 2011

During an inspection in response to concerns

Prior to visiting the home we had some concerns related to us. These concerns were regarding the way people's privacy and dignity was being upheld, particularly with respect to staff carrying out personal care in shared rooms. The concerns were also about staff not displaying good communication skills when talking with people living at the home.

On the day of our site visit we spoke with a number of people living at Balliol Lodge as well as two visitors. We also made observations of the care and support people received.

There were many positive comments about the care and the approach of staff. Visitors said staff supported people who had some very challenging behaviour and they generally did this well.

We spoke with one person who shared a room in the home. They were unhappy with the way personal care was organised as there was no screening available to protect their privacy. They said this had been the case for a long time and it was 'Not very nice' as they were on view when being assisted to wash as well as using the commode. We checked with staff and the manager and confirmed this was the case. This was a major concern. People's basic human rights with respect to privacy and dignity were being seriously undermined.

We carried out some observations and saw care staff interacted well when they approached people. We did not see any adverse or negative interactions on our visit.

We received some concerns prior to our visit that people were being restricted by the rationing of cigarettes which in turn was causing arguments with staff and 'challenging' behaviour. We also received concerns about staff not explaining and communicating with people and getting consent before carrying out care.

We spoke with people living at the home who said that generally the staff communicated well with them and asked for consent on a daily basis when they gave personal care. We saw many examples of good communication. For instance, when staff used the hoist for one person they were careful to provide reassurance.

We spoke with one person who had their cigarettes rationed. They explained the process of this and understood why staff did this but said they would prefer to have their own cigarettes.

We spoke with a person who shared a bedroom and asked how this had been agreed. The person told us they had not really had a choice in this. They had been asking for a single room for some time but this had not been forthcoming.

We discussed the need for these issues around consent and agreement to care to be addressed and the need for systems to clearly indicate how agreement and consent is reached and how these systems will be constantly evaluated.

We received some concerns before our visit about staff who were not moving and handling people correctly and not using the hoist when indicated. This could put both staff and people using the service at risk. We made some observations of the care being delivered and saw that staff used the hoist appropriately and were good at reassuring the person concerned.

Prior to our visit we received concerns that the way food was being managed was inconsistent and lacked necessary standards in some areas. We spoke with people living at Balliol Lodge who told us the food was good and that it was always served on time and at the right temperature. Visitors agreed with this and said there was always a choice provided and the meals were always of a consistent standard.

Prior to our visit we had some information that the way drinks were served was 'institutional'. We also saw how drinks were being served during the afternoon and we have a minor concern with this for the home to address.

We received some concerns before our visit to the home. We were told that the hot water supply for people at the home was faulty. Also the main shower in use 'runs hot and cold' and it was difficult to maintain a consistent temperature. In addition, there was a limited hot water supply to rooms at the top of the building. This meant staff have to, ''run backwards and forwards with bowls of water to wash people.' We were also informed that the cleaning of commode pans was carried out by rinsing them in sinks.

We spoke with people living in the home and found some of these concerns to be true. We also found other areas of concern around the management and maintenance of the home and we have made a compliance action so that this is addressed.

Some of the concerns we received before our visit were that the manager did not always address issues of concern in a timely way. We did not ask specific questions regarding the overall management of the home on the site visit. The people we spoke with seemed generally satisfied and did not express any concerns about the running of the home. They said staff would listen to them if they had any concerns.

However, because of our overall findings, we have concluded that there was a lack of effective systems in place for recording and evaluating the quality and safety of the care, treatment and support the service provided or its outcomes. Some of this placed people using the service at risk.

29 June 2011

During an inspection in response to concerns

Part of our site visit was to check two compliance actions [requirements] we made in December 2010. The first was regarding the provision of better screening in shared bedrooms to ensure privacy for people; and the second was about the consistency of Registered Nurse cover in the home.

We also had a concern raised prior to our visit that the provision of training for staff in the home was poor in that it was not fit for purpose and that some of the training certificates produced were 'forged' and that training had not actually occurred.

Both compliance actions previously made have now been met. This was evidenced by looking at records and speaking to staff on duty as well as speaking to the manager and observing on the day. We were given a date by the manager when full screens will be provided in bedrooms in line with the continual mantainance programme. We spoke with social service contracting team who have also visited the home recently. They confirmed that on their visit there was staff cover in the home and this seemed adequate.

The provision of suitable screening gives more privacy for people as well as enabling people with dementia to be more independent. The consistent cover supplied by nursing staff enables the provision of nursing care to be carried out appropriately.

We spoke with the manager and with four staff on duty as well as looking at training records for staff. Following the visit we spoke with training companies that had worked with the home and had supplied training courses.

The manager was able to evidence recent and ongoing training that staff had received. This training was relevant to the work staff were undertaking. This training was evidenced in staff training files which were well organised. We spoke with four staff on duty individually and all confirmed training attended. All said that training was 'good' or 'excellent'.

We contacted two training companies that have worked with the home recently. Both confirmed staff had attended training courses. We found training is organised for staff and this is ongoing and supports the work they do.

10 December 2010

During an inspection in response to concerns

We were not able to speak to people in any depth due to their level of confusion and communication difficulties. We observed that people were approached positively however and were relatively free to move about the day areas of the home. We also saw one person who was free to spend time in his bedroom.

We spoke with a relative who visited regularly who told us that staff did involve relatives and were easy to approach and were supportive. Also that the nursing staff and the manager were careful to keep relatives informed and involved in any decisions about care.

We visited unannounced and observed the dinner time meal as well as speaking to people. One person spontaneously remarked that the meal was 'nice' and that the food was generally very good. Those people seen clearly enjoyed the meal. We spoke with a relative of person in the home who told us that the meals were good and that a choice is always available.

Although most people have varying degrees of dementia, some spoken with were able to tell us that they felt comfortable and warm in the home. One person seen was spending a lot of time in their bedroom and this seemed comfortable and well personalised and was clean with no malodour. A visitor to the home told us that the home was always clean and standards of hygiene were consistent.