Cordelia Court

Cordelia Court is a residential care home providing accommodation and personal care for up to a maximum of 34 people in one adapted building. The service provides support to adults under and over the age of 65 who may live with dementia or a sensory impairment. At the time of our inspection visit, there were 30 people living at the home.

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

Risk management associated with people's care needs and the environment continued to need improvement. Risks were not always identified, monitored or acted upon in a timely way to ensure people's safety was maintained. There were some medicine discrepancies that had not been identified and acted upon to show medicines were always managed safely. Staffing arrangements were not always effectively managed to ensure people experienced person centred care. Staff understood their responsibility to report any concerns to protect people from the risk of abuse. However, records relating to incidents and accidents were not always effectively maintained to help identify and act on risks.

Our observations of people and review of comments received about the service confirmed people sometimes did not experience care that respected their privacy and dignity and needs. However, staff were observed to have a caring approach when supporting people and we saw some caring interactions. People were not always supported to have maximum choice and control of their lives; however, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Governance systems, management and provider oversight of the service were inadequate. Systems and processes to monitor the quality and safety of the service were ineffective. Areas needing improvement were not always identified and acted upon in a timely way. Records were either not consistently maintained or were not in sufficient detail to show care and incidents had been safely and effectively managed. Staff were positive in their comments of the manager and felt supported in their roles.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 May 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve: safe care and treatment, dignity and respect and good governance. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an unannounced comprehensive inspection of this service on 6 and 8 February 2023. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, caring and well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care, people’s privacy and dignity and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 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.

Cordelia Court is a residential care home providing accommodation and personal care for up to a maximum of 34 people. The service provides support to adults under and over the age of 65 who may live with dementia or a sensory impairment. At the time of our inspection visit, there were 32 people living at the home.

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

Risk management associated with people's needs and the environment needed improvement. Risks were not always identified, monitored, or acted upon to ensure people's safety. Medicine records lacked detailed information to confirm safe management. Staffing arrangements were not always effectively managed to support people’s needs. People had mixed views of their experiences of care.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse. However, records relating to incidents and accidents were not always effectively maintained to identify and act on risks. Actions were needed to ensure temporary staff working in the home were safe and suitable to work with people. Areas of the home needed attention to ensure safe infection, prevention, and control.

New staff completed an induction to the home, and all staff were able to access essential training although this needed updating for some staff. Staff told us they had supervision meetings with the manager to support them in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records were not always clear around decisions made. People’s nutritional needs were assessed, and staff offered support to people where needed. There were some choices of meals provided.

People spoke positively of some staff but told us there was an inconsistency in staff approach in how they were supported. We saw practices within the home that did not support people’s privacy, dignity, and independence.

People's needs were assessed and reflected in individual care plans, but the level of detail was not consistent to support staff in providing person centred care. However, staff knew people well. There were some social activities provided and some people were supported on visits outside of the home.

Governance systems, management and provider oversight of the service were inadequate. The quality and safety of the service continued not to be effective. Whilst there were systems and processes to monitor the quality of care and services provided, areas needing improvement were not always identified and acted upon. Records were either not consistently maintained or were not in sufficient detail to show incidents had been safely and effectively managed. Staff were positive in their comments of the manager and felt supported in their roles.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Cordelia Court is a residential care home providing accommodation and personal care to up to maximum of 34 people. The service provides support to people aged 65 and over who may live with dementia or a sensory impairment. At the time of our inspection visit, there were 26 people living at the home.

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

Risk management associated with people’s care needs and the environment needed improvement. Risks were not always identified, monitored or acted upon to ensure people’s safety.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse. There were enough staff on duty to support people, and people told us they felt safe living at the home. People’s needs were assessed and reflected in individual care plans although the level of detail was not always consistent to support staff to meet people’s needs safely. Medicine records also lacked detailed information to confirm safe management, but people told us they received their medicines.

Whilst there were systems and processes in place to monitor the quality of care and services provided. These had not been effective as they had not always identified areas needing improvement. Records were not always maintained to show incidents had been safely and effectively managed. Staff were positive in their comments of the registered manager and felt supported. The registered manager had identified a number of areas needing improvement on their return from a planned absence. Plans were in place to ensure the necessary improvements were made. People and relatives spoke positively of the registered manager and felt they were approachable and responsive to any issues raised with them.

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 21 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to staffing arrangements, people’s care and ineffective management of the home in the absence of the registered manager. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this 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 Cordelia Court 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 monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cordelia Court is a care home registered to provide personal care and accommodation for up to 23 older people aged 65 and over who may live with dementia or a sensory impairment. At the time of our inspection visit, there were 21 people living at the home.

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

Risks associated with people’s care had been identified but actions taken to manage risks were not always consistent. This included the risks linked to people’s nutritional needs and risks related to people entering other people’s room at night which increased some people’s anxiety.

Cleaning in some areas of the home had not been maintained effectively to minimise the risk of the spread of infection.

Quality assurance systems were in place and had resulted in areas of improvement such as changes to the menu and an increase in the variety of activities. However, some improvements needed had not been acted upon in a timely way. For example, actions to maintain the décor of the home. This had been delayed due to extension works being completed.

People and their family members were aware of how to raise complaints and action had been taken in response to those received, to resolve them.

People told us they felt safe and well supported with the staff that supported them. Staff understood their responsibilities to report concerns to protect people from the potential risk of abuse. Accidents and incidents were recorded and reported as required and action had been taken to minimise re-occurrence.

People’s needs were assessed and confirmed in their care plans. This included information about medicines people needed. Records confirmed people received their medicines when required but there were some actions needed to ensure medicines were managed safely and consistently.

People had access to health professionals when needed including GP’s, opticians and district nurses to ensure they remained well. Staff and the registered manager also worked with local agencies to support people’s needs.

There were enough staff on duty to keep people safe and meet their needs. Staff received ongoing training to maintain their knowledge and skills and they knew the importance of providing care in accordance with people’s preferences. Staff spoke positively about working at the home and of the support they received by the registered manager and senior staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was an open culture, led by the registered manager who was described by staff and people as being approachable and supportive. People had opportunities to share their views of the home and make suggestions of what they felt could be done better. People’s suggestions had been acted upon demonstrating their views were taken seriously.

People told us staff were kind and caring and treated them with dignity and respect. Staff interactions were respectful. Staff used people’s care plans to ensure people needs, including their social care needs, were met. People had access to a range of social activities suited to their abilities and some outside visits had also taken place.

People had a choice of meals and drinks each day and were asked on a regular basis if they continued to be happy with the choices provided.

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 Good (published 3 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Cordelia Court provides personal care and accommodation for up to 23 older people including those living with dementia. Accommodation is provided over two separate floors. There were 23 people living at Cordelia Court when we inspected the home.

A requirement of the service’s registration is that they have 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.’ A registered manager was in post.

At our previous inspection on 5 and 7January 2016, we identified improvements were needed in regards to ‘Safe’ and ‘Well Led’. Staffing arrangements were not always effective and records were not always accurate. This included records to monitor risks, care and the services provided to ensure they met the provider’s standards.

During this inspection we found sufficient action had been taken to address the concerns around staffing arrangements but there continued to be improvement needed to records related to monitoring risks, care and services.

Staff were available to people when they needed them and people told us if they had to wait for support this was not for very long and they understood staff were supporting others.

There had been ongoing work to implement person centred activities in accordance with people’s needs. The registered manager explained how people appeared much calmer and more stimulated as a result of the varied activities programme provided. There was a new activity organiser in post to support the activities programme in the home.

Risks associated with people’s care were identified on an ongoing basis and were detailed in risk assessments within people’s care plans. Staff had a good understanding of people’s needs, the importance of maintaining their independence and how to keep them safe. Staff were attentive and responsive when people showed signs of anxiety. This helped to prevent their behaviours from escalating.

People received their medicines at the times they expected and medicines were stored safely.

Staff had completed training essential to help them carry out their roles safely and effectively. Staff had also completed training linked to people’s care needs such as dementia and Parkinson’s Disease. This training helped staff to deliver more person centred care to people. The registered manager regularly checked staff had learned from their training through competency checks, supervision meetings and observations of their work.

The registered manager understood their responsibilities in relation to the Mental Capacity Act (2005) but had not consistently followed the Deprivation of Liberty Safeguarding (DoLS) referral process. Where people lacked capacity to make decisions, action had been taken to identify if a DoLS referral was required to authorise any restrictions related to their care. However, some of the authorisations had expired and had not been re-applied for. Staff understood their responsibility to seek people’s consent before they delivered care.

People told us they were satisfied with the food provided and they had enough to eat and drink. Menus were made available to people so they were aware of the choices available to them. Adapted plates were used to help people eat independently. Where people were at risk of poor nutritional health, they had been referred to a health professional. Staff followed advice given by health professionals and closely monitored people at risk to ensure they had sufficient food and drinks to maintain their health.

People were complimentary of the staff and the care provided at the home. People looked well presented with clean clothes and hair and people told us their privacy and dignity was maintained.

There were picture signs around the home to help support people find their way around. There was a large main lounge and smaller quiet sensory relaxation lounge and people could choose which lounge they preferred to use.

Assessments had been completed of people’s social, physical and psychological care needs and this information was detailed in people’s care plans. Care plans were regularly reviewed to ensure they contained accurate information about people and supported staff when providing care.

The registered manager held planned ‘resident’ meetings and had implemented a satisfaction survey for people and their relatives to gather their views of the home. Where improvements had been identified, they had been acted upon. The registered manager used meetings to discuss planned improvements, food and activities as well as any areas of concern. People and visitors told us the registered manager responded to their needs and dealt with any concerns effectively.

Accidents and incidents were recorded but we found some of the incidents had not been reported to us as required. This meant we could not be assured appropriate action had been taken to address them. The provider carried out regular visits to the home to carry out quality monitoring and discuss with the registered manager any areas needing action.

People and staff spoke positively of the provider and registered manager and were able to discuss issues related to the running of the home at staff meetings. We found there had been ongoing improvements made to systems, processes and the environment to help ensure people received the quality of care and services they expected. The registered manager and provider were committed to making ongoing improvements to continue to raise standards within the home.

Cordelia Court provides personal care and accommodation for up to 23 older people including those living with dementia. Accommodation is provided over two separate floors. There were 21 people living at Cordelia Court when we inspected the home.

A requirement of the service’s registration is that they have 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.’ A registered manager was in post.

At our previous inspection on 22 and 27 July 2015, the provider was not meeting the required standards. We identified five breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two of these were breaches repeated from previous inspections. We issued a warning notice in relation to, “Good governance” and we met with the provider and asked them to take the necessary steps to ensure the required improvements were made. We asked the provider to improve staffing arrangements, the care provided to people, the arrangements for safeguarding people from risks and abuse and to ensure people’s privacy and dignity was maintained. The provider was also required to develop systems and processes to check and improve the quality and safety of the care and service people received. The provider sent us an action plan which stated all of the required improvements would be undertaken by the 30 November 2015.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations and the warning notice issued. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Overall, staff were available at the times people needed them. Since the last inspection staffing arrangements had been reviewed and additional staff were available to support people during busy periods. However, a further review of this was needed to ensure that there were enough staff to support people in the lounge at the required times.

Risks associated with people’s behaviours had reduced. People were calmer and staff were more attentive and responsive when people showed signs of anxiety. This helped to prevent their behaviours from escalating. Risks associated with people’s care were mostly detailed in risk assessments within people’s care plans. However sometimes written guidance for staff about how to manage these risks was not clear. Despite this, staff had a good understanding of people’s needs and how to keep people safe. People received their medicines as prescribed and medicines were stored safely.

Staff had completed further training to help them carry out their roles more safely and effectively. This included training linked to the care needs of people in the home such as dementia and managing behaviours that were challenging to them and others. This training had supported staff to deliver more person centred care to people. The registered manager regularly checked staff had learned from their training through competency checks, supervision meetings and observations of their work.

The registered manager understood their responsibilities in relation to the Mental Capacity Act (2005). Where people lacked capacity to make decisions, the correct action had been taken for restrictions in people’s care to be authorised. Staff understood their responsibility to seek people’s consent before they delivered care.

People told us they were satisfied with the food provided and they had enough to eat and drink. Menus had recently been reviewed and included increased choices for people. We saw adapted cutlery and implements were used to support people to eat independently. Where people were at risk of poor nutritional health, they had been referred to a health professional and where required, the amount of food and drinks people consumed were being monitored. There had been a reduction in the amount of people losing weight which suggested monitoring systems and actions taken were effective.

People and visitors were complimentary of the staff and the care provided at the home. We saw staff engaging well with people. People looked well presented with clean clothes and hair and people’s privacy and dignity was promoted.

There had been significant improvements to the environment since our last inspection. This had a positive effect on people as the environment was now more suited to people living with dementia. The front room had been redecorated and turned into a ‘sensory relaxation lounge’. New flooring had been fitted to areas of the home and a bedroom refurbishment plan had commenced.

The provider had supported the registered manager to work with other agencies to bring about improvements to the care people received, so that this was more ‘person centred’. Care plans contained more detailed information about people. In particular, they showed staff had worked with people in completing assessments of their social, physical and psychological care needs. Social activities were focused more on the senses such as vision, hearing and smell and people had responded positively to these. We saw where people made requests of staff during the day for drinks and support, staff always responded to them quickly.

The registered manager held planned ‘resident’ meetings and had implemented a satisfaction survey for people and their relatives to gather their views of the home. Where improvements had been identified, they had been acted upon. The registered manager used meetings to discuss any areas of concern and provided feedback on changes being implemented in the home. People and visitors told us the registered manager responded to their needs and dealt with any concerns effectively.

There had been a significant reduction in accidents and incidents at the home. Audit processes implemented by the registered manager meant that incidents were closely monitored to make sure lessons were learnt and risks to people were managed. The provider carried out regular visits to the home to carry out quality monitoring and discuss with the registered manager any areas needing action.

Both the provider and registered manager were committed to making the ongoing improvements required to ensure people received the quality of care and services they expected. The registered manager acknowledged areas for continued improvement. This included the risks associated with staffing and having accurate records in place.

We made compliance actions in relation to these areas and received a report from the registered manager that told us what they intended to do to achieve compliance.

We followed up on these areas of non compliance by undertaking an inspection on 9 September 2014. During this inspection we spoke with some people who lived in the home, visiting relatives, members of care staff on duty the registered manager and the provider. We also looked at two sets of care records for people and other records as appropriate. We found that the areas of non compliance identified at the previous inspection had been partially addressed but the service remained non compliant in both areas.

People and relatives we spoke with told us they were happy with the care and support they or their family member received. We were told, "We prefer this home for my mother here, this is a small home so staff can work closely with individuals.'

We saw care records for people had been reviewed following our visit in April 2014. There was no evidence to demonstrate that these had been regularly evaluated following the reviews. We found information was out of date and not applicable to people's needs.

Staff we spoke with were knowledgeable about people's care needs and we saw good examples of care and staff interactions with people during our visit.

Work had not been undertaken to review the quality surveys that were completed prior to our last visit. Resident and relatives meetings had not been held, therefore the service was not able to demonstrate people's views were taken into consideration to improve the service provided.

Records were not always up to date or readily available. People's personal confidential information was stored securely.

Many of the people who lived at Cordelia Court were not able to share opinions about their care and support. We therefore observed these people in the two lounges at the home to find out what their experiences of the service were like. We spoke with two people and two relatives of people who used the service about the home. We also spoke with the manager and care staff. The evidence we collected helped us to answer five key questions, these being: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations, our discussions with people, staff and relatives and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at Cordelia Court. We saw staff had a caring approach towards people.

Staff knew people's likes and dislikes and what they needed to do to maintain people's needs and keep them safe. We saw some of the care plans and risk assessments were not up-to-date. This meant people could be placed at risk of not receiving safe and appropriate care.

A senior member staff told us she had recently completed external training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). They had a good understanding of principles linked to depriving someone of their liberty to be able to apply them at the home. The manager told us all staff had completed some basic training on the MCA and there were plans for this training to be further enhanced. This meant staff would have a better understanding of how to support people who lacked capacity when decisions about their care and treatment needed to be made. At the time of our visit, no applications for DoLS had been made.

We saw systems in place to ensure the cleanliness of the home was maintained. On the day of our visit there were no unpleasant odours and the home was clean.

We saw health and safety checks had been carried out within the required timescales to ensure equipment and the premises were safe for people.

Is the service effective?

People and visitors we spoke with told us, 'It is very good.' 'There have been positive changes.' 'The thing I like most is I can come any time I like without telling them. That to me is a big bonus.'

We saw healthcare professionals were involved in people's care to support staff in meeting people's needs.

Action had been taken to develop consent forms to help staff provide support in accordance with people's wishes. They were not all completed at the time of our visit.

Staff we spoke with told us they were implementing new records into the care plans. This was so information was more detailed and could demonstrate more clearly how people's needs were being met. We saw the new records had not been fully completed at the time of our visit.

Is the service caring?

We saw people were supported by caring staff. People and relatives we spoke with told us, 'The carers here are the best.' "Staff are busy, it's nice they are in the lounge with the residents.'

We saw care staff were patient with people and did not rush them when assisting them with care. We saw staff inform people of tasks they were about to carry out to make sure they agreed to the task. For example, when staff were supporting people to eat they checked the person was ready for the next mouthful before bringing the spoon or fork to their mouth.

Visitors we spoke with told us they worked closely with staff to ensure their relative's received the care they needed.

Is the service responsive?

We saw staff asked health professionals to visit people when they had concerns about their health.

We saw charts were in place to monitor people's health although we could not be confident information on charts was always acted upon. For example, one person's nutrition charts showed on some days they had minimal food and fluids. We could not see action had been taken to respond to the risks associated with this.

Is the service well led?

We found the service had been effective in carrying out most of the required improvements following our last inspection. We found there continued to be improvements needed with record keeping. This was because some of the records were not up-to-date, accurate or had not been fully completed.

People and relative's experiences of care at Cordelia Court were positive. They told us, 'Everything is alright.' 'I am quite happy with X here.' 'Overall I do not have any complaints.'

We saw new audit processes had been implemented at the home to identify where the quality of care and services may need to be improved. We found sometimes audit processes were not fully effective in identifying the required actions and in managing risks.

We saw there were plans for the ongoing improvement of the premises. This included replacing some of the old furniture, improving the garden and redecorating bedrooms.

Action had been taken to seek people's views of the home through a quality survey and resident/relative meeting. The resulting information had not been fully collated at the time of our visit to determine any actions needed.

We saw the home had been decorated with Christmas decorations. People were watching the television during the morning and listened to music for the rest of the day. Two people we spoke with told us they liked living at Cordelia Court. They were positive about the staff.

We looked at care plan files for three people and observed how people were being cared for. We found there continued to be some people whose care needs were not being met effectively.

We walked around the premises to check they were safe and suitable for the people living there. We saw some improvements had been made to the environment since our last visit but more were needed.

We found many areas of the home were in need of cleaning. This included people's bedrooms and walking aids.

We found records had not been sufficiently updated and reviewed.

As a result of ongoing non compliance being identified, contact was made with the provider with a view to imminent actions being taken to address our findings.

On the day of our visit some people were seated in the lounge and others in the garden. Staff were on hand to supervise people to make sure they did not come to harm. Staff we spoke with had a good knowledge of the people they were supporting. We observed staff to be friendly and approachable.

We found there were improvements needed in relation to the provision of care and care records. This applied in particular to those people who had problems with their skin such as sore areas or ulcers. Records were not sufficient to demonstrate changes in risks and to show how people's care was being managed.

We looked at how medicines were managed and found people had received their medicines as prescribed. The one exception to this had been followed up by the manager.

We walked around the premises to check they were safe and suitable for the people living there. We found environmental changes were needed to help support people with dementia. We also found attention was needed to the d'cor of the home and maintenance of the garden. We found several areas in need of cleaning.

We saw that the care files of people living in the home had been reviewed. These contained information about how people's needs were to be met. Families had been approached to obtain background histories of people as well as information of their hobbies and interests. This information had been incorporated into care plans to support the service in delivering more person centred care.

There were risk assessments in place where risks to people's care had been identified. These included risks of people developing pressure sores to the skin and falling.

People were positive about the service. One person told us: 'I have no complaints about this place at all. It is run very well. I like it here I have met some wonderful people here.'

Staff told us they had been attending more training. Training records confirmed that almost all staff had completed the statutory training required. This included manual handling, safeguarding people and infection control. Staff had also attended dementia care training and half had attained a National Vocational Qualification (NVQ) in care. Staff supervision schedules confirmed this was taking place regularly to identify any staff training and development needs.