Archived: SONACare

SONACare is a residential care home providing personal care to up to 15 older people in a two-storey adapted building. At the time of our inspection there were 9 people using the service.

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

Risk was not consistently managed. We identified improvements were required to help ensure fire safety and risks associated with mobility and a specific health event were managed. Some areas of the home required deep cleaning to minimise the risk and spread of infection.

Audits were completed to help drive improvement and celebrate success. Audits had not identified the concerns we noted on inspection. We have made a recommendation about the effectiveness of audits.

People told us they were happy living at the home. One person commented, “They look after me.” The provider was making improvements to the internal decoration at the home and medicines were managed safely.

Staff were recruited following checks being carried out safely and were deployed in a way to help ensure people’s needs were met. People, a relative and staff, we spoke with raised no concerns with the staffing arrangements at the home.

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.

People were supported and encouraged to give feedback on their experiences of living at the home, regular meetings were held with people to gain their views and the provider visited the home to help maintain oversight of the service.

Staff told us the registered manager was open and honest with them. Staff told us they felt engaged and supported.

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 (15 December 2021).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about skin care and nutritional management, moving and handling practice and risk management. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with fire safety, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 good to 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 full report.

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

Enforcement and Recommendations

We have identified 1 breach in relation to risk management. We found risks were not consistently managed.

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.

SONACare is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one adapted building.

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

People told us they felt safe and they were supported by staff who helped them quickly if required. Checks were completed to help ensure prospective staff were suitable to work with vulnerable people. Risk assessments were carried out to help minimise the risk of avoidable harm and staff knew the help and support people needed. Medicines were managed safely.

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.

People were cared for in a safe, clean environment by staff who were caring, competent and knowledgeable about people’s needs. Some areas of the home required redecoration and the registered manager said the provider was aware of this.

Staff told us training and supervision was arranged to ensure they had the skills to carry out their role. People told us they were happy at the home and they felt cared for. They explained the food was good, activities were arranged, and they were supported to access medical advice.

People were treated with dignity and respect and staff we spoke with us told us how they respected people and ensured their privacy and dignity was maintained. Care was person centred, met people's needs and achieved good outcomes. People were cared for at the end of their life in line with their wishes.

Staff told us they felt supported by the management team and they were able to approach them if they needed support and guidance. People told us the management team were approachable and part of the team at the service.

People were consulted and asked their views on the service provided. Surveys had been completed by people who lived at the home. People told us they were happy at the home and were confident any comments or complaints they made would be listened to. Audits and checks were completed and actioned to drive improvement.

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 30 April 2021) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook a comprehensive inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing, the provision of meals, and care provided. A decision was made for us to inspect and examine those risks. We also checked to see improvements had been made since our last inspection.

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.

SONACare is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 15 people in one adapted building.

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

People could not be assured they would receive support from staff when they needed this as staff were not effectively deployed. During the inspection inspector’s alerted staff to the support a person needed to prevent the risk of avoidable harm. Infection control processes were in place to limit the risk and spread of infection, however these were not consistently followed by staff. People were placed at risk of avoidable harm due to some areas of the home being unclean, and poor practice by some staff. Medicines were managed safely, and staff had been trained in medicines management.

People were not always supported in a dignified manner that empowered decision making and inclusion. Staff did not always seek consent and provided care and support when it was unwanted. Care records were not secured to ensure people’s private information was protected and records were not always accurate. Audit systems were not always effective in identifying where areas of improvement were required. Meetings took place with staff and people to share information and gain views.

The provider and manager took swift action during the inspection process to reduce risks and improve the service.

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

Rating at last inspection

The last rating for this service was good (published 12 January 2019).

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about medicines, the provision of meals, the environment and care provided. A decision was made for us to inspect and examine those risks. We looked at the key questions of safe and well-led.

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

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe 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.

We discussed our concerns with the provider who took action to ensure improvements were made and risks minimised.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SONACare 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 identified a breach of regulations in relation to the safe care and treatment, staffing and good governance. 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 for the provider to understand what they will do to improve the standards of quality and safety. 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 alongside the provider and 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.

SONAcare 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.

Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to care for up to fifteen people assessed as requiring residential care. Accommodation is located on the ground and first floor of the building that can be accessed by a passenger lift. There is a communal dining room with a lounge area as well as a quieter lounge area for people to sit.

The majority of bedroom accommodation is for single occupancy although there are some shared bedrooms for people who would prefer this option. A range of aids and adaptations are in place for people whose mobility might be affected.

At our last inspection in March 2018, the service was rated as ‘Requires improvement’. We found a detailed employment history of prospective employees was not always obtained. This was a breach of Regulation 19 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection, the registered provider sent us an action plan indicating how improvements would be made and compliance with the regulation reached. The action plan indicated the service had taken action to ensure it met the requirements of Regulation 19 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection in November 2018 we found improvements had been made. We looked at two files of staff who had recently been recruited to work at the home. We found the files contained employment checks, references and a full employment history.

We found individual risk assessments were carried out in key areas such as nutrition, falls and skin integrity. Care records continued sufficient information to enable staff to support people. Care records also contained information regarding people’s preferences and social histories. People and relatives we spoke with confirmed they were consulted in decision making and the planning of care.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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 and relatives told us staff were friendly and respectful and caring in nature. We observed interaction between people who lived at the home and staff. We saw staff were gentle and patient with people and encouraged them to maintain their independence whenever possible.

We found the home was clean and tidy and staff were seen to wear protective clothing when this was required. We noted the temperature of two hot water taps at the home were warm, but not hot. The registered provider told us they would address this. Prior to the inspection concluding the registered provider confirmed action had been taken and additional steps taken to identify any future changes in water temperature.

We saw documentation which evidenced the service sought feedback from people who lived at the home and relatives. Documentation asked people to share their opinions on what the home did well and what needed to improve. The registered provider told us they were committed to improving the service provided.

People told us they did not have to wait for help and staff were attentive to their needs. We timed two call bells which were answered promptly. We observed staff were patient and spent time with people chatting and supporting them when they needed help. Staff and relatives we spoke with voiced no concerns regarding the staffing arrangements at the home. Rotas we viewed showed staffing was arranged in advance and staff confirmed replacement staff were provided if unplanned absences occurred. The registered provider told us they were currently planning to recruit a cook to the home as the number of people living at the home had risen.

Staff told us and we saw documentation which evidenced staff attended training to enable them to maintain and update their skills. We also saw evidence and staff confirmed, they had regular supervision with their line manager to discuss their performance.

People were asked to express their end of life wishes. Person centred documentation was available to plan this area of people’s care if people wanted to share their needs, wishes and preferences.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was required.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. We saw people were offered a choice of meals during the inspection and we observed the lunchtime meal. People were given the meal of their choice and were offered more if they requested it. We found staff were available to help people if they needed support. People could choose where and when to eat and spoke positively of the food provided.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they valued them as individuals. Staff were respectful with people who lived at the home and people told us they felt respected and valued.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager, registered provider or the local authority safeguarding team so people were protected. The number of the local authority safeguarding team was displayed on a notice board at the home so staff, relatives and people who used the service could raise concerns if they wished to do so.

There was a complaints procedure available at the home. People we spoke with told us were confident any complaints they may wish to make would be addressed by the registered manager or registered provider. Relatives told us they were aware of the complaints procedure and told us they felt any complaints or comments they made would be responded to.

People told us there were a range of activities provided. They said they could take part in these if they wished to do so. We saw there was an activities planner on display at the home. The registered provider told us they were exploring the possibility of engaging a singer to come to the home.

The registered provider demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Relatives we spoke with told us they could speak with the registered manager if they wished to do so and they found the manager approachable.

Further information is in the detailed findings below.

SONACare is a care home in Cleveleys and is registered to care for up to fifteen people assessed as requiring residential care. The home has two communal rooms and a dining area. Bedrooms are available over two floors which are accessible via stairs or a lift. At the time of the inspection visit 10 people were receiving care and support at the home.

SONAcare 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.

At the time of our inspection visit there was no registered manager in place. 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 registered manager cancelled their registration with the Commission in January 2018. The registered provider said there were plans in place to replace the registered manager. They had not yet however commenced the registration process.

When we completed our previous inspection in May 2017 we found concerns relating to the environment at the home. At this time this topic area was included under the key question of Safe. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of Effective. Therefore, for this inspection, we have inspected this key question and also the previous key question of safe to make sure all areas are inspected to validate the ratings.

At the last inspection visit carried out in May 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards. The registered provider did not meet the requirements of the regulations during that inspection as breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to safe care and treatment, staffing, dignity and respect, safeguarding people from abuse, good governance, person centred care, premises and equipment and failure to display the up to date performance assessment. At the inspection, the service was placed in special measures by the Care Quality Commission, (CQC.)

Following the inspection visit we asked the registered provider to complete an action plan to demonstrate how they intended to make the required improvements. We used this inspection process to check to see if the improvements had been made.

During this inspection in January 2018, we found some improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

Although we found improvements had been made, during this inspection process we identified a breach to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered provider had failed to ensure recruitment documentation included a full employment history for all staff.

Following the inspection visit carried out in May 2018, the registered provider had reflected on concerns identified during the inspection and had reviewed safeguarding processes to promote peoples safety and well-being. At this inspection visit we found staff understood their responsibilities for reporting safeguarding concerns and were aware of how to report safeguarding alerts. The registered provider had become a safeguarding champion, working alongside professionals with up to date knowledge of safeguarding processes and best practice.

The registered provider had reviewed the premises, equipment and fire safety procedures. A period of refurbishment had started at the home. An upstairs bathroom had been replaced, decoration in a lounge had been completed and worn furniture had been replaced with furnishings which supported infection prevention and control processes. In addition, a new nurse call bell system had been fitted at the home. Although improvements had been made during the inspection process we identified a concern with the water system at the home. We have made a recommendation about this.

The registered provider had reviewed infection control processes at the home. They had worked in partnership with the infection prevention and control nurse to develop and manage infection control processes at the home. This included supporting the cleaner at the home to be an infection prevention and control champion. Although changes had been implemented, we found changes were not consistently embedded. We fed back concerns to the registered provider at the end of the inspection process about this. In addition, we relayed our observations to the infection prevention and control nurse working with the registered provider so they could monitor the situation and provide advice and guidance if necessary. We have made a recommendation about this.

The registered provider had worked with a consultant to identify and address all the concerns identified at the last inspection visit. The registered provider said they had gained knowledge from the consultant and were keen to ensure they sustained improvements introduced.

The registered provider had worked with the consultant to develop a staffing dependency tool to assess people’s needs and identify how many staff was required to meet the need. We reviewed the dependency tool and noted staffing levels were above those calculated within the dependency tool. We saw evidence of staffing levels being reviewed when a new person was admitted to the home.

Arrangements for the management of medicines had been reviewed. Protocols for administering as and when required, (PRN) medicines had been developed. Systems had been put in place to ensure topical creams, pain relief patches and ointments were suitably recorded after administration. Since the last inspection visit staff had received training from an external trainer to ensure good practice guidelines were followed. Regular audits of medicines were carried out by both a designated member of staff and a pharmacist responsible for the supply of medicines. Although improvements had been made we found good practice was not fully embedded as times of administrating time specific medicines was not always recorded. We discussed this with the registered provider during feedback

We observed staff responding to requests and noted people’s needs were promptly addressed. People who lived at the home spoke highly of the staff and their attitude. From observations we noted staff were patient and respectful with people.

Person centred care was provided by staff who knew people well. Relatives told us staff knew of people’s likes and dislikes and respected these whilst supporting people. We observed person centred care being delivered throughout the inspection process.

The registered provider said they had reviewed activities for people who lived at the home to ensure activities provided were appropriate to people’s needs and took into consideration people’s spiritual needs. On the first day of the inspection visit we observed care staff carrying out short activities with people who lived at the home. We were shown photos of people taking part in activities.

We looked at how complaints were managed and addressed by the registered provider. At the time of the inspection no one had any complaints about how the service was delivered. We were told by relatives feedback from them was routinely sought to ensure they were happy with the service provided.

Systems had been implemented to ensure people were lawfully deprived of their liberty. Restrictions upon people had been reviewed and wherever possible restrictions had been reduced. We saw appropriate DoLS applications had been made as required.

Training had been reviewed and arranged to ensure staff were equipped with the necessary skills required to carry out their role.

Feedback from relatives about the home and how it was managed was positive. Relatives said the registered provider was approachable and a good provider.

Feedback from staff who worked at the home was positive. Staff said teamwork had improved and care provided was now more organised and efficient.

We saw improvements had been made to ensure the home was well-led. Audits had been reviewed and new audits had been developed. These included external audits from independent people. Audits for the premises and maintenance had been implemented, however these had not been consistently followed up and had failed to identify some of the minor concerns we picked up during the inspection visit.

Partnership working with other organisations had improved. The registered provider had identified staff within the home to take on role of champions. Champions are staff who have a specific interest and are committed to undertaking additional training. Champions had attended external training and had cascaded advice and guidance to other staff at the home. We saw that good practice guidance had been introduced at the home as a result of networking with other groups.

We looked at how people’s dietary needs were met at the home. Following the last inspection visit the registered provider had reviewed the environment in which people ate their meals and had made changes to make the meal time experience more pleasing. We received positive feedback from people who lived at the home and relatives about the standard of meals provided. The registered provider said they were in the process of reviewing menus following consultation with people who lived a

Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to care for up to fifteen people assessed as requiring residential care. Accommodation is located on the ground and first floor of the building which can be accessed by a passenger lift. There is a communal dining room as well as a lounge area. The majority of bedroom accommodation is for single occupancy although there are two shared bedrooms for people who would prefer this option. On the morning of the first inspection visit 11 people resided at the home. An additional person moved in later that day.

There was a registered manager in place. 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 service was last inspected 07 April 2015. At this inspection we found the service was meeting all the fundamental standards and was rated as, ‘Good.’

At this inspection visit carried out in March 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards.

Deployment of staffing did not always meet the needs of the people who lived at the home. Two people we spoke with told us staffing levels did not always meet needs. This meant they sometimes had to wait for assistance. We saw evidence of this occurring at the inspection visit. We found deployment of staffing was inconsistent which meant oversight in communal areas was not always achieved. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing).

We looked at how the service managed risk to keep people safe. We found risk was not consistently addressed and managed. When risk assessments were present they were not consistently followed. We also found when risks were evident; these were not always addressed proactively. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

Person centred care was not always considered and provided. One person asked for something to eat but this was denied. Three people had asked the provider to support them with their cultural needs. We found no evidence these requests had been addressed and actioned. This was a breach of Regulation 9 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Person Centred Care).

Infection control and standards of hygiene within the home were poor. Communal chairs and carpets were stained. There was no evidence deep cleaning had taken place at the home. Hand washing facilities were not always adequate. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

We looked at how medicines were managed at the home. We found good practice guidelines were not always followed. Documentation of medicines management was poor. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, through the inspection process we identified an incident which had not been reported to the local authority safeguarding team and the Care Quality Commission (CQC) for review. Following the inspection visit we raised a safeguarding alert with the local authority safeguarding team. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service users from abuse and improper treatment).

Processes were not consistently followed to ensure people were deprived of their liberty lawfully. We observed several restrictions were in place at the home which had not been considered as such. On the first day of the inspection visit not all DoLS applications had been submitted as required by law to ensure people were lawfully deprived of their liberty. This was a breach of Regulation 13 of the Health and Social Care Act (2008) Regulated Activities (2014) as suitable processes were not implemented to ensure people were lawfully deprived of their liberty.

We found the environment was poorly maintained and did not always meet the needs of the people who lived at the home. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).

We found privacy and dignity was not always considered and implemented by staff. During the inspection process we observed some interactions where dignity was not upheld. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2014, (Dignity and respect.)

We looked at records maintained by the service. Records were not always stored appropriately so information could be easily accessed. We found records were not always accurate and up to date. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

During the inspection visit we reviewed the auditing systems established and operated by the registered provider. We noted some audits did not take place. Those auditing systems in place were ineffective and failed to identify the concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)

During the inspection visit we were made aware of an incident whereby police had been called to the home to provide assistance. This was a notifiable incident which should have been reported to CQC. This had not been completed. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).

We found the registered provider had failed to display their current rating as required within the Health and Social Care Act 2008 regulations. This was breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Recruitment procedures were implemented prior to people commencing work; however we found these checks did not always ensure risks were fully assessed and decisions documented to ensure the suitability of staff employed. We have made a recommendation about this.

We received mixed feedback about the provision of recreational activities at the home. On the days of the inspection visits we observed some activities taking place at the home. These were not always appropriate activities and did not meet the needs of the people at the home who were living with dementia. We have made a recommendation about this.

The registered provider did not always consider the Mental Capacity Act 2005 (MCA) and the relevance to their work. We looked at processes in place for determining capacity and decision making. We found correct processes were not consistently followed. When people lacked capacity to make decisions for themselves, there were no capacity assessments in place to show capacity had been assessed. When decisions had been made on behalf of people there was no documentary evidence to show that decisions had been made in the best interests of people. We have made a recommendation about this.

We received mixed feedback about the quality of the food provided at the home. We discussed this with the registered provider who said they would look into this. Systems were in place for managing people’s dietary needs. We saw evidence of input from health specialists when people were at risk of malnutrition.

We received mixed feedback about the caring nature of staff. Three people told us staff were not always caring. We observed some interactions which demonstrated that caring relationships were not always nurtured.

Staff said they felt supported within their role. They told us training was provided to meet their training needs.

We noted no complaints had been raised to the registered provider. We spoke with people who lived at the home about their right to complain. We received mixed feedback from people about being confident to complain and their complaints being taken seriously.

Systems were in place to seek feedback from people who lived at the home as a means to develop and improve service delivery. People were encouraged to have an annual review of their care to discuss their care. We saw however from the three reviews held, families and representatives were not routinely involved.

The registered provider had a system for managing complaints. People were aware of their right to complain. However, we received mixed feedback from people as to how complaints were dealt with. Two people said they could approach the registered manager if they had complaints. One person told us there had been occasions when they had raised concerns and they were disappointed in the staff response.

Staff at the home told us they considered the home to be well managed. They praised the approachability of the registered manager and the owner. Staff said the senior management team could be called upon for emergencies and would offer support when required. They described a positive working environment. Staff told us they received regular supervisions to assist them in their role. We saw recorded evidence this occurred.

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

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People spoken with told us that they were treated with dignity and respect by the staff team and that they felt safe and secure living at the home.

The home had proper policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) although no applications had needed to be submitted. Staff had received recent training with regard to the MCA and DOLS and understood when an application should be submitted. This meant that people would be safeguarded as required.

Medication practices were robust. Only staff that had received appropriate medication training had responsibility of the administration of medication. A monthly medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring that any shortfall was quickly identified and addressed.

The home’s manager set the staff rotas, which took people’s care needs into account when making decisions about numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

It the service effective?

The two people we spoke with in private told us that they were pleased with the level of care that was being delivered to them and that their needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “It is very comfortable, I have no complaints at all”.

People’s health and care needs had been thoroughly assessed before they moved into the home. From this information, an initial care plan was developed detailing the wants, needs and wishes of the individual. Specialist dietary, mobility and equipment needs had been identified in care plans when required. A range of risk assessments were in place and reviewed periodically along with the care plans. The premises had been arranged to ensure that people could move around freely and safely.

Staff told us that they were well supported by the management team. Good supervision arrangements were in place and staff training had been given some priority.

Is the service caring?

We observed people were supported by kind and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. In the main, the staff group was stable and experienced meaning they had a good understanding of the individual needs and preferences of each person.

People using the service and their relatives and friends were given opportunity to complete a satisfaction survey every six months. Where any suggestions or concerns were raised, these considered and where possible, addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. The homeowner and the home’s manager worked alongside staff on a daily basis. This meant that the care and support provided by the staff team was constantly monitored so that immediate action could be taken if there was any concern with regard to staff performance.

Is the service responsive?

The people we spoke with were not really sure whether they were clear about the home’s complaint procedure but were unconcerned about this. These people did however know who they would complain to if they were unhappy about anything. One person said, I have no complaints at all, they do look after us well and I am quite content. I would speak with one of the girls if anything was wrong.”

We looked at the home’s complaint procedure. Most relevant information was included, including the timescale for a written response. However the name of the person a formal complaint should be addressed to was not included. We were told that the document would be reviewed and amended as a matter of priority. This would ensure that all current and up to date information was incorporated in the procedure.

Is the service well-led

There was a wide range of quality assurance systems in place. This helped to ensure that the quality of the service was continually improving. People told us that they felt listened to and that staff were attentive to their wants and wishes. This helped to ensure that people received a consistent service at all times.

Staff told us that they were clear about their role and responsibility and that they felt very well supported by the management team. Staff confirmed that good supervision arrangements were in place, that they had their say that helped influence change. We were also told that staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including medication, health and safety, infection control, housekeeping and fire safety. Records seen by us showed that any identified shortfalls were addressed promptly. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

Staff we spoke with told us things had changed, in that, people's needs had been reviewed. Comments included, 'It makes sense for residents to move on when their dementia becomes too much to manage here'. Also, 'It's a lot calmer now, we have the time to do more things with residents'.

People we spoke with told us they had a choice of meals.Staff responsible for food preparation told us they got to know individual likes and dislikes so they could prepare food to meet the individual needs of people. Comments included, 'I am preparing three different lunches, that's because I get to know what residents like'. Also, 'The foods lovely here you get what you ask for'.

People told us they liked the way the home provided an environment which made them feel comfortable. One person said, 'It's a home from home', another told us, 'My room is as I like it.

Staff we spoke with told us rotas had been changed and that there were enough staff to care for people living at the home. Comments included, 'We work well as a team, there are enough of us to get on with our jobs'. Another told us, 'I haven't been here that long but all the staff are supportive'.

When we spoke with people about time staff had to spend with them they told us there was always someone around to help them. Comments included, 'Its calmer at the moment, the girls have time to spend with us'

Some people living at this home had a range of dementia conditions. This affected how they communicated with us. For this reason we spent time in communal areas, so we could observe how the home was operating and how staff communicated and helped people. One person told us, 'I usually spend my morning in the lounge but like to go to my room in the afternoon. Its very relaxed I can come and go as I please'. Two other people commented on its 'relaxed and homely atmosphere'. One person told us, "I like it here but I am looking forward to going to my own home'. Also, 'I get everything I need here, but the staff can be very busy'.

Comments we received regarding the numbers of staff on duty included, 'Their aren't enough of them', 'They are always busy I don't like to bother them'. Also, 'They do what they can but there are some very demanding people'.