Archived: East Riding Care Home

East Riding Care Home provides accommodation, personal and nursing care for up to 67 people; some of whom are living with a dementia related condition. At the time of the inspection there were 37 people living at the home. Support is provided across 2 floors in 3 units which have been adapted to meet people's needs.

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

Action had been taken following the last inspection to deliver improvements. However, we identified on-going issues with the management of medicines and the oversight of this. Governance systems had improved but more work was required to ensure medicines audits were effective in identifying issues to enable staff to take the appropriate action to make sure medicines were managed safely.

The registered manager worked in an open and transparent way and understood their responsibilities in relation to the duty of candour regulation. Appropriate documentation was in place in response to any notifiable safety incident.

Policies and procedures in relation to infection prevention and control (IPC) to prevent the spread of infections were in place. Arrangements were in place to support people to maintain contact with people important to them. This included indoor visits from relatives or friends and supporting people to maintain contact using technology.

Systems were in place to review incidents to assess if any improvements to staff practice could be made. Safe recruitment procedures had been followed and there were enough staff deployed to meet people’s needs. Systems were in place to safeguard people from the risk of abuse and the risks people were exposed to had been assessed.

Staff received training which the provider had assessed as mandatory and staff told us they felt supported in their job role. Staff were positive about the registered manager and told us East Riding Care Home was a nice place to work. One member of staff told us, “[Name of registered manager] is interested, she's involved, she helps, and she will stay and cover. It makes people feel better when you know she will do what we are expected to do.”

Staff were kind and spoke fondly about their relationships with people. They described situations where they had gone out of their way to provide person-centred support for people. One staff member said, “I can see the difference from when I first started. It's nice to see the residents with a smile on their face. I feel proud to work here and to make the home a nice, pleasant place for residents to live in.”

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. Best interest’s decisions were completed for people who could not consent to their care and treatment in line with legal requirements.

People’s communication needs were met. Information was available to people in alternative formats to support people’s communication needs. End of life care plans were in place to ensure any wishes people had for their end of life care were recorded. Staff provided care and support which was person-centred to the individual needs of people. Systems were in place to investigate and respond to any complaints and to acknowledge any compliments.

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 inadequate (published 21 November 2022) and there were 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 some improvements had been made. However, the provider remained in breach of regulations.

This service has been in Special Measures since 17 November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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 13 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, dignity and respect, safe care and treatment, safeguarding, nutrition and hydration, good governance, staffing, safe recruitment, duty of candour and notification of incidents.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 breaches in relation to safe care and treatment and 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

East Riding Care Home provides accommodation, personal and nursing care for up to 67 people; some of whom are living with a dementia related condition. At the time of the inspection there were 53 people living at the home. Support is provided across 2 floors in 3 units which have been adapted to meet people’s needs.

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

Safeguarding systems were not robust enough to ensure people were always protected from the risk of abuse. Staff said they would report any concerns to the management team. However, we found documentation which referenced allegations of a safeguarding nature where the information had not been shared with the appropriate authorities.

Safe and effective infection control procedures were not fully in place to ensure people were protected from the risk of infection. Both of the home’s washing machines had broken which had resulted in a build-up of soiled laundry. The quantity and way it was being stored increased the risk of infections being passed on to people and staff.

Medicines were not managed safely. There were inaccuracies and omissions with the administration and recording of medicines. Medicines administration records (MAR) did not always demonstrate medicines had been administered as they were prescribed.

Staff were not recruited safely. Some departments such as the catering department had staffing shortages. Agency staff were used to maintain safe staffing levels. However, this affected the ability of staff to provide a consistent service. We received feedback from staff and some relatives that more staff were required to meet people needs. We have made a recommendation about this.

Staff gave feedback of not feeling supported at work and records confirmed they had not received regular supervision in line with the providers policy. Records to confirm agency staff had received an induction at the service were not available. A range of risk assessments were in place to help ensure the safety of people and the environment. However, all the risks people were exposed to had not been assessed.

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. Capacity assessments were completed where people were unable to consent to their care and support. However, records did not always demonstrate the involvement of the relevant people. We have made a recommendation about this.

The design and décor of the environment did not fully meet people’s needs. We have made a recommendation about this. Records did not confirm that the nutrition and hydration needs of people were met. For example, evidence was not available to show food choices were always available for people who had specific dietary requirements. Systems were in place to work with healthcare professionals to meet the physical health needs of people.

People were not always treated with dignity and respect and the social needs of people were not met. We received positive feedback from relatives regarding the caring attitudes of staff. In addition, throughout the inspection we observed staff to treat people with care and kindness.

Activities which were person-centred to the individual needs of people were not always provided. Systems were in place to investigate and respond to complaints. However, the provider’s policy in relation to the timescale of when responses would be provided was not always followed. We have made a recommendation about this.

People were supported with their communication needs and advocacy services were used to support people where they required help to express their views. End of life care plans were in place to ensure any wishes people had for their end of life care were recorded.

Duty of candour policies and procedures were in place. However, they had not been followed by staff. An effective system to ensure that all notifications were submitted to the CQC in a timely manner was still not fully in place. This failure to notify the CQC of incidents and other matters in line with legal requirements meant people were exposed to a risk of harm as CQC were unable to check whether the appropriate actions had always been taken.

A system to ensure regulatory requirements were met was not in place. We identified shortfalls in many areas of the service, 9 breaches of regulation were identified at this inspection.

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 01 April 2021) and there were 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 the provider remained in breach of regulations. This service has been rated requires improvement or inadequate for the last 5 consecutive inspections.

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 medicines management, safe care and treatment and the management of the home. A decision was made for us to inspect and examine those risks.

We inspected and found there were widespread concerns, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

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.

Enforcement and Recommendations

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 breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding, nutrition and hydration, good governance, staffing, safe recruitment, duty of candour and a failure to notify incidents to CQC at this inspection.

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.

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.

East Riding Care Home provides accommodation, personal and nursing care for up to 67 people; some of whom are living with dementia. At the time of the inspection there were 33 people living at the home.

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

An effective infection control system was not fully in place. Government guidance relating to safe working practices including the use of personal protective equipment [PPE] was not always followed. A fire safety officer contacted us about the risks relating to a temporary unit which had been set up following our visit. After our inspection, the registered manager told us that action had been taken to address these concerns.

Staff were knowledgeable about the action they would take if abuse was suspected. Staff raised no concerns about staff practices or the care and support people received. However, an effective system to ensure CQC were notified of all safeguarding incidents in line with legal requirements was not fully in place.

The provider had a quality monitoring system in place. However, we identified shortfalls relating to infection prevention and control. In addition, fire related risks relating to the temporary unit had not been fully assessed.

We observed positive interactions between staff and people. Staff spoke positively about working at the home and the support they received from the registered manager. People also told us they were happy at the home. Comments included, “I’m as happy as Larry here” and “I feel safe, honestly, I am happy here.”

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 (23 November 2019).

This is the fourth consecutive inspection where the provider has failed to achieve an overall rating of good.

Why we inspected

We received concerns in relation to people’s care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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. The overall rating for the service remains 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 information contained within the key questions safe and well led for further details.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Riding Care Home 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 identified three breaches of the regulations. These related to Safe care and treatment and Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Registration Regulations 2009, which related to the notification of other incidents. You can see what action we have asked the provider to take at the end of this full report.

Follow up

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

East Riding Care Home provides personal and nursing care for up to 67 older people, some of whom live with a dementia. The home was divided into two areas, ‘Millview’ which was situated on the ground floor and ‘Wansbeck’ which was on the first floor. People with a more advanced dementia condition lived in ‘Wansbeck.’ There were 27 people living at the service at the time of our inspection.

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

At our previous inspection, we identified multiple breaches of regulation. We imposed a condition upon the provider’s registration to suspend admissions to the home. At this inspection, action had been taken to improve and the provider was no longer in breach of regulation. However, further improvements were required to ensure support for people living with a dementia met with best practice guidelines. Following our inspection, we removed the imposed condition which meant the provider could now accept admissions to the home.

Effective systems were now in place to ensure people's safety. Risks were assessed and monitored, safe recruitment procedures were followed and sufficient staff were deployed.

People were cared for by staff who were trained and supported. However, some staff were more confident and skilled than others when communicating and interacting with people who had a dementia related condition. Further dementia training was being organised. Staff supported people to access healthcare services and receive ongoing healthcare support.

People's nutritional and hydration needs were met. However, improvements were required to ensure meal times for people living with a dementia were a positive, social experience which promoted people’s independence and involvement.

Action was being taken to improve the design and décor to ensure it met people’s needs. Improvements were ongoing to ensure the environment met best practice guidelines in relation to dementia care. The layout of the building upstairs meant that staff were not always easily visible.

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.

Staff spoke in a caring manner about the people they supported and were knowledgeable about people’s needs. Care plans were in place which documented people's life histories, likes and dislikes and how they liked their care to be provided.

We observed some people with a dementia-related condition were not always encouraged or stimulated to join in with meaningful activities. There were improvements in activities provision on the second day of our inspection, however further action was required. We have made a recommendation about this. The manager told us that this was being addressed.

A new interim manager was in place. She was in the process of registering with CQC to become a registered manager. Everyone gave positive feedback about her and the improvements which had been made

Audits and checks were carried out to monitor the quality and safety of the home. We made a recommendation that the provider reviews their quality assurance system to ensure it effectively monitored the experiences of people who were living with a dementia.

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 inadequate (published 11 April 2019). At our previous inspection, we identified multiple breaches of regulation. We took urgent enforcement action and placed a condition on the provider's registration to suspend admissions to the home to minimise the risk of people being exposed to harm.

The provider sent us a weekly action plan to record what action was being taken to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation. Following our inspection, we removed the imposed condition which meant the provider could now accept admissions to the home.

This service has been in Special Measures since our inspection in February/March 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

This is the third inspection where the provider has failed to achieve a rating of at least good.

Why we inspected

This was a planned inspection based on the previous rating and enforcement action taken

Follow up

We will meet with the manager and provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will 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.

People’s experience of using this service: Medicines were not managed safely. We could not be sure people received their medicines as prescribed.

Staff told us there were not enough staff to support people in a timely manner. Inspectors had to look for staff on several occasions as people needed support.

The environment was not safe for its intended use. Maintenance checks had not been routinely completed and nurse call bells were tied up out of people’s reach. Staff were concerned about how they would evacuate people in the event of a fire.

There were concerns in relation to meeting people's nutrition and hydration needs.

Care records were not always accurate or up to date. Risks to people had not always been mitigated.

Management checks were not sufficiently robust to drive improvement.

There was limited evidence of a person-centred culture and visitors shared concerns around communication and management.

Staff had a caring nature and treated people with kindness however engagement and interaction was limited due to the numbers of staff on shift.

Activities were varied and people were supported to engage with the local community on days out.

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

Rating at last inspection: At the last inspection the service was rated requires improvement. (Report published 12 September 2018).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. During this inspection we found the required improvements had not been made.

Why we inspected: The inspection at East Riding Care Home was brought forward due to the receipt of information of concern. These included concerns around staffing, provision of care, nutrition, hygiene and premises. This inspection examined those risks and we shared the concerns with the local safeguarding and commissioning team. East Riding Care Home is currently within the local authority organisational safeguarding framework.

Enforcement: We identified two ongoing breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. New breaches in relation to staffing and nutrition and hydration were identified. Please see the Action we told provider to take section towards the end of the report.

We are taking action against the provider for failing to meet the Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made

significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept

under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Follow up: We will continue to monitor the service and will undertake another comprehensive inspection within six months.

East Riding is a 'care home.' People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 67 people. There were 34 people living at the home at the time of the inspection.

The home was divided into two smaller ‘homes.’ Millview was located on the ground floor and accommodated those people who had general nursing and personal care needs. 'Wansbeck' was located on the first floor, for those people who had a dementia related condition.

We last inspected the home in August 2016. At that time, we found the provider was meeting all the regulations we inspected. We rated the service as good.

A registered manager was in post. 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 and associated Regulations about how the service is run.

Following our inspection, the registered manager told us she was going to step down from her post, because her passion was “hands on care” and she wanted to return to care duties. The regional manager explained that they had advertised the post and the registered manager was going to remain in post until a replacement manager was found. The service was supported by senior management.

The service had been through a period of unsettlement. There had been a number of anonymous concerns raised in late 2017 and early 2018. The local authority was investigating these concerns and had placed the service into organisational safeguarding. This meant that the local authority was monitoring the whole service.

Prior to the inspection, the provider had agreed to a voluntary suspension of admissions to the service. At the time of the inspection, the suspension had been lifted, however, the local authority were monitoring all admissions to the home.

There had been a fire safety visit on 19 May 2018 by Northumberland Fire and Rescue Service who had deemed that some people were at risk in the event of a fire. There were shortfalls and omissions relating to the fire risk assessment and fire/smoke detection devices. The registered manager told us that these issues were being addressed. We also found that maintenance and servicing records were not always available or accessible to demonstrate that the premises and equipment were safe.

There were omissions in the recording of some people’s medicines. Individual guidance to inform staff about when medicines prescribed to be given only when needed, was not always detailed or person centred.

Most people, relatives and staff told us that more staff would be appreciated. Because of the previous suspension, occupancy levels were still quite low. Some staff raised concerns about staffing levels once occupancy levels increased. Due to the size of the service, it was difficult at times to find staff in ‘Wansbeck.’ The registered manager and regional managers were aware of this issue and were looking at possible solutions such as dividing Wansbeck into two smaller areas. We have recommended that the provider keeps staffing under review to ensure that sufficient staff are deployed at all times.

Prior to our inspection in late 2017 / early 2018, there had been two episodes of diarrhoea and vomiting followed by a flu outbreak. The registered manager told us that this had contributed to a number of people losing weight. We found that nutritional risk assessments were not always completed accurately and there had been a historic delay in referring two people to the dietitian. This delay corresponded to the time when there had been a number of concerns raised about the home and the home had been placed into organisational safeguarding. At the time of our inspection in June 2018, we found that those who had lost weight loss had now been correctly referred to the dietitian and most people who had previously lost weight had now gained weight.

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

Staff had completed training in safe working practices and specific training to meet the needs of people who lived at the home. There was a supervision and appraisal system in place to support staff.

Most people and relatives told us that staff were caring. Staff promoted people’s privacy and dignity. Staff knew people well and could describe their likes and dislikes. Care plans were in place, however, some care plan reviews were not always specific or person centred.

There was an activities coordinator employed to help meet the social needs of people. A varied activities programme was in place.

Regular audits and checks were carried out to monitor all aspects of the service. However, these had not highlighted the shortfalls identified by Northumberland Fire and Rescue Service. We found other shortfalls which had not all been identified by the provider’s auditing system relating to servicing records and medicines management.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

The inspection took place on 27 July and 2 August 2016 and was unannounced. The inspection was carried out by one inspector. There were 54 people using the service at the time of the inspection.

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

The service was inspected on 14 and 15 Oct 2014 and we found they were not meeting the regulation in relation to the safe management of medicines. A focussed inspection carried out on 8 June 2015 found safety had been improved but the rating of requires improvement in the safe domain was not changed as to do so requires consistent good practice over time. At this inspection we found that medicines were managed safely.

Safeguarding procedures were in place and staff had received training in the safeguarding of vulnerable adults. Staff were aware of the procedures to follow and told us they had never had cause for concern. Safe recruitment practices helped to ensure that people were protected from abuse.

The safety of the premises and equipment was risk assessed and monitored on a regular basis. Individual risks to people related to health, safety and wellbeing were also assessed. These included risks related to falls, nutrition and skin damage for example.

We saw that the building was well maintained and clean. Staff were aware of infection control procedures and had received regular training. An item of equipment stored inappropriately in an en- suite bathroom was immediately removed and stored elsewhere. The manager acknowledged that storage of bulky items could be a problem and that alternative storage solutions were being considered.

Medicines were managed robustly and clear procedures were in place. Regular audits were carried out to ensure that medicines continued to be managed safely.

There were suitable numbers of staff on duty during the inspection. We found that due to the layout of the Wansbeck unit in particular, it was not always easy for staff to observe people. We discussed this with the registered manager who agreed to speak with staff to remind them that care must be taken to ensure that staff are effectively deployed in the unit to maintain close supervision.

The service was working within the principles of the Mental Capacity Act 2005 and there were suitable records in place. Capacity assessments were carried out and applications had been made to deprive people of their liberty where necessary, in line with legal requirements.

The health needs of people were supported. People had access to a range of health professionals and a GP visited to conduct a weekly 'ward round'. The GP was complimentary about the way staff responded to the health needs of people. The nutrition and hydration needs of people were assessed and monitored. People and relatives told us the food was very good and we found that alternative choices were readily available.

Staff were observed to be caring and considerate during the inspection. They responded promptly to the needs of people and did so respectfully. They demonstrated warmth and tenderness towards people, particularly those who appeared distressed. Staff were trained in end of life care, and a palliative care support team had been set up to support people and their relatives towards the end of life.

Person centred care plans were in place which were up to date and regularly reviewed. These included information related to life story and past interests. A varied activities programme was displayed and we observed people joining in activities during the inspection. Relatives told us that the home was not easily accessible unless by car due to the steep driveway. This meant that it was difficult for them to take people out in a wheelchair for example. Relatives had requested a minibus to help to increase access to the community, and the registered manager confirmed that this was to be provided.

People, staff and relatives spoke highly of the registered manager stating that they had noted an improvement in the service. The registered manager carried out a number of audits and checks to monitor the quality of the service. The provider also arranged regular quality monitoring checks by a senior manager employed by the organisation to ensure high standards of care were maintained.

We spoke with 11 people and 10 relatives to hear their opinions. We also spoke with a Community Matron for Nursing Homes who was visiting the home. She informed us, 'There's been positive changes.'

People and relatives informed us that staff respected privacy and dignity. One person informed us, 'They always knock on the door and draw your curtains.' A relative told us, 'They're very conscious of privacy and dignity'There's also never any smells.' We considered that people's diversity, values and human rights were now respected.

People were positive about the care and support they received. One person told us, "They're very responsive to people's needs'They respond in every way they can.' We concluded that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people's diversity, values and human rights were not always respected.

We concluded if people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Some relatives informed us that certain aspects of people's care could be improved. We found that people's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan.

People told us that they were happy with the meals provided. One person informed us, 'I get very good food. I enjoy it.' We judged that people were provided with a choice of suitable and nutritious food and drink.

We received varied comments from relatives and staff about whether there were enough staff to look after people. Some relatives informed us that more staff would be appreciated. One person said, 'There's enough of them. The staff couldn't be better.' We found that there were enough staff employed to meet people's needs.

The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

People's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.