Archived: Gables Care Home

Gables Care Home is a care home providing accommodation and personal care to seven people aged 65 and older with a mental health diagnosis, dementia and a learning disability. People live in one adapted building.

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

Risks to people were not always assessed, monitored and managed safely. There was no formal recording of people’s behaviours to look for trends and themes. The management of medicines required some improvements around competency assessments and correct processes in place when errors had occurred. All other aspects of the administration of medicines was undertaken in a safe way.

The provider and staff had not received adequate training and supervision in relation to their role.

There was a lack of meaningful activities for people and staff lacked an understanding of people’s needs. Care plans lacked detailed guidance and information on people’s backgrounds and family history. There were no end of life care plans in place.

People were not always being treated in a caring and dignified way and people’s choices were at times restricted. People’s nutrition and hydration was being monitored; however, choices around meals and drinks were at times restricted. We have made a recommendation around this.

Quality assurance and governance systems were not effective in making sure risks to people were managed safely. Staff had not always been supported to understand and fulfil their expected roles and responsibilities.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of all the domains:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Not everyone was being supported in a way that enabled them to have choice and control in their daily lives. We found people had restrictions placed on them in relation to accessing the kitchen. There had not been an assessment of any risk associated with this.

Right care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. People did not always have access to meaningful and person-centred activities.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. There were institutionalised practices where care was decided for people rather then people being supported to remain independent.

Rating at last inspection and update

The last two ratings for this service were Inadequate (published 07 June 2021 and 17 August 2021) and there were breaches of regulation. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last 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.

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

Enforcement and Recommendations

We have identified breaches in relation to the safe care and treatment, training and supervisions of staff, lack of adherence to the principles of the mental capacity act, people not always being treated in a caring and dignified way, the lack of meaningful activities, staff being aware of people’s care, and the lack of robust oversight of the care provision 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 ‘Inadequate’ and the service remains 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.

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

About the service

Gables Care Home is a care home which provides personal care and accommodation to people with a mental health diagnosis, people living with dementia or a learning disability. It can accommodate up to 16 people and has communal lounge and dining areas. At the time of our inspection the service provided personal care to eight people.

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

The provider had not ensured there were sufficiently trained staff at the service who knew and understood people’s needs. The management of medicines was not safe and there was a risk that people would not always receive their medicine. The management of risks associated with people’s care was not robust which put people at risk.

There were parts of the service that were clean and well maintained, however the disposal of continence aids did not adhere to good infection prevention control. The provider was not undertaking appropriate recruitment processes to ensure that only suitable staff were working at the service. The oversight and management of the service was not robust and there was a lack of clear direction for staff.

People looked comfortable with staff and told us they felt safe. Staff understood what they needed to do if they suspected abuse. There was a system in place for staff to record and report accidents and incidents.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Safe and Well Led key questions, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture

Right support:

• Model of care and setting did not maximise people's choice, control and Independence

Right care:

• Care was not person-centred and did not always promotes people's dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered live.

The last rating for this service was Inadequate (published 5 June 2021).

Why we inspected

We received concerns in relation to insufficient staff being on duty and the safe recruitment of staff. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gables 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 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 breaches in relation to risks related to the care being provided to people, the management of medicines, recruitment processes, staff levels, staff training and supervision, and the lack of robust provider and management quality assurance at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Gables Care Home is a care home which provides personal care and accommodation to people with a mental health diagnosis, people living with dementia or a learning disability. It can accommodate up to 16 people and has communal lounge and dining areas. At the time of our inspection the service provided personal care to nine people.

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

There were not enough staff deployed at the service which left people at risk. Risks associated with people's care was not always being managed in a safe way including the management of medicines and safety in the event of a fire. Incidents and accidents were not always followed up on to avoid the risk of reoccurrence.

Staff had not received appropriate training and supervision that ensured good practice within the service. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The provider was not always working with health care professionals in ensuring people’s health needs were being met.

People did not always have choices around their care delivery and at times were not treated with dignity and respect. There were not sufficient meaningful activities to keep people occupied and meet their need for mental stimulation and well-being.

We found complaints required further information on what actions had been taken to address the concerns. We have made a recommendation around this.

The provider was not effective in ensuring staff were delivering appropriate care and had failed to maintain robust oversight of the service. As a result, the level of care had deteriorated from the last inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always supported with their independence. Staff did not always have an understanding of the support and care people needed to enable them to have a fulfilled life. The was a closed culture at the service where practices were at time institutionalised.

Right support:

• Model of care and setting did not maximise people's choice, control and Independence

Right care:

• Care was not person-centred and did not always promotes people's dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

People told us that staff were kind and we did see examples of this. Relatives and visitors were welcomed as often as they wanted.

Rating at last inspection (and update)

The last rating for this service was Good (published 25 May 2018).

Why we inspected

We received concerns in relation to the delivery of safe care to people. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led. However, whilst at the inspection we identified further concerns and as a result looked at key questions Effective, Caring and Responsive.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive, and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gables 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 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 breaches in relation to risks related to the care being provided to people, the management of medicines, incident and accident reporting, care planning, activities, the assessment of people’s capacity, staff training and supervision, and the lack of robust provider and management quality assurance at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Gables Care Home is a care home which provides personal care and accommodation to people with a mental health diagnosis or a learning disability. It can accommodate up to 16 people and has communal lounge and dining areas. At the time of our inspection 10 people were living at the service.

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 coronavirus and other infection outbreaks effectively.

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

People said they felt safe living at Gables Care Home. They said staff were kind to them and there was always staff around. People said the provider was approachable and they would go to them if they had any concerns.

Staff knew how to recognise and report any safeguarding concerns. Risks to people had been identified and staff worked with health care professionals to help support people to live a good life and receive good care.

We were assured by the provider’s infection control processes. We had no concerns about the infection prevention and control practices of staff.

Staff told us they felt supported by the registered manager. They said they worked well together as a team.

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 (report published 26 May 2018).

Why we inspected

This targeted inspection was prompted following anonymous concerns we received which indicated people may be at risk of receiving unsafe care. This included infection control, the risk of abuse and a poor culture within the service. We made the decision to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

At this inspection we reviewed selected Key Lines of Enquiry in the key questions of Safe and Well-Led only and this report covers our findings in relation to those.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme, when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

This inspection took place on 17 April 2018 and was unannounced. During this inspection we found that the concerns identified at our previous inspection had been dealt with.

Gables Care Home 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.

Gables Care Home is a privately owned and managed establishment accommodating a maximum of 16 older people and adults with learning disabilities and/or mental health issues. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our visit ten people lived at the service.

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

There was positive feedback about the home and caring nature of staff from people who live here.

People knew how to make a complaint. Where complaints and comments had been received the staff had responded to try to put things right. We made a recommendation that the registered manager should review how they record what action had been taken to address people’s concerns.

People had access to a range of activities. These helped stimulate people’s minds to prevent them from becoming bored or isolated. The provision of activities was under review by the registered manager to ensure people did things that were meaningful and of interest to them.

People were safe at Gables Care Home. Staff understood their duty should they suspect abuse was taking place. There was an ongoing safeguarding investigation at the time of our inspection and the provider was working with the local authority safeguarding team.

Risks around people’s health and safety had been identified and clear plans and guidelines were in place to minimise these risks. The home was clean and staff practiced good infection control measures, such as hand washing, hygienic cleaning of the environment and equipment and correct use of personal protective equipment.

There were sufficient staff deployed to meet the needs of the people who lived at the home. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received an induction when they started at the home and ongoing training, tailored to the needs of the people they supported.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Accidents and incidents were reviewed to minimise the risk of them happening again.

Before people moved into the home, their needs were assessed to ensure staff could provide the care and support they needed. Adaptations had been made to the home to meet people’s individual needs. These included the installation of ceiling hoists, large open communal areas and bathrooms to suit individual requirements.

People told us they enjoyed the food. They received a balanced diet and they were encouraged to keep hydrated. People had enough to eat and drink, and specialist diets either through medical requirements, or personal choices were provided.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve because of the effective care and support given by staff.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People received the care and support as detailed in their care plans. The staff knew the people they cared for as individuals, and were positive in their interactions with them. Staff treated people with kindness and respect. People were involved in their day to day care decisions. People would be supported at the end of their lives to have a dignified death.

The registered manager had a clear vision and set of values based on providing personalised care to people. Staff understood this and demonstrated these values during the inspection in their interactions with people. Quality assurance processes were used to make improvements to the home and the experience of people who live here.

People and staff were involved in improving the service. Feedback from meetings and annual surveys was reviewed and action taken to respond to ideas and suggestions. The management liaises with outside agencies to review and make improvements to the service.

This was an unannounced inspection that took place on 16 May 2017. This inspection was to follow up on actions we had asked the provider to take to improve the service people received.

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

At our previous inspection on 2 March 2016 we found a breach of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the lack of quality assurance and the maintenance of the environment. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by September 2016. We also made five recommendations to the provider in regard to management of medicines, recruitment processes, deployment of staff, Mental Capacity assessments and Deprivation of Liberty applications and activities.

During this inspection we found that some improvements had been made, however they were not sufficient enough to meet the requirements of the regulations. We also found new concerns that put people at risk of harm. After the inspection, the provider sent us an action plan which identified action to be taken in regard to the concerns raised. The provider told us they were old fashioned and so they concentrated more on people than the paper work but they were working to improve. The local authority told us they had been and would, continue to work with the provider to improve the quality of the service. They did say that people looked well and were thriving and happy at the home and people who had recently moved from another home which had closed were being well cared for.

People were not always safe because robust and up to date risk assessments were not in place to identify, assess and manage risk safely and to minimise the risk of harm to people. The environment was not always safe but had been improved recently.

There were insufficient numbers of staff deployed to meet people’s needs. This had an impact on the care and support provided, the activities and the quality of information recorded in care plans. The local authority told us that people did looked well groomed and cared for and one person who had recently moved in had had their hair cut and looked much better.

The provider did not have a clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were not fully protected and best practices were not being followed. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.

Information about people needs was not always provided to the staff before people moved in to determine whether their needs could be met. However part of this related to the local authorities responsible for people’s moves had not always been prompt in supplying assessments and information to the provider. Although the provider should still always ensure they assess whether they can meet people’s needs prior to any admissions.

There were quality assurance systems in place, to review and monitor the quality of service provided, however they were not robust or effective at identifying or minimising risk or correcting shortfalls.

The provider ensured staff had the skills and experience which were necessary to carry out their role. Arrangements had been made for staff to attend mental health awareness training which they needed. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing. We made a recommendation that the provider reviews their training in line with people’s care and support needs.

People attended activities in the home and in their local community; however they were not always specific to people’s needs or preferences. We have made a recommendation that the provider reviews individual hobbies and interests and looks at ways these could be implemented and people supported to participate.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP or psychiatrist and administered appropriately.

People told us they felt safe at the home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Recruitment practices were in place and were followed to ensure that relevant checks had been completed before staff commenced work.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding and power cuts.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. Staff worked effectively with healthcare professionals and were proactive in referring people for treatment.

People were not always involved in decisions about their care and people were not always treated in a dignified way. Apart from these few examples staff were usually kind and compassionate towards people. People’s relatives and friends were able to visit and made to feel welcome.

People told us if they had any issues they would speak to the staff or the manager. People and their families knew how to raise complaints and felt confident to do so.

We found four of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made recommendations to the provider. You can see what action we told the provider to take at the back of the full version of this report.

Gables Care Home is registered to provide accommodation with care for up to 16 people. There were seven people living at the home, some living with complex needs as a result from living with long term conditions. During our visit, we were informed that there were at least three people living at the home with dementia. After the inspection the registered provider informed us this was incorrect and only two people had received a dementia diagnosis. The accommodation is provided over two floors that were accessible by stairs.

The registered provider was also the registered manager for Gables Care home. 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.

Systems and procedures to protect people from harm were not being followed correctly. Whilst some risk assessments were in place, others were not, they were not person centred or in line with current guidelines.

There were quality assurance systems in place, to review and monitor the quality of service provided, however they were not robust or effective at identifying or minimising risk or correcting poor practice.

Medicines were administered safely, however arrangements in place for the management of medicines needs to be reviewed to ensure the safe storage and disposal of medicines. Protocols regarding the administration of as and when needed medicines (PRN) were not in place therefore people were at risk of not receiving this type of medicine in a consistent way. We made a recommendation that the registered provider reviews and ensures arrangements and systems in place for the management of medicines are in line with current national guidelines.

Staff did not have the appropriate support that promoted their development. However, people were supported by staff that had the necessary skills and knowledge to meet their assessed needs. Staff we spoke with told us they spoke to their manager about concerns they had. The registered provider confirmed that regular meetings with staff to discuss their work and performance had not taken place.

People were not always protected from being cared for by unsuitable staff because although recruitment processes in place, they were not always followed. We made a recommendation that the registered provider obtains information as specified in Schedule 3 of the regulations.

People living at the home had different opinions about how staff were deployed to meet their needs. During the visit we observed how staffing levels had an impact on how staff responded to people’s needs. We made a recommendation that the registered provider reviews best practice techniques when allocating the deployment of staff to meet people’s needs.

Staff had basic understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Documentation regarding MCA and people appointed to make decisions on people’s behalf was not always fully completed in accordance with current legislation. We made a recommendation that the registered provider reviews its MCA assessments and DoLS applications to ensure that people are protected from having their freedom restricted in accordance with current legislation.

People attended activities in the home and in their community; however they were not always specific to people’s needs or preferences. We have made a recommendation that the provider reviews individual hobbies and interests and looks at ways these could be implemented and people supported to participate.

Staff responded to people’s needs and information about people’s care and support needs were not always detailed with the correct information.

People told us they felt safe at the home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

The manager ensured staff had the skills and experience which were necessary to carry out their role. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. Staff worked effectively with healthcare professionals and were proactive in referring people for treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s relatives and friends were able to visit. People’s privacy and dignity were respected and promoted. Staff told us they always made sure they respected people’s privacy and dignity when providing personal care.

People told us if they had any issues they would speak to the staff or the manager. People were encouraged to voice their concerns or complaints about the home and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service provision.

The provider had sought, encouraged and supported people’s involvement in the improvement of the home. Action taken had been recorded to make people aware of the concerns raised and how these were being addressed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that staff were always ensuring that people were giving their consent to care and respected their right to refuse care. We also found that staff had an understanding of mental capacity issues.

We found that people who used the service were generally happy with the level of care they received, and that people's needs were being properly assessed, managed and reviewed.

We found that staff had a proper understanding of safeguarding people from abuse and would know how to respond to and report any incidents of abuse.

We found that although there were no visible signs that the service was understaffed the provider was unable to provide us with evidence that the service was fully staffed at all times.

We found that to a certain extent the provider sought the views of people who used the service, their relatives and staff regarding the quality of the service. However, we found that the provider was not currently taking any steps to monitor and assess the service in any systematic and audited manner.

We saw that people had their needs assessed before admission and that they had been involved in planning their care and support. We noted that staff treated people who used the service with dignity and respect.

We observed that people looked well cared for and that those who wished to had seen the general practitioner who was in the service during the inspection. One person we spoke with told us, "They do ask how things are going and I do tell them if there's a problem'

We noted that guidance regarding safeguarding people from abuse was available to staff and that they had received recent training. One person that we spoke with told us, I've never really thought about it. I just take it for granted that I am safe here'. We also saw that the general security of the premises and gardens appeared appropriate and adequate.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged. Staff had been provided with appropriate induction training for the role.

We noted that there was an effective complaints system in place. A person we spoke with told us, 'If I have anything to raise I just speak straight to the manager. They do all they can and if they can't help, they point you to someone that can'.