St Raphael's

About the service

St Raphael's is a care home for up to 21 adults with learning disabilities. At the time of the inspection, 19 people were living at the service. The service is divided into three interconnected buildings, St Raphael's and Fatima House which offer accommodation in single bedrooms and Taylor House which is used as an activity centre.

The service is managed by The Frances Taylor Foundation, a not for profit Catholic organisation, offering accommodation and care for people with learning disabilities and older people in care homes and supported living services across the United Kingdom.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

The size of the care home was large, but this did not compromise the quality of care or safety for people. There was a sense of community, which people using the service, their relatives and staff described. Shared communal areas were popular and people enjoyed spending time together.

The staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests. The provider gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff enabled people to access specialist health and social care support in the community.

Right Care

The service was part of a Catholic order and people had opportunities to celebrate their faith and religion. The provider's ethos included the aim to treat all faiths equally, and they ensured information about people's other faiths and religions was clear, understood by staff and their needs were met.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff assessed the risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We carried out an unannounced comprehensive inspection of this service on 29 September 2021. 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 the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring 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 requires improvement to good. This is based on the findings at this inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 November 2021). 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.

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.

St Raphael's is a care home for up to 21 adults with learning disabilities. At the time of the inspection, 19 people were living at the service. The service is divided into three interconnected buildings, St Raphael's and Fatima House which offer accommodation in single bedrooms and Taylor House which is used as an activity centre.

The service is managed by The Frances Taylor Foundation, a not for profit Catholic organisation, offering accommodation and care for people with learning disabilities and older people in care homes and supported living services across the United Kingdom.

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

Improvements had been made to all aspects of the service, however, the provider's systems and processes for ensuring people received a quality service had not always been operated effectively.

More permanent staff were needed to provide consistent good quality care. The provider relied on a high proportion of temporary (agency) staff and this meant people were not always being cared for by familiar staff who knew them well. As a result of staffing problems, sometimes people had to wait for care. Additionally, staff working with people did not always have the advanced knowledge and skills to meet all their needs.

We identified potential hazards within the environment which the provider had not fully assessed to help ensure control measures were in place to mitigate any risks. The registered manager felt confident people were not at risk and agreed to fully assess the situation to make sure of this.

People were happy with the care and support they received. They liked the staff, who were kind, polite and caring. People took part in a range of different activities and made choices about their care and support. They were able to access healthcare services and medicines were safely managed.

Staff felt well supported and had opportunities to discuss their work with each other and the management team. They took part in a range of training and regular meetings. They enjoyed working at the service.

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.

Since the last inspection, a new registered manager started work at the service. They had made a number of improvements, with further work planned. The provider had kept us updated with information each month about how they were managing the service. There were appropriate procedures for dealing with complaints, accidents and incidents. The staff worked closely with other professionals to make sure people's needs were being met.

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.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture, although further improvements were needed.

Right Support: The size of the care home was large, but this did not compromise the quality of care or safety for people. There was a sense of community, which people using the service, their relatives and staff described. Shared communal areas were popular and people enjoyed spending time together. Most people had lived at the service for many years and felt comfortable and relaxed living there. When people had moved to the service, this had been well planned to make sure the service was suitable for them and they were happy with the move. People were supported to make choices. Some people were supported with independent living skills, although further work to support others to increase their skills would be beneficial.

Right Care: The service was part of a Catholic order and people had opportunities to celebrate their faith and religion. The provider's ethos included the aim to treat all faiths equally, and they ensured information about people's other faiths and religions was clear, understood by staff and their needs were met. People received personalised care, although staffing shortages sometimes impacted on the quality of their experience and sometimes meant their needs were not met in a timely way. There was a reliance on temporary staff who did not always have the opportunity to get to know people or provide holistic care.

Right culture: There was a positive culture at the service. This had improved since the last inspection, with staff demonstrating a commitment to the provider's values, aims and objectives. People using the service and staff felt able to speak up, valued and heard. People cared about each other and were happy living at 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 (and update)

The last rating for the service was requires improvement (published 13 November 2020).

At this inspection we found improvements had been made. However, further improvements were needed to ensure good quality care and support was delivered in line with people's needs.

Why we inspected

This was a planned inspection based on the previous rating.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well-led sections of this full report.

The overall rating for the service not changed.

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 good governance and staffing at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Raphael's Care Home offers accommodation with personal care for up to 21 people with a learning disability. The accommodation is provided in two adjacent buildings, Fatima House and St Raphael's itself. At the time of the inspection eight people were living in Fatima House and eight people lived in St Raphael's.

St Raphael's is part of the Frances Taylor Foundation, a charitable organisation providing a range of services mostly for people with a learning disability.

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

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people living at this service did not fully reflect the principles and values of Registering the Right Support for the following reasons, people using the service did not always receive person centred care which was appropriate and inclusive for them. Staff were not applying the principles of the Mental Capacity Act 2005 to empower people to make their own decisions about their care or to demonstrate how they made best interests decisions where people did not have the mental capacity to make specific decisions.

The provider had quality assurance systems and structures, but these were ineffective because areas identified for improvements through audits and various investigations were not always addressed in a timely manner. There was also a lack of clarity within the management team as to whose role it was to address identified shortfalls, who was accountable, and who would have oversight of the overall quality of the service and take appropriate action if identified improvements did not take place within set timescales as per the home’s action plan. This meant people were not being adequately protected from the risk of receiving unsafe and inappropriate care.

People's medicines were not always managed in a safe way. Some risks to people had not been identified or addressed. Senior staff were not able to provide evidence of safeguarding incidents having been fully documented. We have recommended that the provider seek and implement national guidance in relation to safeguarding adults and recording information accurately. The home was not using a dependency toolkit to assess staffing levels. We have recommended that the provider implement best practice in ensuring staff numbers reflect the support needs of people using the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were not receiving appraisals in line with the providers policy.

Since the last inspection, care plans had been updated and staff were reviewing the care plans but they were not updating them with important information about people's changing medical needs. This meant staff were not always provided with clear guidance to help care for people. There was a lack of person-centred practices to ensure people's needs were met.

The provider had introduced a training matrix since the last inspection, however, the provider had not received evidence of training certificates for agency staff which meant we could not be assured agency staff had the appropriate knowledge and skills to meet people's needs. We reviewed two people’s care plans and they were meant to be receiving a higher level of individual support, but from the staff rota we could see no evidence of staff being allocated to provide this care and support.

The service was clean and well maintained. Systems were in place to ensure equipment was safe and in good working order. Since the last inspection the provider had recruited a chef, and this helped to ensure people’s nutritional needs were met. Staff were receiving regular supervisions in line with the providers policy. Staff felt better supported and we could see evidence of staff morale improving.

The manager demonstrated a willingness to make further improvements and after the inspections sent us documentation to evidence how they were committed to improve the running of the home.

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 (report published 21 October 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on some specific concerns we had about staffing and person centred care and whether the provider had met the requirements of the Warning Notices in relation to regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014. It was also carried out to check if the provider had met regulations 9 (Person centred care), 15 (Premises and equipment) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities), which they were also breaching at our last inspection in August 2019.

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.

Enforcement

At the previous inspection the service was in breach of regulations 9, 12, 15, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served Warning Notices on the provider for the breaches of regulations 12 and 17 (safe care and treatment and good governance and requirement notices for breaches of regulations 9, 15 and 18 (person centred care, premises and equipment and supporting staff). At this inspection we found that the provider had made some improvements but was not fully meeting the requirements of the Warning Notices and also remained in breach of regulations 9 and 18. The provider was no longer in breach of regulation 15.

We have imposed conditions on the provider's registration.

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 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Raphael’s on our website at www.cqc.org.uk.

St Raphael's offers accommodation with personal care for up to 20 people with a learning disability. The accommodation is provided in two adjacent buildings, Fatima House and St Raphael's itself. At the time of the inspection eleven people were living in Fatima House and nine in St Raphael's.

St Raphael's is part of the Frances Taylor Foundation, a charitable organisation providing a range of services mostly for people with a learning disability.

Although the service was developed and designed according to the values that underpin the Registering the Right Support (Registering the Right Support CQC policy) and other best practice guidance, the provider did not always ensure that care and support to people was being provided in line with these values which include choice, promotion of independence and inclusion. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to twenty people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These principles ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The home did not have effective measures in place to ensure the environment people lived in was safe Some risks to people had not been identified or addressed. Staff did not always appreciate the risks people faced and did not make sure the risks were appropriately mitigated. We observed the home was not very clean in places. People and staff did not have access to appropriate handwashing facilities. Medicines were not always managed safely.

The home provided some training for staff, but they did not always attend which meant some staff did not receive appropriate training to ensure they were knowledgeable and competent to do their work. Staff did not also receive regular supervision and appraisal.

Some people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests, the policies and systems in the service supported did not support this practice. We have made a recommendation for the provider to improve this.

People did not consistently get varied meals that met their needs and preferences and that were presented to them in an appetising way. We have made a recommendation about improving this aspect of the service.

People and their relatives told us staff were kind although our findings did not suggest a consistently caring service or a service that was always respectful of people’s choices. There was a lack of meaningful activities happening within the home or in the local community to keep people stimulated and engaged. The provider had a complaints procedure and people and relatives knew how to complain.

The service has not had effective leadership and staff morale was low. Staff told us they did not feel supported by the management team. The home did not have effective quality assurance and governance systems and had failed to address key concerns identified at the last inspection which are repeated at this inspection.

The service worked with other organisations and people were supported to access a range of healthcare services.

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 (report published 29 February 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection to check the provider has made the necessary improvements at the service. We had also received feedback from stakeholders that the provider was not making enough progress to address concerns at the service.

Enforcement

We have identified five breaches of Regulations in relation safe care and treatment, premises and equipment, person centred care, staffing and good governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• St Raphael’s offers accommodation with personal care for up to 21 people with a learning disability. The accommodation is provided in two adjacent buildings, Fatima House and St Raphael’s itself. At the time of the inspection 11 people were living in Fatima House and eight in St Raphael’s.

• St Raphael’s is part of the Frances Taylor Foundation, a charitable organisation providing a range of services mostly for people with a learning disability.

People’s experience of using the service:

• Although the service was developed and designed according to the values that underpin the Registering the Right Support (Registering the Right Support CQC policy) and other best practice guidance, the provider did not always ensure that care and support to people was being provided in line with these values which include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should expect to live as ordinary a life as any citizen and their safety maintained.

• The provider had systems in place to help ensure people who used the service were safe from avoidable harm. However, these were not always effective.

• During the inspection we found there were risk assessments in place but these did not always identify all risks that people faced and did not always include guidelines for staff to follow to help ensure people were safe from harm and could lead as ordinary a life as possible.

• People’s healthcare needs were not always met because staff did not always take appropriate action when concerns were identified.

• The provider told us they had systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, these were not always recorded and had failed to identify the issues we found at this inspection so the necessary improvements could be made.

• People received their medicines safely and as prescribed. However, we found some issues relating to the storage and stock management.

• Care and support plans contained a lot of information, some out of date. This made it difficult for staff to find relevant information about the people they supported and for people who used the service to have easy access to this document and be involved in reviews.

• Staff received training. However, we saw that some training was out of date. Staff received supervision, but this was not always consistently undertaken. The registered manager was in the process of making improvements in this area.

• Most people’s records were reviewed and updated monthly. However, almost all reviews stated ‘No change’ by staff even when information stated otherwise.

• Staff had not received training in end of life care. Some people had an end of life care plan in place and the registered manager was in the process of introducing this for everyone.

• There was evidence that people were engaged in activities in house and in the community. There was an activity plan displayed and most people reported they were happy with the activities on offer.

• Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

• People were protected by the provider’s arrangements in relation to the prevention and control of infection. Communal areas were clean. However, some areas were cluttered and used as storage. This could present a health and safety risk

• The environment was tailored to the individual needs of people and areas of the home had been updated and decorated since our last inspection.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA). People had their capacity assessed before they moved into the home. Where necessary, people were being deprived of their liberty lawfully.

• The provider had processes for the recording and investigation of incidents and accidents. We saw that these included actions taken and lessons learned.

Rating at last inspection: Good (4 March 2017)

Why we inspected: This inspection was brought forward due to information of concern we had received about the quality of care and support people were receiving.

Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, person centred care and good governance. You can see what action we have asked the provider to take at the end of the full report.

St Raphael’s offers accommodation with personal care to 21 people with learning disabilities. The accommodation is provided in two adjacent buildings, Fatima House, and St Raphael's itself. Fatima House provides accommodation for 13 people, six on the ground floor and seven on the first floor, and has a lift. St. Raphael's provides accommodation for eight people. All rooms are single and many have en-suite facilities. There were 20 people living at the service at the time of our inspection. One of whom was in hospital.

There was a registered manager in post at the time of our 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.

The provider had taken action to meet the concerns identified at the inspection of 26 January 2016 and had put systems in place for the safe management of medicines.

The provider had put systems and processes in place to ensure that important information about identified risks was communicated to all relevant staff. This ensured that people were protected from the risk of harm.

The provider had made improvements to the provision of activities for people who used the service and we saw that detailed activity plans were displayed in the home. A range of activities were provided both in the home and in the community, and people were supported to undertake activities of their choice.

The provider had taken action to ensure that people were consulted and involved in developing menus, and these were displayed in the home. People told us they enjoyed the food offered at the service and their likes and dislikes were recorded in their care plans. People’s nutritional and healthcare needs had been assessed and were met.

The provider had improved the way staff communicated with people who used the service and had implemented comprehensive communication guides.

There were enough staff on duty to meet people’s needs at the time of our inspection and people’s needs were met in a timely manner. Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed and they had consented to their care and support.

Staff received regular training, supervision and appraisal. The registered manager attended forums and conferences in order to keep abreast of developments within social care.

Care plans were in place and people had their needs assessed and reviewed regularly. The care plans were clear and comprehensive and reflected the needs and wishes of the individual.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. People and relatives were sent questionnaires to gain their feedback on the quality of the care provided.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

People, relatives and professionals we spoke with thought the home was well-led. The staff told us they felt supported by the registered manager and there was a culture of openness and transparency within the service.

St Raphael’s provides accommodation and personal care for up to 21 adults with a learning disability. It is divided into three units where people are accommodated according to the level of their needs. There were 21people living at the service at the time of our inspection, including three people living with dementia.

There was a registered manager in post at the service at the time of our 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.

People told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. However, important information about an identified risk for a person who used the service had not been communicated to a visiting activity officer.

The storage of medicines was disorganised. There was no temperature monitoring on the medicines fridge, and there was no protocol in place for medicines prescribed “as required”.

A range of activities were provided both in the home and in the community. However, there were no activity plans displayed in the home, and some people were not supported to undertake activities of their choice.

People told us they enjoyed the food offered at the service and their likes and dislikes were recorded in their care plans, however we did not see evidence that people were consulted or involved in developing menus, and those were not displayed.

There were enough staff on duty to meet people’s needs at the time of our inspection. The registered manager was undertaking a recruitment drive to cover staff vacancies and required the use of agency staff to ensure people’s needs were met. Checks were carried out during the recruitment process to ensure only suitable staff were employed.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). Records showed that people had consented to their care and support.

Staff received effective training, supervision and appraisal. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff. This ensured that the staff team were well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity, compassion and respect. Care plans were clear and comprehensive and written in a way to address each person’s individual needs, including what was important to them, and how they wanted their care and support to be delivered. We saw that people were cared for in a way that took account of their diversity, values and human rights.

People, staff, relatives and stakeholders told us that the management team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

We found a number of 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 looked at people's care records and found that they were written in a format that people could understand. People were asked about activities they wanted to participate in and were supported to be active members of their community.

We found the service had made improvements in relation to care planning and risk assessments following our visit on the 12 January 2013. We found people's needs were met and where there had been a change in a person's health the service had made the necessary changes to ensure people's needs were met.

At our visit on 12 January 2013 we requested the service make improvements in the way in which it recorded the administration of people's medication. We found at our recent visit the service provided staff with additional training and also carried out a weekly audit to ensure people received their medication correctly and the information had been properly recorded.

We checked staffing levels during our visit and found there was sufficient staff to meet the needs of people. However, we have asked the provider to note that staff had not received training in areas such as communication and pressure area care as there were people who use the service who had a communication impairment and were at risk of developing pressure ulcers.

We found the service had a system to monitor the quality of the service to ensure people received safe and effective care. The service had sought the views of people and staff had regular meetings to develop good practices.

People who talked with us said they were very happy with the care and support they received. We observed that all people appeared cared for. One person said 'I have lived here for many years and I am very happy'. One relative said that their family member was very happy and settled in the home.

The service arranged a range of activities for people. Whilst people with a lower level of needs were able to participate in the activities, we did not see as much engagement and interaction with a few older people who were living in the home.

The provider ensured that all people had appropriate care plans and risk assessments. These were overall appropriately completed but had not always been reviewed and updated according to the times that had been identified for their review.

People were appropriately supported with their healthcare needs. The arrangements in place for the management of medicines were however not always adequate to ensure the safety and wellbeing of people.