St Johns Nursing Home Limited

St Johns Nursing Home is a residential care home providing personal and nursing care to up to 54 people in one adapted building. The service provides support to people who need nursing support, including people living with dementia. At the time of our inspection there were 44 people using the service.

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

Staff administered medicines to people appropriately, but we found medicines administration records were not always adequately completed. The risk of people developing pressure sores was managed by a range of measures designed by healthcare professionals. However, records relating to these were not always completed. For example, there were gaps in people’s turning and hydration records. In the weeks prior to our inspection a new manager came in to post at the service. They had introduced auditing processes that identified these shortfalls. We will continue to monitor the service to ensure that the provider’s quality checks improve and maintain people’s safety. The service’s new manager had recruited new staff, including nurses and a clinical lead, to the team. This ensured there were enough staff available at all times to deliver safe and effective care. Staff received training and supervision.

People’s needs were assessed and reviewed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People received the support they required to eat and drink and accessed healthcare services whenever they needed.

Caring staff maintained people’s privacy and dignity. People were supported to maintain relationships with friends and relatives. People’s spiritual and cultural needs were met and they were supported to make decisions

People’s changing needs were identified and met. People were supported to participate in a range of activities. The provider planned to double its number of activity coordinators and increase the choice of activities available to people. The service had access to specialist support should people be identified as requiring end of life care.

The service did not have a registered manager in post. However, a new manager had recently joined the service and had immediately implemented a range of changes to drive improvements. Whilst we had identified some shortfalls at the service these largely predated the new manager's arrival. The new manager intended registering with the CQC to become the service’s registered manager. People and staff expressed confidence in the new manager who was working in partnership with others to meet people’s needs.

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 07 September 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation related to governance but remained in breach of regulation related to safe care and treatment. We have found evidence that the provider needs to make improvements. The new manager had identified these and was in the process of making 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.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, people’s weight, complaints and the management of the service. A decision was made for us to inspect and examine those risks.

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.

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

Enforcement and Recommendations

We have identified a continued breach in relation to people’s safe care and treatment.

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.

St Johns Nursing Home is a residential care home providing personal and nursing care to up to 54 people. The service provides support to people who need nursing support, including people living with dementia. At the time of our inspection there were 47 people using the service.

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

Safe medicines management processes were not in place and we found accurate, up to date records were not maintained in relation to medicines. Other risks to people’s safety were appropriately assessed and mitigated. There were sufficient staff to meet people’s needs and there continued to be a recruitment drive to provide more consistency and stability within the staff team. Processes were in place to protect people from the risk of infections.

People were supported by staff who received regular training and supervision to ensure they had the knowledge and skills to undertake their roles. People’s needs were regularly assessed to ensure staff were aware of people’s current care and support needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People received support with their dietary needs and were supported to access healthcare services. A redecoration programme was in place to ensure a homelier environment was provided.

Since our last inspection a new manager had been appointed. In addition, a deputy manager had been recruited to further strengthen the management team. Processes were in place to review the quality and safety of service delivery. Where improvements were identified as being required, prompt action was taken to address the concerns. The manager was working with the newly established staff team to build a positive culture within the team. Staff, people and their relatives were encouraged to express their views and opinions, and there was a commitment to making continued improvements.

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 22 January 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations in relation to the need for consent and good governance. However, we found the provider remained in breach of regulation relating to safe care and treatment.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to check whether they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. 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 Johns Nursing Home on our website at www.cqc.org.uk.

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 safe medicines management at this inspection.

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

Follow up

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

St Johns Nursing Home is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of this inspection. The service can support up to 58 people.

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

At our last inspection we found a safe environment was not provided. Windows had not been appropriately restricted and management records and audits had not identified or addressed these concerns.

At this inspection people’s safety was still at risk as they were not cared for in an appropriately safe environment. Windows had still not been appropriately restricted to protect people from the risk of falling from height, and there were concerns about the security of the building.

Whilst there were systems in place to review health and safety procedures and the safety of the environment, these continued to not be effective in identifying the concerns we found during our inspection.

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

Rating at last inspection

The last rating for this service was requires improvement (published 24 September 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This targeted inspection was prompted in part due to concerns received from a Coroner following an inquest into the death of a person in 2017 whilst receiving care at St Johns Nursing Home. The concerns included unsafe care due to the risk of people falling from height and the risk of people, who were unsafe to do so unaccompanied, leaving the service. A decision was made for us to inspect and examine those risks.

We also undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to check on a specific concern we had about the safety of the environment. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 safe care and treatment and good governance at this inspection.

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 have requested the provider provides us with regular updates on their action plan so we can monitor the improvements being made.

St Johns nursing home is a residential care home providing personal and nursing care to 30 people at the time of the inspection. The service can support up to 58 people. The home accommodates people across three floors, however the top floor was closed on the day of our inspection due to the reduced occupancy levels.

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

We had concerns the provider was not learning from previous incidents. In February 2021 CQC brought a criminal prosecution following the death of a resident in 2017. The provider pleaded guilty to failing to provide safe care and treatment, resulting in avoidable harm, namely the death of a resident at the home after they fell from height due to a window not being appropriately restricted. At this inspection we found a window that was not restricted. When we bought the unrestricted window to the registered manager’s attention they arranged for prompt action to be taken to ensure the window was made safe. However, we were concerned that the health and safety audits in place had not identified that the window was not safe and the provider had not taken appropriate action following our prosecution to ensure this risk was mitigated and people were protected from the risk of harm.

Whilst the registered manager had implemented a number of new systems across all of the provider’s services to improve practice, particularly in relation to safeguarding adults and incident management. We continued to have concerns the provider did not have effective systems in place to learn from all areas of previous inspections. We identified concerns at this inspection regarding the environment and the completeness of care records. These had been identified as requiring improvement at our previous inspection. Governance structures had been implemented to improve communication across the provider’s services and included external scrutiny from independent auditors. However, these improvements had not addressed all of the concerns we identified during inspection and further improvement was required.

A new electronic care records system had been introduced. This had the capacity to capture information about people’s risks and their care needs, as well as maintaining a record of the ongoing support provided by staff. Whilst the quality of care records had improved since our last inspection, we found that complete records were not always maintained about risks to people’s safety and how to mitigate those risks.

A redecoration programme was in place but it had not been completed by the time of our inspection and we found that some areas of the home were not maintained to a sufficient standard to enable adequate cleaning of the service. We would also recommend the provider consults guidance on providing a dementia friendly environment when completing their redecoration programme.

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. People, including those without a deprivation of liberty safeguard in place, were accompanied by staff when out in the community but we were not assured that these arrangements had been discussed and agreed to by people.

Improvements had been made to meet previous breaches in relation to safeguarding people and staffing. Safeguarding adult’s procedures had been improved to ensure any concerns were identified and reported. Recruitment processes had been strengthened to ensure suitable staff were recruited to support people and there were sufficient numbers of staff to meet people’s needs. Staff had been supported to access training courses and update their knowledge and skills.

Staff were knowledgeable about the people they were supporting and people told us they felt well cared for. Staff understood people’s care and support needs, and we saw staff interacted with people in a caring, polite and friendly manner. Staff were respectful of people’s privacy and dignity, and enabled people to be as independent as possible. Staff supported people to access healthcare services and supported them with their nutritional needs.

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. (Report published 9 December 2020)

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider continues to need to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

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.

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 St Johns nursing 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 safe care and treatment, consent to care and treatment and 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St John’s Nursing Home limited is a residential care home providing personal and nursing care to 33 people at the time of the inspection. St John’s Nursing Home is one adapted building arranged over three floors. At the time of our inspection the top floor was empty and not in use. People living at the home experience a range of mental health needs and many are living with dementia. The service can support up to 58 people.

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

People were not supported in a way that was consistently safe. The condition of the home meant staff could not keep people safe from the risks of infection and staff had deeply embedded misconceptions about infection prevention and control measures. Risks faced by people living in the home had not been effectively mitigated and not all staff knew how to access risk assessments. The systems in place to manage medicines left people at risk of not receiving their medicines as they needed. People were at risk of having their rights infringed as the Mental Capacity Act (MCA) was not always followed.

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.

The leadership and governance of the home had failed to operate effectively to maintain the quality and safety of the service. Quality audits and reviews had not taken place regularly. A newly appointed nominated individual and recent external audit had identified there were wide ranging issues with the governance arrangements within 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 good published July 2019. The service had now deteriorated to being requires improvement.

Why we inspected

We undertook this 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 infection prevention and control. A decision was made for us to inspect and examine those risks.

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

We have found evidence that the provider needs to make improvements.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

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

Follow up

We will request an action plan 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 to ensure improvements are made. If we receive any concerning information we may inspect sooner.

St Johns Nursing Home is a nursing home that provides personal and nursing care for up to 58 older people, some of whom were living with dementia. There were 35 people using the service at the time of our visit.

The provider had visiting arrangements in place for families and relatives. Family members had to pre-book a time slot for a window visit with their family members. These visits were limited to one family per time slot in order to ensure social distancing could take place safely.

Special arrangements were in place for people receiving End of Life Care. Family members were escorted to their relative's bedroom and required to follow the home’s policies and procedures for the use of personal protective equipment [PPE] in the home.

The provider had appropriate arrangements for all other visitors to help prevent the spread of Covid 19. They were required to have their temperatures taken and complete a Covid 19 risk assessment which included screening for symptoms of Covid 19 before being allowed to enter the home. Visitors were required to wear a face covering and wash hands before and after mask use.

The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. This ensured that people and staff were tested for Covid 19 so that appropriate action could be taken if any cases were identified.

The provider ensured all staff received appropriate training and support to understand and to manage Covid 19. This included best practice for infection prevention and control and the use of PPE.

Staff also received appropriate guidance on how to support people with dementia to understand the pandemic and Covid 19. Separate groups of staff work in specified areas of the home including domestic and housekeeping staff.

The second floor of the home has been designated as a specialist area. It is a separate and segregated area to be used as a designated setting. There are robust procedures in place to ensure risks are minimised. This area will be staffed separately to minimise risks to other areas of the home.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

St Johns Nursing Home is a care home that s provides personal and nursing care for up to 58 older people, some of whom were living with dementia. There were 42 people using the service at the time of our visit.

People's experience of using this service

Staff recruitment followed suitable processes so only suitable staff were employed. There were enough staff to support people safely and staff had enough time to interact with people and build good relationships.

The provider assessed risks to people and took action to reduce the risks. Staff were aware of the risks. People received medicines safely as systems were in place to ensure staff were competent and followed best practice. The provider checked the premises and equipment to ensure risks were identified and reduced. The service was clean and free of malodours and staff followed suitable infection control procedures.

A new manager was in post who was registering with us. The manager had worked at the home for many years in a different role and was well respected by people, relatives and staff. Staff received regular supervision to support them in their roles. The provider had good oversight of the service with a system of checks and audits to ensure high standards were maintained. Staff received a wide range of training to understand people’s needs.

People and relatives were positive about the staff who were described as kind and caring. Staff treated people with dignity and respect and encouraged them to maintain their independence.

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

People were provided with a wide range of activities they were interested in and people who remained in their beds also received individual activities. People enjoyed the food they received. They received choice of food and their needs and preferences, including any religious or cultural needs, were met. Staff supported people to see the health and social care professionals they needed to maintain their health and wellbeing.

People and relatives knew how to complain and had confidence the management team would respond appropriately to any issues they raised. The provider communicated well with people, relatives and staff and listened to their views as part of improving the service.

We found the service met the characteristics of a "good" rating overall.

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 7 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The rating has improved to “good” overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk relating to people using the service. This inspection examined those risks.

At this inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Appropriate action had not always been taken to support people where risks to them had been identified. Staff were not always supported in their roles through training and supervision. You can see what action we told the provider to take at the back of the full version of the report.’

We also found that appropriate health care professionals, the local authority and CQC had not been notified the in a timely manner of a recent incident of attempted self-harm. Although there were systems in place that complied with the Mental Capacity Act 2005 (MCA 2005) we found that Deprivation of Liberty Safeguards applications and conditions were not always managed appropriately. During our routine observations we found a number issues with maintenance at the home. The registered manager addressed the issues above during the inspection.

The home had 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 provider reviewed records of accidents and incidents to determine whether any changes were needed to the way in which people were supported, but improvement was required to ensure accidents and incidents were consistently reported to the appropriate authorities. People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. There was a good staff presence at the home and staff were attentive to people’s needs. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. There were procedures and policies in place to protect people from the risk of infections and to ensure the home environment was kept clean.

Staff were aware of the importance of seeking consent from people when supporting them with their needs. Assessments of people’s care and support needs were carried out before they moved into the home. Most people told us they enjoyed the meals provided to them and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.

People had been consulted about their care and support needs. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People told us their privacy and dignity was respected. There were plenty of appropriate activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on.

The provider sought people and their relative’s views through residents and relative’s meetings and satisfaction surveys. The registered manager worked with other care providers and professional bodies to make improvements at the home. All of the staff we spoke with said they enjoyed working at the home and they received good support from the registered manager and deputy manager.

We previously carried out an unannounced comprehensive inspection of this service in November 2014. Breaches of legal requirements were found because records relating to people’s mental capacity were not always completed or clear, the procedures in place to ensure people received their medicines safely were not always appropriate and staff training was not up to date.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook a focused inspection in June 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

During this inspection we found the provider was meeting the regulations.

St Johns Nursing Home provides nursing and personal care for up to 58 people. At the time of our inspection there were 39 elderly people living in the home some of whom were living with dementia.

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

People told us they were felt safe from abuse. Care was planned and delivered to ensure people were protected against abuse and avoidable harm. There was a sufficient number of suitable staff to help keep people safe and meet their needs. Staff had been recruited using a thorough recruitment process which was consistently applied. Appropriate checks were carried out before staff were allowed to work with people.

People’s medicines were appropriately managed so they received them safely. Staff understood their responsibilities in relation to infection control. People were protected from the risk and spread of infection because staff followed the procedures in place. The home was clean and well maintained.

People were cared for by management and staff who had the necessary experience and knowledge to support them to have a good quality of life. Staff had received relevant training and were supported to obtain further qualifications relevant to their roles. Staff understood the relevant requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and how it applied to people in their care.

Staff enjoyed working with the people in their care. People were treated with respect, compassion and kindness. They were fully involved in making decisions about their care including what they ate and how they spent their time day-to-day. Where appropriate their relatives were also involved. The management and staff knew people well. They knew their routines and preferences and understood what was important to them. People were supported to express their views and give feedback on the care they received.

Staff knew what constituted a balanced diet. People were given a choice of nutritious meals and had enough to eat and drink. People received the help they needed to maintain good health and had access to a variety of healthcare professionals.

People were supported to maintain their independence and avoid social isolation. People were supported to participate in a variety of activities inside the home and attend organised trips outside the home. Relatives were made to feel welcome and were regularly consulted about how people were supported.

The registered manager had worked in adult social care for many years and understood what was necessary to provide quality care. The home was well organised and managed. People's records including their medical records were fully completed and up to date. There were a variety of systems in place to regularly check and monitor the quality of care people received.

One person said 'the home is marvellous, staff do everything to help and I am not afraid to ask.' A second person said they thought 'the staff are good.' A third person said it is a 'lovely place to live' and they were, 'happy in the home.' One relative said 'it is not five star accommodation, but the care is.'

The atmosphere was friendly and relaxed on the day of inspection. We saw people engaged in colouring pictures and they were supported by staff. We saw that hairdressing services were available on the day of inspection.

We observed that staff respected and involved people in their care. People received the care and support that met their needs. We saw that the home met people's nutritional needs. We observed that staff were properly trained and adequately supported. We saw that people were protected against the risk of unsafe equipment. The provider assessed and monitored the quality of care that people received.

People who use the service said "it's smashing", "I have the best view in the house", "the care is good but I get frustrated when staff don't understand me", 'the quality of care is fine' and 'its ok here".

Most people made positive comments about the food saying "good", "always two choices", "I choose to eat in my room" and "they give me the help I need" although we saw that people who needed their food pureed did not get a choice of meal.

Comments about staff included 'extremely nice', "kind, caring and wonderful", "staff who take care of you are cheerful', "staff are ok, some aren't but you get that everywhere', "they come when I call" and "staff give me the help I need and want".

Relatives we spoke with were happy with the care and support provided saying that they were kept informed of any changes and made to feel welcome when they visited. People we spoke with had not made a complaint but would speak to the manager or staff if they did. Relatives said people had plenty of opportunities for activities and outings.

Staff we spoke with said that there were enough staff to meet people's needs. We saw one floor where staff were busy and people could have had more to do, although some people had gone out for lunch which meant the activities staff were not available to help as they usually did.