Archived: Maple Court Nursing Home

Maple Court Nursing Home is a care home providing personal and nursing care to 42 people at the time of the inspection. The service can support up to 80 people in one adapted building, over two floors. At the time of the inspection there were two separate units, one on each floor, providing support to people with differing needs. Saunders unit was upstairs and predominantly supported people living with dementia or other mental health needs and Elizabeth unit was on the ground floor.

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

People felt safe at the service, however some people said there weren’t enough staff to meet their needs. Improvements had been made to the way people’s risks were managed and we saw people’s falls had reduced as a result of this.

There had been improvements to infection control practices though further improvements were required. People’s medicines were now managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, there were some inconsistencies in the way staff applied the Mental Capacity Act (2005).

People were treated with kindness and compassion; however, some people felt staff deployment impacted on their choice and control.

A new registered manager was in post since the last inspection and they had implemented new ways to manage and monitor the quality and safety of the service. These were working well but needed to be further embedded into practice and sustained.

Some staff did not feel well supported and involved in the service, but other staff told us they felt the registered manager had a positive impact on 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 this service was inadequate (published 6 February 2021) and there were multiple breaches of regulation. We took enforcement action and the provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made in most areas, though further improvements were required, and the provider was still in breach of some regulations.

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

Why we inspected

We carried out an unannounced inspection of this service on 2, 4 and 10 December 2020. Five 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 safe care and treatment, safeguarding, staffing, dignity, good governance and notifications to CQC.

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

A rating from a previous comprehensive inspection for the Responsive Key Question was used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Court 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 staffing 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 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.

Maple Court Nursing Home is a care home providing personal and nursing care to up to 80 people. At the time of the inspection there were 58 people living there. There are three separate units accommodating people with differing needs. The home supported younger and older people, some of the people were living with dementia and/or physical disabilities.

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

People did not always feel safe in the home. People were not always protected from the risk of cross infection. Risks to people’s health and well-being were not always adequately assessed and planned for. People were sometimes supported with moving and handling in an unsafe way. Lessons were not always learned when things went wrong. Medicines were not always managed safely. There were not always enough staff and staff did not always have the training and knowledge to support people effectively.

People had access to other health professionals, however advice was not always followed in a timely manner. People were being restricted and this had not always been taken into consideration. There was poor oversight in relation to applications to deprive people of their liberty.

People were not always well-treated. People sometimes had to wait for support and staff did not always know people well. People were not always listened to and not always treated with respect.

The provider had consistently failed to make improvements that were effective or sustained. Systems to monitor the safety and quality of care were ineffective and did not always identify areas for improvement. Incidents we should have been notified of were not always sent to us. Systems in place were not always effective at sharing important information.

The environment was adapted so it was suitable for the people living there. People were supported to have enough food and drink of their choice. Staff were recruited safely.

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 5 June 2019). The service has deteriorated to inadequate. This service has been rated less than good for the last three consecutive inspections. This will be the fourth consecutive time the provider has failed to achieve a good rating overall.

Why we inspected

We had concerns in relation to some safeguarding concerns that were being looked into and some complaints that were reported to us. As a result, we undertook a focused inspection to review the key questions of safe and well-led. Due to concerns we found during the inspection we expanded the inspection to also include the effective and caring key questions.

The ratings from the previous comprehensive inspection for the responsive key question was used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to inadequate overall. This is based on the findings at this inspection.

Enforcement

We have identified multiple breaches of regulation in relation to the safe care and treatment of people, safeguarding people from abuse, the monitoring and sustainability of quality and safety at this home, staff training, staffing levels and notifying the CQC of particular incidents.

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.

You can see what action we took at the back 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.

Special Measures

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.

About the service: Maple Court is a residential care home that was providing personal and nursing care to 53 people at the time of the inspection, some of whom were living with dementia.

People’s experience of using this service:

Decisions about people’s care and treatment had not always been made in line with law and guidance. Care records did not always reflect people’s individual needs and some gave inconsistent information.

People felt safe and staff knew how to identify and report concerns for people’s safety. People were supported by a caring and compassionate staff team. People were supported to maintain their independence and their dignity was valued and respected.

People’s wishes about how they wanted to be supported at the end of their lives had not always been recorded, which meant their values and beliefs may not be respected. Activities were available for people to take part in; however, people felt more could be done to help them participate in hobbies and interests. People and their relatives knew how to raise a concern about the service and were confident these would be addressed.

People, relatives and staff found the registered manager approachable. Although the quality audits completed had not always identified the shortfalls found at the inspection; the registered manager had an improvement plan designed to identify and improve the quality of service people received.

Rating at last inspection: 09 April 2018, Requires Improvement, with a breach of Regulation 12, Safe Care and Treatment. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we found a number of improvements had been made, however some were still required.

Why we inspected: This was a planned inspection based on the rating from our last inspection.

Enforcement: No enforcement action was required.

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

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

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to send us an action plan to show what they would do and by when to make improvements to meet the regulations.

At this inspection we found improvements had been made however there was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for safe care and treatment. The provider was meeting all other regulations.

Maple Court Nursing 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.

Maple Court Nursing Home accommodates up to 80 people in one adapted building. Care and support is provided over two floors and these floors are operated as two separate units. At the time of the inspection there were 50 people using the service.

There was a registered manager in post at the time 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.

People’s medicines were not consistently managed safely. We found two prescribed medicines that were out of stock, so people had not received these medicines. The provider had a system in place to check medicines daily and this had not identified the low stock.

People’s risks were not always suitably managed in order to keep them safe, though we saw improvements in the management of some people’s risks. Further work was required to ensure that these were consistent for all people who used the service.

Improvements had been made to staffing within the home but further improvements were required to ensure that people had access to the support they required in a timely manner.

People were protected from avoidable harm and abuse by staff who were trained to recognise signs of abuse and knew how to report their concerns. Most risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were kept clean and tidy. Staff had their suitability to work in a care setting checked before they began working with people.

Improvements had been made to the mealtime experience though one person received fluids with the incorrect amount of thickener that had been prescribed by a professional.

People told us they were happy with the care they received. However, we observed that staff did not always protect people’s privacy and dignity.

People told us they had choices however we observed that people were not consistently offered choices.

People had been involved in developing their own plans of care. However, not all people’s care plans had been reviewed and updated which meant that some people’s plans did not accurately reflect their needs and preferences.

The systems in place to check the safety and quality of the service were not consistently effective as they did not identify all the issues we found during the inspection.

People were supported by trained staff. Staff received regular supervision and had access to training. The environment was designed to support people effectively. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

People were supported to consent to their care when they were able and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

A range of activities were on offer and people were supported to participate in activities that they preferred.

Complaints were managed in line with the provider's policy.

A registered manager was in post and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback on the service. People, relatives and staff all felt that the management team were approachable and that there was a more positive atmosphere.

The provider had made improvements following the last inspection, however further work was required to ensure this was sustainable.

Maple Court Nursing Home is a care home providing accommodation, personal and nursing care for up to 80 people. The home was divided into two separate units. Elizabeth suite on the ground floor provides general nursing care and Saunders suite on the first floor provides nursing care for people who may be living with dementia or with more complex support needs. At the time of this inspection 72 people were using the service.

There was no 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 told us that a new manager had been recruited and they were undertaking an induction with the provider before commencing in post at Maple Court Nursing Home. An acting site manager was responsible for managing the home until the new manager was in post.

At our previous inspection on 27 July 2016 the home was rated ‘Good’. At this inspection we found that there were breaches of Regulations and the home was rated ‘Inadequate’. The service is therefore in ‘special measures’.

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

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

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.

Risks to people's safety, health and wellbeing were not always suitably assessed and managed and plans in place to manage risks were not always followed by staff.

There was not always enough suitably skilled staff deployed effectively to keep people safe or to meet their needs. Staff were not always trained to provide safe and effective care.

People were not always protected from the risks of avoidable harm and abuse because incidents of possible abuse were not always identified and reported to the local authority as required. Action was not always taken to protect people from further occurrences.

We found that medicines were not managed safely and people were at risk of not receiving their medicines as directed by the prescriber.

Systems in place to consistently assess and monitor risks to people and the quality of care provided were not operated effectively. This meant that issues with the safety and quality of the care were not reliably identified and rectified.

People did not consistently have choices about food and drinks and improvements were needed to ensure that people were supported in a timely manner at mealtimes.

People told us they had access to healthcare professionals when they required them. However we observed that staff did not seek medical attention for one person who was experiencing pain.

People were not always offered the reassurances they needed because staff did not have time to spend with them. People’s dignity was not always respected and promoted.

Some people told us they were happy with the care they received and that staff knew their care needs and preferences. However, we saw that some staff did not know people well and did not have time to read care plans so this meant there was a risk that people did not receive personalised care.

Some people had access to activities although others were not supported to engage in meaningful activity.

There was a complaints procedure in place and formal complaints were responded to in line with this procedure.

People who were able to make their own choices were supported to have maximum choice and control of their lives. When people were not able to make their own choices, staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We identified 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 the report.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. 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.

At this inspection we found improvements had been made to protecting and safeguarding people from abuse, people were provided with a more person centred care approach and suitably trained staff had been recruited. Sufficient improvements had been made in all areas of this service therefore this service is no longer in special measures. However the provider must now ensure the improvements are maintained. We will continue to review the service.

Maple Court Nursing Home provides support and care for up to 80 people, some of whom may be living with dementia. At the time of this inspection 63 people used the service. The service was divided into three separate units. Elizabeth suite (ground floor) provides general nursing care and support for up to 35 people. Saunders and Sycamore suites (first floor) provide support for up to 45 people with more complex nursing care and support needs.

The service had a registered manager. Since the inspection in February 2016 the service had a new registered manager. The registered manager was absent 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.

Staff were aware of the action they should take where they had concerns regarding the safety of people. Appropriate action was taken when allegations of abuse and concerns with people’s safety were identified. Sufficient staff were available to keep people safe and meet people's care needs in a timely manner.

Risks to people's health and wellbeing were identified, assessed and reviewed to ensure the actions needed to mitigate the risks were recorded and risks were minimised.

Staff were supported through training opportunities to require the knowledge and skills necessary to meet people’s individual care and support needs. The provider operated recruitment and vetting procedures that ensured appropriate people were employed. Staff received induction, training and supervision they needed to ensure they felt able to provide care and support to people.

People medicines were stored and administered safely by medication trained staff Topical medicine monitoring documents were completed at the time of the administration; checks were made daily to ensure medicines were administered as they were prescribed.

People told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. People considered to be nutritionally at risk had food and fluid charts to monitor their daily intake.

People had access to a range of health care professional and various agencies were contacted when additional support and help was required to ensure people’s health care needs were met.

Staff showed care and kindness towards people who used the service. Improvements had been made to ensure people's rights to privacy and dignity were upheld.

There was a range of daily activities arranged for people to enjoy. People were offered the choice of whether they wished to participate or not and staff respected their choices.

The provider had a complaints procedure and people knew how and who to complain to. All complaints were dealt with quickly and action taken to reduce the risk of recurrence.

Systems were in place to monitor the quality of the service had improved. Changes had been made to the internal management structure of the service, which provided clear leadership and guidance for staff to deliver an improved service for people.

Maple Court Nursing Home provides support and nursing care for up to 80 people, some of whom may be living with dementia. At the time of this inspection 73 people used the service. The service is divided into three separate units. Elizabeth suite (ground floor) provides general nursing care and support for up to 35 people. Saunders and Sycamore suites (first floor) provide support for up to 45 people with more complex care and support needs.

The service 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 were not always protected from the risk of abuse as people had been abused by other people who used the service. These incidents had not been identified as potential abuse; they were not reported or investigated.

Risks to people’s health and wellbeing were identified and reviewed, but lacked detail of the action needed to mitigate the risks. People’s management plans were not consistently followed.

There was insufficient suitable staff available to meet people’s individual needs. People experienced delays when staff were needed to provide them with the care and support they required.

The provider had a recruitment process in place. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. However there have been continuous concerns regarding the recruitment and retention of staff and the impact this had on providing safe and effective care to people who used the service.

People’s medicines were not always managed safely, and some people did not receive their medicines in a timely way. Not all medicine monitoring documents were completed accurately and at the time of the administration.

Staff did not always receive the training they needed to be able to support people in a safe way. This meant some people’s specialist needs were not met safely or effectively.

People generally told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Not all records for the purpose of monitoring people’s dietary needs had been fully completed to ensure people’s nutritional needs were fully met.

People had access to a range of health care professionals but the guidance from the professionals was not always consistently followed.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

Leisure and social activities were provided, but not all people got the support they needed to engage in meaningful activity when they needed to. People did not receive the right care at the right time.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask '

Is the service safe?

Some people cannot make decisions because of frailty or ill health. Professionals and some relatives were involved in making decisions to ensure they were in the person's best interests. Assessments were not always completed to determine the mental capacity of people who may find it difficult to make important decisions. We have asked the provider to tell us how they will make improvements.

The service placed people at risk because of unsafe handling of medication. People did not always receive their medicines as prescribed and intended. We have asked the provider to tell us how they are going to improve their service in relation to medication practices.

Is the service responsive?

We saw staff were allocated to work in the two units of the service. People who used the service and visitors told us the staff were very good at supporting them. However there were not enough staff and people reported delays when support was required. There was a reliance on agency staff to cover the shortfalls in the staffing levels. We have asked the provider to tell us how they will ensure staffing levels were sufficient to provide care and support to people in a timely way.

Is the service caring?

Most people who used the service told us that the staff were good and they were satisfied with the care and support provided. We saw that most staff were patient, understanding and kind in their interactions with people.

Visitors told us that they were satisfied with the care provided but they had to prompt staff with some aspects of their relative's personal care needs. We have asked the provider to tell us how they will make the required improvements to ensure individual care needs were met.

Is the service effective?

Care plans were not person centred, lacked meaningful information and some were not reviewed or updated on a regular basis or when a change was identified. We have asked the provider to tell us how they are going to improve the recording and reviewing of people's care needs.

Is the service well led?

The service had systems in place to review the quality and safety of the service. Some issues had been identified and solutions had been planned. We have asked the provider to tell us how they are going to improve the quality of the monitoring of the service.

Improvements were needed to ensure that records were accurately completed, maintained and provided the necessary information to meet the needs of people who used the service.

At the time of our inspection 74 people were living in the home. We spoke with staff, visitors and people who used the service that were able to tell us about their experiences.

One person who used the service told us: "I like it but it's not like being at home, but I have nothing to grumble about". Another person told us: "So far so good, the staff seem fine they are all friendly and the food is good".

A visitor told us of their satisfaction with the care and support provided to their relative. Another visitor told us that in one of the units: "People just sit in there (the lounge) not doing anything".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people. We spoke with staff about the care and support they provided. They gave a detailed account of the specific individual needs of people. We saw that staff treated people compassionately; offering discreet assistance to those who required it.

We saw that staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care.

We saw systems were in place for effective record keeping.

We spoke with staff about the care and support they provide each day, they offered an explanation of people's individual needs. We looked at a selection of care records to check the care being given to people. We saw some inconsistencies in the recording of people's care needs. The manager who acknowledged this stated that a new system of assessing and recording care needs was being introduced.

We spoke with staff about their understanding of safeguarding vulnerable adults, they told us what they would do if they had any suspicions of wrong doings. We saw records of safeguarding concerns that had been raised with the multi agency safeguarding team, this included the concern, the actions taken and the conclusions. Staff told us they had received training in safeguarding and that further training and updates were planned.

We saw staff present in all areas of the home, they were quick to offer help and support to people when it was needed. The manager confirmed that the staffing levels were currently sufficient to meet the needs of people who used the service.

We saw the service had an effective system for monitoring the quality of the service.