Philips Court

We found the following examples of good practice.

Staff were confident and knowledgeable about government guidance and what visitors were required to do prior to entering the service.

Professional visitors and relatives were tested for COVID-19 at the service or provided a negative lateral flow test result that was less than 72 hours old.

Staff wore appropriate PPE and could explain what PPE to wear and how to safely put on/remove their PPE. PPE was available throughout the home and there were designated PPE stations. Staff followed government guidance to keep people safe.

The management team had effective systems in place to check that safe infection prevention and control processes were being followed by staff. The home was clean and supported social distancing guidance.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 72 people using the service.

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

Since the last inspection the provider and registered manager had made significant improvements to the operation of the service. Staffing levels had increased and this enabled care to be delivered in a safe and timely manner on all the units in the service. Staff now had time to place people at the heart of the service.

The registered manager and staff demonstrably showed people were valued and respected. The activities coordinators provided a range of opportunities for people to engage in meaningful activities. They had secured lottery funding to run various projects, such as musicians running groups.

We found staff were committed to delivering a service which was person-centred. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Staff were making a difference to people’s wellbeing by working well as a team, and by sharing the same values and principles.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. People's health needs were thoroughly assessed via comprehensive profiles that had been put in place. External professionals were involved in individuals care when necessary.

Staff had received a wide range of training and checks were made on the ongoing competency of staff. Appropriate checks were completed prior to people being employed to work at the service.

The cook had received a range of training around meeting people's nutritional needs. Staff were encouraging people who were under-weight to eat fortified foods. A range of menu choices were available.

The registered manager had acted on concerns and complaints and had taken steps to resolve these matters. They actively promoted equality and diversity within the home. People’s voices were of paramount importance in the service.

The service was well run. The senior managers and registered manager carried out lots of checks to make sure that the service was effective. The registered manager constantly looked for ways to improve the service. They continually researched information about best practice and ensured staff practice remained at the forefront in introducing new guidance.

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

Rating at last inspection

Requires improvement (report published 10 April 2019).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

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.

People’s experience of using this service: Improvements had been made to the service following our last inspection in July 2018. The provider and acting manager had improved the way the risks of falls were managed, the maintenance of falls sensor equipment, the maintenance of the wheelchairs and the effectiveness of the audits.

The registered manager had left and a new manager had come into post the day before we inspected. In the four months the deputy manager was overseeing the service they had driven improvement and made positive changes. Systems for overseeing the service were far more effective. The changes had enabled staff to address issues noted at previous inspections. However, the changes made were not fully embedded and further time was required for the provider and manager to be assured that these were effective.

Staffing levels now met people's needs but the provider’s dependency tool did not assist staff to complete an accurate assessment of needs.

Staff stated they felt confident and able to raise safeguarding concerns. People discussed past concerns and at previous inspections we noted that concerns were not always sent to safeguarding teams. The new manager said they would check that concerns had been raised and where appropriate referrals had been sent.

Building works were being completed to improve the medication rooms and plans were in place to upgrade the kitchen. Medicine management was generally effective.

People and relatives in general felt the service had improved and was meeting their needs. Staff said they felt positive about how the service was being operated now and that staff morale had improved. They now felt able to contribute to the operation of the service.

Rating at last inspection: Requires Improvement (report published 13 September 2018).

Why we inspected: Philips Court has been rated as requires improvement since September 2017 and during this period we have inspected on three other occasions. We completed this focused inspection to review the service’s progress and see if they met the regulations. The service had improved in one of the two key questions that we reviewed.

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 CQC website at www.cqc.org.uk

In September 2017, the local authority commissioners raised concerns around the operation of the service. The provider agreed to not accept new placements and this was regularly reviewed by the local authority and on 12 July 2018 this ended.

We completed a comprehensive inspection on 14 September 2017 and found the provider was meeting the fundamental standards of relevant regulations. We rated Philip’s Court as ‘Requires improvement’ overall and in all five domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place.

Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.

On 30 January 2018 we completed a focused inspection to check that improvements were being made. We found that although some improvements had been made and they were now compliant with the regulation related to maintaining people’s privacy and dignity. The provider however, continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action plan they had previously sent stated they expected to be compliant with the regulations by the end of June 2018.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 63 people using the service.

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

At this inspection we found that action had been taken to resolve the issues found at the last inspection.

We found practices had improved but the staffing levels on the downstairs nursing unit often prevent these from being fully implemented.

On the downstairs nursing unit staff were expected to complete 15-minute observation for six people on this unit, as they were prone to falling. We observed practices on the unit and found for long periods of time staff were not visible. The 15-minute checks were not completed but the records were retrospectively filled in to suggest this had happened.

We found there were insufficient staff to ensure effective observations were completed and the quality assurance processes had not identified this issue.

Four door sensors were in place across the service. We found only one was working and this had a warning light on suggesting the battery was running out. Staff believed all were working and were unable to tell us who was responsible for fitting sensors or how these were checked.

We found that staff were being supported to complete training but the provider needed to ensure there were sufficient qualified first aiders to cover 24 hours every day. Staff had not completed falls prevention training or being taught how to use bed, floor and door sensors.

During our visits we found that the temperatures in the service exceeded 25°c. The registered manager informed us that the provider had authorised them to have air conditioning units fitted.

We observed the meal time experience and found on the first day that the meal-time was chaotic and it took two hours for everyone to have a meal. Also, staff adopted poor practices when handling food such as leaving food with people who needed support for over 20 minutes then putting it back in the food serving trolley to warm until staff were free to assist.

Staff knew the people they were supporting but the care records still did not always reflect this. Staff needed to ensure that care plans did not act as an assessment and detailed the interventions. When other professionals suggested monitoring the impact of interventions staff needed to make sure there was a process in place to do this.

Staff understood the principles of the Mental Capacity Act 2005. We discussed how decisions made for people in their ‘best interests’ and how assessments could be enhanced to cover practices, which were imposed and restrictive for people who didn’t have capacity to make decisions.

Since the last inspection it was noted that improvements had been made in relation to the overall cleanliness of the service. Additional cleaners had been employed. However, staff needed to ensure the food serving and cutlery trolleys were clean.

We found that the registered manager kept information about complaints that had been made but there were no records about the investigations or resolution. We also found no records to show they investigated incidents or what lessons were learnt. However, the deputy manager could readily discuss what action had been taken and accepted better records needed to be maintained.

We found that improvements had been made to the management of medicines. However, staff needed to ensure all appropriate action was taken when medicine was given and different administration methods.

We found that the registered manager completed a range of audits but these did not pick up issues we found. Although they analysed incidents and accidents this was not completed fully so did not explore issues such as the number of unwitnessed falls for people who were regularly checked.

We found that the provider’s quality assurance system did not proactively support people to complete a critical and thorough review of practices.

The service had experienced problems with ants but we found action had been taken to deal with this matter.

Staff were familiar with the safeguarding protocols in place to help keep people safe.

We noted that improvements were being made to the environment. An additional maintenance person had been employed.

Plans were in place to re-create a dementia-friendly environment following the recent refurbishment.

People spoke positively about the staff at the service and their attitude. We found that staff were kind and caring.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to staffing; and having good governance systems in place.

This is the second consecutive time the service has been rated Requires Improvement.

You can see what action we told the registered provider to take at the back of the full version of the report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

We last inspected the service on 14 September 2017 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Philip’s Court as ‘Requires improvement’ overall and in all five domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place.

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; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? and Is the service well led? to at least good.

In September 2017, the local authority commissioners raised a number of concerns around the operation of the service and the registered manager’s practices and since then the provider has had a range of regional staff working at the service. The provider agreed to a voluntary embargo on accepting new placements at the service whilst action was taken to improve the operation of the service.

This focused inspection was done in part to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 14 September 2017 had been made. We were also aware that local commissioners and healthcare professionals had raised further concerns following their recent visits.

We inspected the service against two of the five questions we ask about services: is the service well led, and is the service safe? This is because the service was not meeting some legal requirements in these areas.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. There were 62 people using the service when we visited.

The home has not had a registered manager since 28 June 2017. 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 recruited a person to be the registered manager who started working at the service at the end of August 2017. They have submitted an application with CQC to become the registered manager.

Staff knew the people they were supporting but the care records still did not reflect this knowledge. Also the records did not provide evidence that could be used to demonstrate to external parties why some people needed one-to-one support. The diaries that had been introduced for this purpose showed people were settled and did not record instances when people had been distressed. The care record documentation also did not provide evidence to demonstrate what people’s needs were, how staff needed to work with individuals and why they were using the service.

We noted that the home was changing from Well-pad back to Boots medication systems in the next few months. However, we found there were multiple issues with medication administration, including failures to ensure appropriate rotation of patches, difficulties with stock balances, failings to adhere to guidelines in relation to using covert medication, as required medicines and topical creams.

Although the manager had been completing audits these had not picked up issues, for instance the poor administration of medication, the variability in the quality of care records, minimalistic and uninformative care records being completed on some units and lack of reference to guidance and care plans provided by external healthcare professionals.

In discussions with the Consultant Psychiatrist for older people using facilities in Gateshead we established that the client group in Philips Court were the most complex and challenging in the whole area. We found that staff rated people as having high dependency levels where in comparison to other homes and it would have been expected that a number of individuals would have been rated as ‘extremely high’ dependency levels. Also the regional manager told us that the provider expected staff to rate everyone as having high dependency levels so they could provide 10% extra staff. However, it was not evident that this occurred as in the residential unit there were only two staff but it would have been expected that there would be more staff if everyone was rated as having 'high' dependency levels.

We found that more consideration needed to be given to staffing levels on the residential unit as we observed that for long periods of time one staff member would be looking after 11 people. Also we found staff providing activities were too stretched to provide support to each unit. We saw that the majority of the time people were asleep or watching television rather than have meaningful occupation to engage in. Also the current staffing levels provided insufficient staff to support people to go out into the local community.

We noted that improvements were being made to the environment, with a completion date for refurbishment scheduled for end March 2017. The issues identified on the health and safety audit in October 2017 had been addressed but the hazards within the internal courtyard and external fire routes had yet to be addressed.

The home was cleaner but the additional cleaner appointed no longer worked at the home and we saw the potential for domestic staff to be spread too thinly to keep on top of cleanliness’ in the service. We noted that the deep clean identified on the action plan from Oct 2017 had been undertaken.

We were pleased to find that frosting effect material had been used to cover the glass walls on the upstairs floor, as the clear glass had posed perceptual risks to people; allowed people’s dignity to be compromised and caused distress for some of the people. We also saw that the upstairs unit had been redecorated and all of the bathrooms/showers were now in working order.

We noted that the provider had ensured that additional resources were being put in place to support the manager to effect change. We saw that a critical review of the service had been completed and the practise improvement manager was reviewing the current action plan to determine what issues remained outstanding. Also, the regional manager had completed a robust review of the service and was aware of the issues we found so had started to take remedial action.

All of the staff and visitors we spoke with were positive about the steps the manager had taken and the improvements they were witnessing. They found their hands on approach very refreshing and felt they provided more support and enabled the nurses to undertake their clinical tasks.

People did speak positively about the staff at the service and their attitude. People and staff also told us that they found over the last 12 weeks improvements had been made to the service and they thought the manager was approachable. We found that staff were kind and caring and practices had improved. We found staff had benefitted from attending various courses and this had assisted them to work with people whose behaviour may challenge.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment; staffing; and having good governance systems in place.

The service was rated Requires Improvement at the last comprehensive inspection and this rating has not changed.

You can see what action we told the registered provider to take at the back of the full version of the report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

We last inspected the service on 2 February 2017 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Philip’s Court as ‘Good’ overall and good in all five domains. We carried out this inspection in response to concerns that local commissioners and healthcare professionals had raised following their visits. During our inspection on 14 September we identified shortfalls throughout the service and breaches of regulations.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. There were 70 people using the service when we visited.

The home has not had a registered manager since 28 June 2017. 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 recruited a person to be the registered manager who had started working at the service at the end of August 2017.

We identified a number of health and safety risks such as a fire exit being blocked with mattresses and a fire exit route leading towards an un-railed path that was adjacent to a steep slope. The new manager immediately ensured the fire exits and courtyard were cleared of hazards before we left. The provider took action to ensure the fire exit route had appropriate railings in place.

Although the domestic staff tried their best to keep the service clean there were insufficient staff to do the day-to day work. We also saw that the laundry staff needed more support or better cleaning products. The new manager immediately organised for the service to be deep cleaned and the provider ensured cleaning products were effective and additional domestic staff were employed.

We found staff were not always aware of who needed their food and fluid intake monitoring. Additionally staff needed to improve the accuracy of their recording when monitoring peoples' fluid intake. The manager had identified this gap in practice and was in the process of ensuring staff monitored people and supported them to receive adequate food and fluid.

We found from the review of records that some people displayed behaviours that challenge but staff had not received training to deal with their behaviours safely and the actions they needed to take were not detailed in the care records. During the inspection the manager contacted the provider’s training department and organised for staff to immediately receive ‘safe holding’ training.

Safeguarding and whistleblowing procedures were in place. We found that previously concerns and complaints had not always been dealt with in a meaningful manner and no process had been put in place to ensure the issues were not repeated. Staff had not always ensured concerns were reported to the manager as they only recorded the issues in the particular person’s daily records. The new manager had started to address this matter.

People’s care records were cumbersome and we found it difficult to get a sense of a person’s needs. The lack of a detailed written assessment had contributed to the difficulties around developing the care records as an effective working tool.

Accidents and incidents were monitored, but we found improvements were needed around how the information was analysed and used. We also found that medicines were not always administered safely. The new manager took immediate action to address these matters.

The environment on the upstairs nursing unit was not user friendly and this was compounded by the centre of the unit having glass walls that looked over the downstairs unit. This had led to people’s dignity being compromised and provided a stressful environment for people who lived with dementia. Following the inspection the provider confirmed that frosting had been put across the glass walls and they had brought forward their plan to complete a full refurbishment of this unit.

People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected but staff would benefit from more bespoke training around the completion of capacity assessments. Staff training and supervisions had not been kept up to date. We found that the manager and provider’s training and development team were dealing with this issue.

Effective recruitment and selection procedures were undertaken before staff began work to ensure people’s safety. However, the provider’s process for monitoring agency staff needed to be more robust. During the inspection the manager put in place additional steps to ensure check the suitability of all agency staff who worked at the service and ensure they were safe to work with vulnerable adults.

We found that the previous manager had not ensured regular audits were completed. Also they had not ensured that the staff adopted practices which showed they took ownership for their actions or worked as a team. We discussed this with the manager and following the inspection they confirmed that they had taken proactive steps to improve the way in which the service operated.

Staff spoke with people in a kind and caring manner, but we found staff needed to improve how they engaged with people receiving one-to-one support.

Following the inspection we wrote to the provider and asked them to put measures in place to address these issues. The provider supplied a detailed action plan, which detailed all the measures they were taking to improve the service.

Prior to the inspection the new manager had commenced a complete review of the service and was in the process of working through an action plan they had developed. We found that they had identified the same concerns that we found and were starting to address them.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We also found there were sufficient staff on duty. We found a range of activities were available on the ground floor that people could access from the other units.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place. You can see what action we told the registered provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Philips Court is a 75 bedded care home that provides personal and nursing care to older people including people who live with dementia. At the time of our inspection there were 73 people living at the home.

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.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Staff had developed good relationships with people and communicated in a kind and friendly manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had. There were no outstanding complaints in the service.

The service had a dementia friendly environment that was innovative and creative. The registered manager and her team ensured that people had a structured meaningful day and provided a variety of activities.

Philips Court was well-led by a registered manager and her team who had high expectations around standards of care at the service. A quality assurance system was in place that was utilised to improve the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Systems were in place for checking safety equipment and systems such as fire alarms, lifts and hot water temperatures.

Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe. Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

Staffing levels were in place to ensure all the needs of the people who lived at the service were met in a timely way and to ensure their safety. A member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and three people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well as individuals. Relatives we spoke with told us that the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One relative commented; "Yes I am aware and the plan is regularly reviewed and I sign it." Another person said; "Yes they (the staff) have discussed the care plans and I understand what is included." And; "We have had an initial meeting in the first four-six weeks. We have discussed things specific to Dad."

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people. One person said; "I like it here, I'm not saying I like it every day but 99% of the time I do." And a relative commented; "It's a lovely home and you are made to feel very welcome and I know he is getting well looked after ' I am pleased. Another person commented; "Yes they (staff) are very kind ' they know everyone, there is not a great turnover of staff, they know how to talk to everyone." Another person commented; "There are different personalities, some we feel more confident with ' some you warm towards, they (staff) are all very friendly and welcoming. Other comments included; "There are some lovely girls in here." And; "The staff are lovely; they are very nice people- it's nice that they are just not there for Dad, they are there for us."

Is the service responsive?

People's needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives. We saw a large day room had been created on the ground floor for the use of people during the day. The activities person used the room for running activities sessions which were attended by many people throughout the service. Activities included: arts and crafts, pet therapy, knitting club, quizzes, exercise, music, reminiscence, movie afternoons, religious services, pamper sessions and hairdressing. We spoke with some people who used the service who were also involved in gardening. We saw some animals such as guinea pigs, hens and rabbits were kept for the enjoyment of people who used the service. Staff we spoke with were very enthusiastic and the manager had a wealth of ideas to ensure activities were appropriate to help people with dementia remain engaged and stimulated. People were positive about the service and activities. One person commented; "There have been students in and they have made tactile mats. My mother does go down if there are any entertainers on, there are really good activities for people." Another said; "There is all sorts of things to do, we sing and dance and look at the papers. It's a very, very happy place as far as I am concerned." And; "There are lots of things in here, my father likes the animals outside, the staff try and get him engaged. They take him out he has been to the museum and the thrift shop. Another person said; "I get involved in the meetings about the hens. The hen power meetings."

Is the service well-led?

The home had a registered manager in post. She was aware of dementia research and guidance available from Salford, Bradford and Stirling University. There was an ethos of involvement and it was apparent the manager was passionate about keeping people with dementia involved and engaged in daily living for as long as possible, to improve their experiences. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. Staff had a good understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. People spoke highly of the manager. Comments from relatives included; "I feel that the manager has the resident's best interests at heart and is doing all sorts." And; "To be honest since the manager took over it's like a different world."

We found people had their needs assessed and the assessment was used to develop personalised care plans. People we spoke with said, 'Everybody is very nice', and, "They (staff) work hard from nine in the morning till late at night.' Family members said: 'There are lots of activities and staff try to involve as many people as possible and their family'; Staff know the residents very well and understand them; and, 'They (staff) go out of their way to help you.'

Staff and family members we spoke with said there were enough staff to meet people's needs. Family members commented: '(The) staff are very caring and committed, they are brilliant'; 'They (staff) have more time to sit and chat now. There is lots going on all of the time'; and, 'Staffing levels have never impacted on my wife's care. The staff are really good.'

People and their family members said they were happy with their care. Family members said: 'This is the best care home I have been to'; 'I have no concerns at all but I would contact the manager immediately if I needed to'; 'If I had any problems I would speak to the nurse'; and, 'I don't worry about mam.'

We found the provider had systems in place to ensure that people received their medication in a timely manner. Medication was only administered by trained and competent staff.

We found, since our last inspection, improvements had been to the environment. This included new carpets and furniture and re-decoration. Family members said: 'The place has been transformed'; 'The place is lovely, there is plenty of room'; and 'The home has been opened up.'

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, 'It's a lovely care home. The service is excellent. Staff are always checking we are ok, during the day and they check in on us during the night too. I feel well cared for."

We reviewed six care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

However we saw that care was provided in an environment that was not suitably designed and adequately maintained.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.