Archived: The Haven

The Haven is a residential care home providing accommodation and personal care for up to 12 older people in one adapted building. There were seven people using the service at the time of the inspection, some of whom were living with dementia.

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

The service had been without hot water since 15 January 2022, a period of five weeks, before it was restored. This meant people were unable to have a bath or shower, which increased the risk of skin damage and lessened the opportunity for relaxation from distressed behaviours. The lack of hot water compromised good infection control practice, such as effective handwashing. There was an increased risk of scalding, as staff were using a domestic kettle and then carrying the water to people’s handwash basins in their bedrooms.

Less visible areas of the home were not clean and additional cleaning to work safely during COVID-19 was not evidenced. This included the cleaning of high levels of contact touch points. Night staff completed some cleaning, but there was only one housekeeper who worked for five hours each day in the week. Other aspects of the environment did not enable effective cleaning. There was chipped paintwork on door frames, skirting boards and the tops of radiator covers.

Staffing arrangements at the service was fragile. Some staff had left and recruitment was a challenge. There was a high reliance on agency staff and permanent staff were working excessive amounts to help cover. The manager completed some shifts, which took them away from their management responsibilities. Records did not evidence robust recruitment procedures were being followed. There was a lack of information about the process or the applicant’s attributes, to enable a successful appointment.

Some aspects of the environment did not ensure safety. This included an open door to the sluice, which gave access to hazardous substances, and two fire doors to people’s bedrooms that were propped open. Other aspects of the environment needed maintenance. This included a radiator in a person’s bedroom which did not work, another radiator that had a broken cover and a tap on a hand washbasin in a bathroom which had been turned off. At the time of the inspection, there was no date for these items to be fixed.

Systems were not sufficiently robust to ensure people’s safety. Accidents, incidents and injuries people had sustained had not been properly investigated or reported. Records were incomplete or insufficiently detailed to evidence what had happened and the injuries sustained. There was no information about what action had been taken to minimise a re-occurrence or any learning moving forward.

Risk management was not effective. Risk assessments were not regularly reviewed, or updated following an accident or injury. Not all assessments were accurate, which did not ensure control measures in place were sufficient. Care records did not clearly demonstrate the assistance people received. This did not enable an accurate review of people’s needs or the care they received.

There had been some improvement to the way people’s medicines were managed. However further improvements were needed.

The service has a poor history of compliance, with a lack of oversight from the provider. There has been a lack of auditing, and shortfalls in the service have not been identified and addressed in a timely manner. There had not been any urgency to rectify problems such as restoring the hot water and previously, repairing the broken dishwasher and passenger lift. These shortfalls and the injuries sustained to people following an accident or injury were not reported to CQC or the local authority as required. People, their relatives or advocates were also not appropriately informed.

As a result of our inspection in November 2021 and December 2021, we issued two warning notices to ensure improvements were made to the service. One warning notice was in respect of regulation 15, which related to the premises and equipment. The second notice was in respect of regulation 17, good governance. We returned to the service in January 2022 to check compliance with the notice related to premises and equipment. We found this had not been met in full, and shortfalls remained. The compliance date for meeting the second notice is not yet due. However, we can inspect if we have new concerns about people’s health or safety.

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 25 February 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to a high level of bruising people had sustained and there not being any hot water in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Haven 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 the systems to protect people from the risk of abuse, risk management, infection prevention and control, and good governance including not reporting notifiable events.

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

Follow up

We will 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.

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.

The Haven is a residential care home providing accommodation and personal care for up to 12 older people in one adapted building. There were seven people using the service at the time of the inspection, some of whom were living with dementia.

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

Some action had been taken to make the environment more secure and safe for people, following concerns raised at our last inspection. However, other aspects had not been addressed and required further attention.

The measures taken to restrict access to the stairs to the second floor, were ineffective. This was because people could walk around or climb over the sofa, which had been positioned to restrict access. Locks had been fitted to the doors to rooms, which posed risks to people’s safety. This included the sluice and boiler room, but the locks had not been set so they were not in working order. There was an external fire door, which although alarmed, did not have a lock on the outside. This had not been addressed, which posed a security risk.

Other than a window on the second floor, restrictors had been fitted to identified windows, to stop them being opened in full. This minimised the risk of people falling from a height. The provider had not undertaken an assessment of all other windows, to ensure people’s safety. Mould had been removed from the walls in the laundry room. The cause of the leak had been attributed to blocked guttering outside. Redecoration was planned once the walls had dried out.

All toilets and bathrooms, except a shower, had been repaired and were in good working order. Bolts were fitted to the kitchen doors but these were not always used, to minimise risk, when staff were not in the vicinity. Cleaning substances had been moved from an unlocked cupboard to an outbuilding.

Water from hand wash basins in some areas of the home, was over 50 degrees. This increased the risk of scalding. The temperature of the water was being controlled by a thermostat on the boiler. This did not ensure a safe, consistent temperature of the water throughout the home at all times.

The home was experiencing staff shortages, and there was a reliance on agency staff. The same agency staff were employed to ensure consistency of care. Staff were also committed and doing extra shifts to cover any shortfalls.

People and staff were recovering from a COVID-19 outbreak, which affected each person in the home. Staff were wearing personal protective clothing and following the government’s guidance on testing. People and staff had been vaccinated. The home was now open to visitors, where specific procedures were followed. The layout and size of the home, however, did not enable social distancing to be easily adhered to.

Rating at last inspection and update

The last inspection of this service took place on 10 December 2021, but a rating was not awarded. The report was published on 27 January 2022. A previous inspection, which took place on 10 December 2021, rated the service requires improvement. The report was published on 28 January 2022. A warning notice was issued at both inspections to ensure the provider took action to address the shortfalls identified.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check 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 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. This included checking the provider was meeting COVID-19 vaccination requirements.

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.

The Haven is a care home registered to provide accommodation and personal care for up to 12 people aged 65 and over. At the time of the inspection 10 people were living at the service, in one adapted building.

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

People were not always supported to take the medicine they were prescribed. Staff did not always keep accurate records of medicines they supported people to take.

Risks to people were not always effectively assessed and managed. Action was not consistently taken following incidents to reduce the risk of a similar incident happening again. Systems to ensure the building was safe were not always implemented.

The provider did not have an infection prevention and control policy in place. Audits to check infection control procedures were being followed had not been completed.

The provider did not have effective systems in place to assess the quality of the service provided and make improvements where needed. The provider did not regularly visit the home to assess how it was operating. The manager had not completed some of the regular checks and audits that were needed for effective oversight of the service.

Staff demonstrated a good understanding of people’s individual needs and a commitment to provide person-centred care.

People and their relatives felt they received good care and praised the staff. People felt safe living at The Haven. Relatives felt the manager had started to make improvements to 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

The last rating for this service was good (published 6 February 2021).

Why we inspected

The inspection was prompted in part due to concerns received about management of the service. A decision was made for us to inspect and examine those risks. 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 monitor the service and 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, statutory notifications and management oversight and governance. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The Haven is a residential care home providing accommodation and personal care for up to 12 older people in one adapted building. There were seven people using the service at the time of the inspection, some of whom were living with dementia.

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

People were at risk of harm as the provider had failed to carry out timely maintenance in all areas. Some internal locks on doors were broken or not suitable for their purpose. This meant people were able to access areas of the home which were not safe such as the boiler room. People had access to chemicals as they were being stored in cupboards that were not locked. Not all windows on the first or second floors were secured with window restrictors.

We observed there was some equipment out of use and areas in need of repair. The passenger lift and dishwasher were out of action. The provider had sourced external contractors to fix the equipment but there was a delay with parts. Two bathrooms were out of action which limited access for people to use toilet and washing facilities. The bedrooms at the home were not en-suite which meant access to the communal bathrooms was important. The manager told us they were in the process of having the bathrooms fixed but there was a COVID-19 outbreak. External contractors were not able to access the home until the outbreak was clear.

Prior to our inspection, the provider had made a decision to reduce staffing numbers. We wrote to the provider to ask for an explanation. During our site visit we were told the provider had made a decision to increase the staffing numbers which meant we observed people were being supported by safe numbers of staff. However, we were not clear about how the provider was calculating safe staffing numbers.

During our inspection the home was experiencing a COVID-19 outbreak. The provider had been slow to implement safe cleaning regimes to ensure all areas of the home were thoroughly cleaned. We observed staff were wearing appropriate personal protective equipment (PPE) and in daily communication with local public health staff for advice and guidance.

Staff were following testing for COVID-19 as per the government guidance. Visitors were required to complete a Lateral Flow Test (LFT) prior to being able to enter the premises. They were also required to wear (PPE). All professionals were required to show evidence they had been vaccinated against COVID-19 before being able to enter the home.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published xx).

Why we inspected

We undertook this targeted inspection to check specific concerns we had about staffing numbers, failure to carry out timely maintenance and the impact of this for people. 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 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.

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 one breach of regulation in relation to premises and equipment at this inspection.

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

Follow up

We met with the provider following our site visit to discuss the improvement that was needed. We will work with the 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.

The Haven is a residential care home providing accommodation and personal care for up to 12 older people in one adapted building. There were nine people using the service at the time of the inspection, some of whom were living with dementia.

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

Relatives thought people were safe living at The Haven and said staff treated them well. People were supported to take any medicines they needed. There were enough staff to provide safe care for people. Staff had a good understanding of systems in place to keep people safe and were confident action would be taken if they reported any concerns.

The home was clean and the provider had taken additional infection prevention and control measures as a result of the COVID-19 pandemic. Relatives said they had observed staff following these new procedures, including wearing additional personal protective equipment and cleaning more frequently.

The service was well-led. The registered manager said they received good support from the provider and senior staff in the home. Relatives felt the management team had a good understanding of any issues in the home and led by example. The quality of the service was regularly assessed, and action taken to make improvements where needed. Concerns raised with the registered manager had been investigated.

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

Rating at last inspection

The last rating for this service was good (published 9 August 2018).

Why we inspected

We received concerns in relation to infection control procedure, management of risk and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Follow up

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

This inspection was unannounced and took place on 4 July 2018.

The Haven is a ‘care home’ for 12 older people. 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.

A registered manager was 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.

Risks were assessed and action plans were devised on minimising the risk. Individual risks to people included mobility needs and prevention of pressure ulceration and choking. However, risk assessment for the same identified risk were repeated and for some people the information was not consistent with each other.

Members of staff were knowledgeable on how risks were managed. Where people presented with behaviours that placed others at risk of harm the staff knew how to divert and distract people. The guidance was not detailed on how staff were to manage these levels of anxiety when people became frustrated. For example, how to distract and divert people. The registered manager made some risk assessments clearer during our inspections.

Mobility risk assessments were detailed on each movement and the equipment used. For one person the risk assessment should include the colour of the hoist. The registered manager added this information to the risk assessment.

Care plans were person centred and reflected people’s physical, emotional and leisure needs. However, some care plans had been repeated and the information was not always detailed or consistent with each other.

Some people we spoke with told us they made their own decisions in relation to their health and welfare. Staff knew how to support people with the day to day decisions. People’s mental capacity was assessed and best interest decision taken where they lacked capacity to make specific decisions. Care and treatment capacity assessment must include the specific decisions. For example, staying in bed for part of the week, thickeners, administration of medicines and photographs. We recommend the registered manager seek from a reputable source the guidance on the assessments that must carried out for complex decisions made on behalf of people that lack capacity.

The arrangements for medicines were mainly safe. The introduction of Topical Medication Records (TMR) ensured staff consistently record the applications of topical creams and ointments. The directions of thickeners (used when people were at risk of choking) needed to be detailed in care plans. This information was updated by the registered manager during the inspection.

Audits were used to assess the quality of care. Where shortfalls were identified action plans were devised. However, the medicine audit had not identified that staff were not consistently signing records to show they had applied creams. The registered manager said these Medication Administration Records (MAR) had not being audited for June 2018 and this would be identified in the next audit. Person centred care was identified in the audits and staff were to attend further training. However, records were not always accurate. We made recommendations for the registered manager finds out more about developing care plans and risk assessments to ensure staff have detailed guidance on meeting people’s needs.

The people we spoke with said they felt safe and the staff made them feel safe. The staff told us they had attended safeguarding training. They knew the types of abuse and what action they must take where there were concerns of abuse.

Incident and accidents reports were completed and analysed for patterns and trends.

Staff and professionals told us there had been improvements with staffing levels. Three staff were on duty during the day and two staff were awake in the premises at night.

Housekeeping staff were employed and schedules in place on maintaining the home clean and free from the spread of infection.

New staff had an induction to ensure they were confident to perform their role. Staff told us they had attended core training set by the provider as mandatory. One to one supervision ensured that staff were supported to maintain their skills and improving their performance.

People were supported with their ongoing healthcare needs. The staff organised routine visits with the GP and as needed for more urgent visits.

People knew who to approach with concerns. People told us the staff were caring and felt able to express their views about their care. They said the staff respected their rights. There were no complaints received since the last inspection. We observed staff engage and interact with people in a sensitive and kind manner. Relatives told us there had been improvements with staffing levels and with the environment.

At the last comprehensive inspection in November 2016, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and the environment was not safe. In addition, there were not always enough staff to meet people’s needs effectively and quality auditing systems were not identifying shortfalls in the service. We issued a notice telling the provider they must take action. As a result of the concerns we had identified, the service was rated as inadequate. The service was placed into ‘Special Measures’ and the provider placed a voluntary embargo on admissions to the home.

At this inspection, we found the provider had taken the immediate action necessary to ensure people were safe. Many improvements had been made but some work was still required for people to receive a consistently good service. As a result of our findings the service was removed from ‘Special Measures’. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Haven on our website at www.cqc.org.uk.

Work had been undertaken to make the internal and exterior of the premises safe. There were clear procedures in place to ensure a clean environment and safe hygiene practices. We observed staff followed safe infection control practices in the delivery of care and support.

Medicines were administered safely and people received their medicines on time.

A chef had been employed and there was a robust food hygiene regime in place. Food was freshly cooked and people told us the food was varied, ample in portion size and nutritious. We observed people were well supported with their nutrition and hydration needs.

Activities were taking place on a regular basis and the recruitment of a chef and housekeeper freed up care staff to spend more time with people and engage them in social interaction and activities. People and families told us the staff were caring, attentive and respectful towards them. We observed this was the case throughout the inspection.

We observed that staff were available when people required support and on many occasions were spending time socialising with people. People were not hurried and care was delivered at the person’s pace.

Staff training around the Mental Capacity Act 2005 had not been fully effective as not all staff were confident in their understanding of the Act or around how best interest decisions were made. Staff were receiving mandatory and specific training, however some refresher courses had fallen behind.

Staff told us they felt very well supported through supervision with their line manager and appraisals had been set up for the year ahead. Staff took part in meetings with other staff to share information, discuss good practice and the home’s development plan.

People told us they knew how to raise a complaint but had not needed to because the provider and the registered manager were approachable and would listen to any concerns they had. People and their families had been kept informed about the improvements to the home.

The provider had improved the number and quality of the audits in place, however further improvements were required to ensure there was an overview of audits.

The provider had not ensured that people were protected from risk as robust employment checks had not been completed.

The home was in a significant poor state of repair and people were placed at risk because of this. Due to concerns identified in the electrical systems at the home we asked the provider to seek immediate advice from a qualified electrician to ensure the safety of people.

We contacted the environmental health officer due to the concerns we found in the safe handling of food and the poor state of cleanliness and repair of the kitchen. The Environmental health officer visited and has downgraded the food hygiene rating for this service from a level five to two. Five being the highest rating and one being the lowest. The Environmental health officer has told the provider they have to make improvements. Staff had not received the appropriate training in relation to safe food hygiene practices and infection control was poor.

Prior to the inspection we were made aware of one person who had developed pressure ulceration (sometimes called pressure sores) as a result of equipment not working. The provider did not notify us of this. The local authority that is responsible for investigating safeguarding concerns, substantiated the safeguarding concerns raised.

There was not sufficient staff employed. Care staff had taken on additional roles such as cooking, cleaning, laundry. This impacted on the time that care staff had to spend with people either delivering care or providing meaningful activities. During the inspection the manager told us they had recently offered two people the position of cook and cleaner pending successful references.

Not all staff showed a caring approach to people. There was limited interaction and staff did not have the appropriate skills to support and engage with people who were not able to verbalise. Staff did not maintain people’s dignity and self-esteem.

When assisting people to eat, staff did not explain the food content or make conversation to enable a more pleasant experience. Some people were not supported to eat and drink sufficient amounts. People who were in the lounge during the day time were not offered drinks apart from set times. Medicines were not always administered safely.

Care plans were not person centred and were task focused. Records did not demonstrate a clear understanding of the Mental Capacity Act 2005. Not all people were properly assessed or monitored in terms of the risks to their safety and wellbeing.

Staff told us they received training however during the inspection staff did not demonstrate the necessary skills when communicating with people, infection control and the MCA 2005.

Staff had not received regular supervision with their line manager to discuss their performance or personal development. The manager told us they were in the process of implementing a new schedule of supervision dates. Staff told us they felt well supported by each other and the manager.

Quality assurance systems, governance and the audits in place had not identified shortfalls in the provision of the service and there was a lack of effective monitoring of the environment to ensure people were safe. There was no analysis of accidents and incidents to identify possible trends or triggers, to minimise further occurrences.

There was not a Registered Manager in post. The Registered manager had recently left the service and the deputy manager was “acting up” in the interim. Following the inspection the provider told us that the Deputy Manager had been promoted to the post of manager and would be submitting an application to be registered with us.

Due to the concerns identified at this inspection we wrote and subsequently met with the provider to express our concerns and, given the lack of investment in the environment and buildings, to seek assurances about the financial viability of the service. We are also working with the local authority to ensure the safety of people at the service.

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.

We saw that people's health and welfare needs were being met and the support they received was appropriate to their needs.

We found that people were being well treated and there were systems in place to protect them from possible abuse.

We found that staff received appropriate training and support to be able to meet the needs of people living in the home.

The home was clean, safe and well maintained and further improvements were being carried out.

We found that the quality of the service was being monitored and systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

People said they liked living in the home and their needs were met. One person told us the home was 'very nice' and a person who had recently been admitted told us 'what I've had here is very good'. We saw staff supported people with dementia and who were frail in an appropriate manner.

The home was clean and staff followed safe practice in infection control. The provider had plans in place to further improve facilities for infection control.

The provider was recruiting more staff, to ensure people had the numbers of staff they needed to meet their needs.

People said they liked the home environment. One person told us 'it looks nice'. The provider had an action plan to make improvements in the service, this involved consultation with people, their supporters and staff.