Pinhay House Residential Care Home

Pinhay House is a residential care home registered to provide personal care to up to 25 people aged 65 and over. There were 23 people living there when we visited, most of whom were living with dementia. The home is a grade II listed Victorian building, overlooking the sea, just outside Lyme Regis. Accommodation is over two floors with stair lift access to most, but not all rooms on the upper floor. Three bedrooms are double rooms for shared occupancy, with the rest single room accommodation.

In September 2019, we inspected the service where we identified eight breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, good governance, staffing and a failure to notify CQC of the absence of the registered manager. Following this inspection, the Care Quality Commission (CQC) took enforcement action by imposing a condition on the provider’s registration. This required the provider to provide CQC with a monthly report outlining actions and progress towards making the required improvements.

In August 2020, CQC carried out a further inspection where we reviewed the Safe and Well Led domains only. These were the areas where the highest risks were identified in our September 2019 inspection. We found improvements had been made in staffing, safeguarding and notifications. However, some care and treatment risks, related to choking and dehydration, were identified, which had not been identified or addressed by the provider’s quality monitoring systems. This meant the service remained in breach of safe care and treatment and good governance regulations. CQC asked the provider to continue to provide CQC with a monthly report outlining actions and progress towards making the required improvements.

This latest inspection was to follow up the remaining five breaches of regulations in safe care and treatment, consent, person centred care, dignity and respect and good governance. All five remaining breaches of regulations were met at this inspection.

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

People, relatives and staff all reported ongoing improvements since the last inspection. People said, “I couldn’t be better looked after.” Relatives said, “I am pleased with the home,” “I can’t fault them, I am kept informed” and “I don’t worry.” A staff member said, “People are safe here.”

People felt safe living at the service and relatives felt confident people were safely cared for. Further improvements had been made in managing people’s risks and care plans had detailed up to date information for staff on ways to reduce risks. The service had enough staff with the right skills to meet people’s needs.

Improvements in leadership and quality monitoring systems had continued, with evidence of improvement actions taken in response to risks, concerns and audits. The provider sent monthly reports to CQC, so we could monitor progress.

Staff knew people well and people's care was more personalised. However, we found some aspects of people’s care was based around routines. For example, getting certain people up and downstairs and carrying out regular day and night checks. The provider and registered manager have since confirmed they have reviewed this, to ensure they meet people’s individual needs and preferences.

People received effective care and were treated with dignity and respect. Staff skills and communication had improved through further training in dignity and respect and person-centred care.

Staff helped people keep in touch with their friends and relatives throughout the pandemic, which helped alleviate their worries. Limited indoor visiting had resumed with the appropriate testing and safeguards in place to prevent cross infection. There was a comfortable visiting area in the garden where people could see visitors in a safe way.

People's care plans were up to date and regularly reviewed, although daily records remained task focused. The provider had plans to replace the paper care record system with an electronic care record and was currently researching more person-centred options.

The home was clean. Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.

Where people lacked capacity, improvements in seeking people’s consent and in documenting best interest decisions had been made. 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.

Some improvements to environment had been made but planned worked to improve disabled access to shower/bathroom facilities had been delayed due to the COVID 19 pandemic but was planned for September 2021. Further improvements in letter/symbol signage were still needed to help people find their way around the home more easily.

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

Rating at last inspection

The last rating for this service was Requires Improvement (report published 4 August 2020) with two ongoing breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. We followed up two ongoing breaches of Safe care and treatment and good governance found at the previous focused inspection. We also followed up three previous breaches of regulations Person centred care, Dignity and respect and Consent found at the September 2019 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 Pinhay House Residential Care Home 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.

Pinhay House is a residential care home registered to provide personal care to up to 25 people aged 65 and over. There were 21 people living there, when we visited, most of whom were living with dementia. The home is a grade II listed Victorian building, overlooking the sea, just outside Lyme Regis. Accommodation is over two floors with stair lift access to most, but not all rooms on the upper floor. Three bedrooms are double rooms for shared occupancy, with the rest single room accommodation.

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

People, relatives and staff all reported improvements since the last inspection. Comments included, “Things had gone downhill, now they are on the up, definitely improved”, “We all feel that we can approach them (management) with our concerns which are usually sorted quickly.” Staff said, “We are moving in the right direction, but care still needs to be more person centred.”

People’s risk assessments and care plans provided more detailed and up to date information for staff about how to safely care for each person. However, we identified a new risk in relation to a person with a swallowing difficulty/choking risk, which we asked the provider to take further steps to address.

Improvements had been made in quality monitoring systems. Further improvements were still needed, as provider audits had not identified nor fully addressed known risks. For example, related to increased risks of dehydration due to inconsistent record keeping for people reluctant to drink.

People were better protected from potential abuse and avoidable harm through neglectful care. Staff had undergone additional training to meet their needs. We found improvements in people’s skin care, in moving and handling practice and in managing people at risk of poor nutrition. Staff had a good understanding of signs of abuse and felt confident any safeguarding concerns reported were listened and responded to.

Staffing levels had improved and staff sickness levels had fallen. A long term vacancy on the night shift had been filled. Staff were working extra hours and the service no longer needed agency staff, so people received care from staff who knew them.

The provider was more proactive in identifying and tackling risks relating to people’s health, welfare and safety. Previously lapsed quality monitoring systems such as weekly weights, care audits and monitoring of accidents/incidents had been reinstated. Areas for improvement highlighted by audits led to further staff training.

People’s care plans and risk assessments were more detailed, personalised and up to date about their care needs and any risks. We have made a recommendation about improving monthly care plan reviews to evaluate what was working well and to capture any recent changes.

Staff felt better supported and reported improved communication, team working and improved staff morale. Where mistakes were made, staff were supported to learn lessons and improve practice through further training and support.

The service was clean and free from odours. Staff were wearing face masks and following Covid 19 government guidance to minimise risks to people. Systems were in place to ensure equipment was safe and in good working order.

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 Inadequate. (report published January 2020). This service has been in Special Measures since September 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve . Since then the provider has sent monthly reports on their progress.

During this inspection the provider demonstrated that 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

At the end of May, a visiting health professional made us aware of some concerns about moving and handling practice, support for people with eating and drinking and about some poor staff interactions with people. Shortly afterwards, The Care Quality Commission (CQC) received two anonymous concerns which included similar themes and reflected areas of concern we highlighted at the previous inspection .

A decision was made for us to inspect and examine those risks and follow up what improvements had been made since we last visited the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Effective, caring and Responsive e Key Questions were not looked at on this occasion.

We found evidence the provider has made a number of improvements. Two ongoing breaches in relation to people’s safe care and treatment and quality monitoring systems were identified. These related to a safety risk relating to a person with swallowing difficulties. Where areas for improvement had been identified, for example, in relation to dehydration risks, further improvements were still needed to minimise the risk of harm and improve people’s quality of care people receive. 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.

Follow up: 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. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

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

Pinhay House is a residential care home registered to provided personal care to up to 25 people aged 65 and over. There were 21 people living there, when we visited, most of whom were living with dementia. The home is a grade II listed Victorian building, overlooking the sea, just outside Lyme Regis. Accommodation is over two floors with stair lift access to most, but not all rooms on the upper floor. Three bedrooms are double rooms for shared occupancy, with the rest single room accommodation.

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

Although people said they felt safe, people's care and treatment needs were not always managed safely. We identified concerns about out of date risk assessments, prevention of pressure ulcers, nutritional risks and poor moving and handling practice. Further improvements were also needed in medicines management and in accident and incident reporting systems.

Following a period of sickness absence by the registered manager, the provider's quality monitoring systems had lapsed. This meant they had not been used to monitor the quality and safety of the service people received or identify improvements needed. Safety and quality issues identified had not been recognised or responded to in a timely way. This caused harm to some people and increased the risk of harm for others.

People were not protected from abuse and improper treatment because systems and processes designed to monitor people’s safe care and treatment were not effective. This exposed people to harm and increased risk of harm from neglectful care. Three safeguarding concerns were identified during the period of inspection. These related to concerns about circumstances of a person’s fall, delays in recognising and report skin deterioration to professionals leading to a person developing a pressure ulcer. Also, neglectful care by staff failing to complete people’s weekly/monthly weights since June/July 2019 resulting in delays in recognising and responding to significant weight loss.

There was a high turnover of staff. Staff vacancies and short-term sickness were affecting recommended staffing levels and there was high use of agency staff. Improvements in staff training and practice were needed to ensure all staff adhered to best practice guidelines published by the National Institute for Health and Care Excellence (NICE).

People and families praised a number of staff who had developed positive and friendly relationships with people. However, we also identified issues about attitude and approach of some staff in treating people with dignity and respect.

The implementation of person-centred electronic records started nine months ago had not been completed successfully. Paper care records were out of date about people’s care and treatment needs and any risks. This meant care records lacked up to date information to guide staff about how to meet people's individual needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity, improvements were needed in consistently assessing people's mental capacity and in documenting best interest decisions, and capturing involvement of representatives, families and professionals in those decisions.

People did not always receive person centred care that met their individual needs or preferences. People, relatives and staff all identified activities as an area for improvement. People were not consistently offered opportunities to take part in regular activities and there wasn't enough to occupy them. Activities were dependent on staffing levels and the availability of an activity co-ordinator. Some people were bored and wanted to go outside more but couldn’t as they needed staff support to do so. Where they were provided, activities did not always take into account the individual needs of people living with dementia.

Systems were in place to ensure equipment was safe and in good working order. The premises were clean and free from odours. Some parts of the environment required redecoration and refreshment to ensure it was homely. We have made a recommendation that improvements were needed in providing people with disabled access to shower, bath and toilet facilities.

People and families were concerned about staff turnover but were happy with the care and the leadership of the service. Families were made welcome and could visit anytime. They praised the quality and variety of the meals provided.

Following our feedback, the provider voluntarily agreed not to admit people until further improvements are made. District nurses and other social care professionals and the local authority quality team were supporting the service to make the required improvements.

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

Rating at last inspection: Good (Report published March 2016). At this inspection the rating has deteriorated to Inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Enforcement

We identified eight breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, good governance, staffing and a failure to notify CQC of the absence of the registered manager. Please see the action we have told the provider to take at the end of this report.

Following the inspection, the Care Quality Commission (CQC) took enforcement action by imposing a condition on the providers registration. This required the provider to provide CQC with a monthly report outlining actions and progress towards making the required improvements.

Follow up

We met with the provider on 23 October 2019 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.

On 5 May 2016 two breaches of regulations were found in relation to serious concerns about people’s safety and more minor concerns in relation to consent. Following this inspection the service made safety improvements to the environment and worked closely with local health and social care professionals and with the local authority quality monitoring team. We last inspected the service on 29 June 2016 to check if the required improvements had been made, which they had been with evidence of further improvements being made.

The service has 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.

Staff demonstrated a high awareness of each person's safety and how to minimise risks for people. Personalised risk assessments balanced risks with minimising restrictions to people's freedom. Accidents and incidents were reported and included measures to continually improve practice and reduce the risks of recurrence.

Staff developed positive, kind, and compassionate relationships with people. People appeared happy and content in their surroundings and were relaxed and comfortable with staff that were attuned to their needs. There were lots of smiles, good humour, fun and gestures of affection. People's care was individualised, staff knew people well, treated them with dignity and respect, and were discreet when supporting people with personal care. The service had enough staff to support people's care flexibly around their wishes and preferences

Staff understood the signs of abuse and knew how to report concerns, including to external agencies. They completed safeguarding training and had regular updates.

People experienced effective care and support that promoted their health and wellbeing. Staff had the knowledge and skills needed to carry out their role. Each person had a comprehensive assessment of their health and care needs and care plans had instructions for staff about how to meet those needs. Staff worked closely with local healthcare professionals such as the GP, community nurses and mental health team to improve people's health. People had access to healthcare services for ongoing healthcare support. Staff recognised when a person's health deteriorated and sought medical advice promptly when they were feeling unwell. Health professionals said staff were proactive, sought their advice and implemented it. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely.

People praised the quality of food and were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet, make healthy eating choices and to exercise and maintain their mobility.

People and relatives were happy with the service provided at Pinhay House. The culture of the home was open, friendly and welcoming. Care was holistic and person centred, staff knew about each person, their lives before they came to live at the home. They understood people's needs well and cared for them as individuals.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and involved person, family members and other professionals in 'best interest' decision making.

People pursued a range of hobbies, activities and individual interests. For example, reading, arts and crafts and organised quizzes and games such as Bingo and Scrabble. Where people chose to remain in their rooms, volunteers and staff spent time with them to chat and keep them company.

People received a good standard of care because the staff team were led by the provider and registered manager who set high expectations of standards of care expected. There was a clear management structure in place, staff understood their roles and responsibilities, and felt valued for their contribution. Staff were motivated and committed to ensuring each person had a good quality of life. The provider used a range of quality monitoring systems such as audits of care records, health and safety and medicines management and made continuous improvements in response to their findings.

This inspection was to follow up if the required improvements had been made following our last inspection on 5 May 2016. At that inspection we found two breaches of regulations related to people’s safety and to consent. People were at increased risk due to a lack of detail in care records about risks, staff not following instructions. Also related to environmental risks relating to a new keypad system staff were unfamiliar with and hazards for people within the grounds.

At our previous inspection in 2015, we had also identified a breach of regulations relating to people’s safety, although these risks have since been addressed. Following the most recent inspection, the Care Quality Commission (CQC) took enforcement action by serving a warning notice, which required the provider to take further urgent actions to comply with the regulations by 20 June 2016.

Since then, the provider and registered manager contacted relatives to make them aware of the accidents which had occurred at the home, in accordance with the Duty of Candour regulations. They also made people and relatives aware of the findings of the CQC inspection and displayed a copy of the inspection report in the main entrance and on their website. A relative we spoke with confirmed senior staff had been “very open” about the problems found at the home during the last inspection. At this visit, we concluded risks for people had significantly reduced because safety improvements had been made, and the provider has complied with the regulations.

This report only covers our findings in relation to these topics. You can read the report from the last

comprehensive inspection by selecting the 'all reports' link for Pinhay House on our website at

www.cqc.org.uk

The service had a registered manager who registered with the Care Quality Commission on 25 May 2015. 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 safer because risks were being managed to reduce the risk of avoidable harm. People’s individual assessments had been reviewed and updated, staff had more detailed instructions about how to minimise risks for each person as much as possible. Staff knew about people’s individual risks, and were consistently following the staff guidance in people’s care records. Environmental risks had been reduced because a programme of works had been undertaken which had improved safety with the home and the grounds. Staff had been trained to use new security equipment installed at the home.

In response to the safeguarding alert we raised with the local authority safeguarding team about increased risks for some people living at the home, two local authority representatives visited the home on 12 June 2016. This was to monitor progress and review people’s safety, and they reported positively on improvements underway at the home.

Since our last inspection, all staff had completed update training on safeguarding vulnerable adults and on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood their responsibilities to safeguard vulnerable people from abuse. The provider had arranged for individual supervision meetings with each member of staff. They reiterated to staff their expectations of their role and emphasised the need for increased vigilance of people’s safety around the home.

A trainer had also undertaken practice observation to check staff were consistently implementing the improvements in practice and to identify any further measures needed to improve people’s safety at the home. The provider and registered manager carried out several unannounced visits during the night and at the weekend. This was to monitor that safety improvements were being maintained, and to provide support and encouragement to staff to raise any concerns or difficulties experienced, so they could be resolved.

People were supported by enough staff so they received more support and supervision around the home. Staffing levels had been reviewed and staffing levels increased, with rotas changed to provide people with more support during busy periods. The provider had introduced regular documented welfare checks for people, during the day and at night, to monitor people’s safety and their whereabouts at regular intervals. Accidents and incidents were proactively monitored to identify and address any themes or trends, and the number of accidents and incidents had significantly reduced.

People’s personal evacuation plans had been updated to show how staff could best assist each person to evacuate the building in the event of a fire. A programme of upgrading and replacing fire doors to meet the latest fire regulations was ongoing. A recent fire drill, undertaken by a designated fire warden at the home, showed a slow staff response time in implementing the fire procedures. They recommended the drill was repeated within a month, however, this had not yet been carried out. We followed this up with the provider who said they would arrange another fire drill in the near future.

Environmental risk assessments had been updated and a programme of work undertaken at the home to improve the environment of care for people and further reduce risks. All staff had been trained on how to use the new security key pad system fitted and knew what immediate steps they needed to take if the alarm was triggered. A key pad had been fitted to the cellar door to prevent any unauthorised access to the cellar, and another fitted to the staff office, which had a rear door to the outside. Three gates and fencing had been fitted around the outside of the property. This included a gate where a path in the grounds led to the cliff path, which prevented people being able to access the cliff path if they wandered in that direction whilst out in the garden.

Staff understood the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and how these applied to their practice. Improvements had also been made to consent procedures to protect people’s legal rights where they lacked capacity.

On 7 and 12 May 2015 we carried out an unannounced comprehensive inspection, where we judged the service to be overall good, but which required improvement in the safe domain. This was because we identified a number of risks related to the premises, in relation to a leaking boiler flue and because the home did not meet current fire regulations. Also, because we witnessed some unsafe moving and handling practices and a lack of detailed moving and handling care plans to instruct staff about how to move people safely. The provider sent us an action plan outlining work planned to meet the people’s safety needs and to comply with statutory requirements, which they said would be completed by the end of August 2015.

On 5 May 2016 we carried out a focused inspection to check on the safety and welfare of people living at the home. This was in response to notifications we received about two serious incidents which occurred at the home over the early May bank holiday weekend. In separate incidents, two people left the home unaccompanied and wandered onto a nearby cliff path, one of whom fell and was seriously injured. The other person was found unhurt and was returned to the home. Over the previous two months, the registered manager had also notified us about two other serious incidents, in which two people had fallen at the home and sustained broken bones.

This report only covers our findings in relation to these topics. You can read the report from the last comprehensive inspection by selecting the 'all reports' link for Pinhay House on our website at www.cqc.org.uk

The service had a registered manager who registered with the Care Quality Commission on 25 May 2015. 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.

When we arrived at the home on 5 May 2016, a further two people had fallen in their bedrooms overnight. One person had been taken to hospital and the second person had sustained facial bruising.

Staff were aware of signs of abuse and knew how to report concerns about suspected abuse, and any concerns reported were investigated. However, people were at increased risk of avoidable harm at Pinhay House because of the lack of clear risk management procedures. There were a high number of unwitnessed falls, with insufficient actions being taken in response to further reduce risks for people. People’s individual risk assessments and care records lacked detail about the level of supervision they needed. Risks for individuals were not effectively communicated within the staff team which led to inconsistent care and safety practices. Some environmental risks had not been identified and others had not been reduced to an acceptable level in a timely way.

Staff offered people choices and supported them with their day to day preferences. However, where people lacked capacity, their legal rights were not fully protected because staff were not acting in accordance with the requirements of the Mental Capacity Act (MCA) 2005. Where people lacked capacity, relatives and health and social care professionals were not consulted and involved in decision making in people’s 'best interest’. This meant people’s legal and human rights were not fully protected.

On 6 May 2016, the day after the inspection, we contacted the provider to request them to take further urgent steps that day to address some of the ongoing safety risks we identified for people at the home. Later that day they contacted us to advise us of additional measures they were taking to improve safety at the home. This included a temporary increase in staffing levels at the home day and night to protect people and the introduction of regular documented checks of the whereabouts of people. The provider also brought forward urgent works needed to protect people such as arranging for a gate to be installed to prevent people being able to access the cliff path.

We also raised a safeguarding alert to the local authority safeguarding team about the care of eight people we identified were most at risk at the home. We are working in partnership with the provider, registered manager and other agencies to protect people from further avoidable harm.

People were supported by enough staff so they could receive care at a time convenient for them. Although there were some vacancies at the home, existing staff worked extra shifts to cover any gaps in the rota. This meant people had continuity of care from staff they were familiar with who knew about their needs. A robust recruitment process was in place to make sure people were cared for by suitable staff. We followed up the safety concerns we had raised previously about risks at the home and found these had been addressed.

We identified two breaches of regulation at this inspection. We identified two breaches of regulations at this inspection. You can see what action we told the provider

to take at the back of the full version of the report.

The home had recently been through a change of management; the new manager had been in post since August 2013 and was applying to become the registered manager. All the staff told us it had been a time of change but that it was a happy place and they understood where the home was going. The manager sent us an action plan following the inspection telling us what they had already done, and what they were going to do to make improvements.

People told us they were well looked after. We saw that people who could not talk with us appeared relaxed and happy. People appeared well cared for and most people were engaged in varied activities. One person told us, "They look after us well. I like it here." Another person told us, "The staff are very good, they work very hard', and another person told us, 'There is always something to do.' We spoke with nine members of staff, the manager and one of the owners during the course of the inspection. One member of staff told us, "I think care is good. There is a real emphasis on activities.'

We saw that systems for keeping the home clean were not consistent throughout the home. Some areas were very clean and other areas had been missed until we highlighted them to the manager, or housekeeping staff.

We found that there were processes in place to ensure people had the medication that was prescribed to them. The medicines were stored and administered safely.

The provider operated an effective recruitment procedure in order to ensure the people they employed were of good character, suitably qualified, skilled and experienced. People who used the service told us they liked the staff and found them kind and helpful.

There were enough qualified, skilled and experienced staff to meet people's needs. However, the staff were not receiving appropriate supervision and training to ensure they were supported to carry out care in an appropriate and safe manner.

People's care records were not accurate and lacked sufficient detail to advise staff how to meet people's needs effectively. We saw evidence that some aspects of people's needs had been recorded, but we found gaps in seven care records.