Archived: Palace House Care Home

Palace House Care Home is a residential care home providing personal and nursing care to 33 people. At the time of the inspection, there were 33 people living in the home.

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

People felt safe. They said staff were kind and helpful and they were treated well. People and their relatives were happy with the service they received. Staff understood how to protect people from abuse and recruitment processes ensured new staff were suitable. There were enough staff to meet people's needs and to ensure their safety, although people’s views varied on this. People’s medicines were managed safely. People received their medicines when they needed from staff who had been trained and had their competency checked. We discussed areas for improvement such as ensuring opening dates were recorded to all boxed and bottled medicines. Any risks to people’s safety and well-being were assessed and recorded; clear guidance was provided for staff and any changes in people's health and well-being were referred to healthcare professionals as appropriate. Infection control was well managed, and the home was clean, maintained and free from odours. We discussed areas for improvement such as the lift flooring and walls and doorways in need of attention. However, there was a development plan available to support improvements.

People, their relatives, visitors to the home and staff told us the service was managed well. Staff enjoyed working at the home. The home worked in partnership with other organisations to provide safe, effective and consistent care. People were treated as individuals and their diversity was respected. People's care was tailored to their needs and preferences and staff knew people well. There were effective systems to assess and monitor the quality of the service and the practice of staff. People's views and opinions of the service were sought and acted on. The registered manager promoted an open culture in relation to accidents and incidents. There was clear evidence of changes to practice and lessons learned from any incidents.

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 11 September 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident and concerns in relation to failure to seek prompt medical advice. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. We found lessons had been learned and measures had been put in place to improve the service provided.

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.

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 remains good. This is based on the findings at this inspection.

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

We found the following examples of good practice.

Personal protective equipment (PPE) stations and hand sanitiser were available throughout the home. There were enough stocks of PPE. Staff were able to don and doff their PPE safely and had received training in the use of PPE, infection control and hand hygiene. We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use. The correct use of PPE was regularly monitored by the registered manager. Clear signage was displayed to remind staff, visitors and people about the use of PPE, the importance of washing hands and the regular use of hand sanitisers.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included vaccination and regular testing of staff and people living in the home and testing of visitors to the home. There were enough staff available to provide people with safe and effective care and support and to provide continuity of support should there be a staff shortage.

There was a good standard of cleanliness in all areas of the home. Enhanced cleaning schedules, designated housekeeping staff and adequate ventilation were in place. The atmosphere of the home was calm, and people looked happy and content.

We observed visiting was taking place in a secure and safe visiting pod; we noted guidance was followed to ensure people’s safety. The registered manager and staff were preparing to allow designated visitors into the home in line with the new guidance. Policies and procedures were in place to support this. People had been supported to maintain contact with their relatives in different ways including the use of social media, face time and telephone calls; this assisted in promoting people's emotional wellbeing. Guidance was followed to ensure people were safely admitted to the home during the pandemic.

The provider’s infection prevention and control policies and procedures were up to date and audits had been carried out on a regular basis. The provider also had a business contingency plan and had developed guidance and risk assessments in relation to the current pandemic.

Palace House Care Home provides accommodation and care and support for up to 33 people. The service also provides nursing care. There were 30 people living in the home at the time of the inspection.

Palace House Care Home is an extended detached older property which has retained many original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking is available to the rear of the house.

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

People were happy about the care and support they received and with the way the home was managed. They made positive comments about the registered manager and staff. People's views about the quality of care provided were used to make improvements to the service. The quality of the service was monitored, and appropriate action was taken to improve the service when needed. Lessons had been learned and shared with staff when things went wrong.

People felt safe and described staff as kind, friendly and caring. Staff understood how to protect people from abuse. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. Staff received induction training and ongoing training, supervision and support. They felt valued and supported and enjoyed working at the home. They told us the home had improved since the last inspection.

Recruitment processes ensured new staff were suitable to work in the home and there were enough numbers of staff to meet people's needs and ensure their safety. People had no concerns about the care they received. People received their medicines when they needed them from staff who had been trained and had their competency checked. The registered manager was making improvements to some aspects of the management of people’s medicines and was currently being supported by the local authority medicines management team.

People's care needs were assessed prior to them living in the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people with dignity, respect care and kindness and knew people well. We observed positive, caring and warm interactions between staff and people. Staff spoke with people in a friendly and patient manner and we overheard friendly banter. Staff knew about people's routines and preferences and people told us they received the care they needed and wanted. Each person had a care plan that detailed their care and support needs; improvements were being made to the records. People or their relatives, where appropriate, had been consulted about care needs.

People enjoyed the meals and were offered choices. They were supported to eat a nutritionally balanced diet and had access to various healthcare professionals, when needed. People enjoyed activities and entertainments. Links with local community groups were being further developed to enhance people's lives. People were supported to maintain contact with their friends and family and friendships had developed within the service. People could raise any complaints or concerns if they needed to and they knew who to speak with.

People were happy with their bedrooms and with the communal areas. Communal areas were comfortable, clean and bright. Bathrooms were appropriately adapted and there was access to outside seating areas. An improvement plan had been developed to ensure ongoing refurbishment and redecoration.

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 27 November 2018). There was a breach of regulation12 in relation to medicines management. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Palace House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Palace House Care Home provides accommodation and care and support for up to 33 people. The service provides nursing care. There were 30 people living in the home at the time of the inspection.

Palace House Care Home is an extended detached older property which has retained many original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking was available to the rear of the house.

At the time of our inspection, the registered manager was no longer managing the service. A new manager had been in post from August 2018 but had not yet applied to register with CQC. A registered manager is a person who has registered with CQC 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 the last inspection on 1 and 2 November 2017, our findings demonstrated there was a continued breach of the regulations in respect of staffing; the service was rated Requires Improvement. The service had also been rated Requires Improvement following the inspections of March 2016 and March 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

During this inspection, we found improvements had been made. However, we found a breach of regulation 12 in relation to medicines management. Therefore, this is the fourth consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not always managed safely. The clinical commissioning group medicines optimisation team were supporting management and staff with making improvements. However, we found there were still some shortfalls in medicine management practices in the home and further improvements were needed. People received their medicines when they needed them and staff administering medicines had received training and supervision to do this safely.

Quality assurance and auditing processes were in place to help the manager to effectively identify and respond to matters needing attention. We saw evidence of regular monitoring that had identified shortfalls in the service and appropriate action had been taken to address the shortfalls. However, the audit tools had not identified the shortfalls found during the inspection in relation to medicines management. The manager addressed this following the inspection. People's opinions on the quality of care provided were sought. The provider had good oversight of the service.

We found people’s care records and staff members’ personal information were stored securely in locked cabinets and were only accessible to authorised staff. The manager could describe the improvements being made to systems and records in response to shortfalls found during the audits.

Risk assessments had been developed to minimise the potential risk of harm to people. They had been reviewed in line with people's changing needs. The manager was currently improving the incidents and accidents recording and monitoring systems.

Safeguarding adults' procedures were in place and staff had received training. Staff understood how to protect people from abuse and how to report any concerns. People told us they felt safe in the home and that staff were caring. People appeared comfortable in the company of staff and it was clear they had developed positive trusting relationships with them.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to various aspects of their care was considered and was being included in the care records.

People's care and support had been kept under review and, where possible, people and their relatives were involved in decisions and reviews about their care. Relevant health and social care professionals provided advice and support when people's needs changed.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. Improvements were being made to the recruitment and selection procedures to ensure a robust and fair process was followed. Arrangements were in place to make sure staff were supported, trained and competent. People's opinions about the staffing levels varied; some people considered there were enough staff to support them when they needed any help whilst others felt there were at times insufficient staff. The manager was monitoring this.

The environment was clean and adaptations and decorations had been adapted to suit the needs of people living at the home. Equipment was stored safely and regular safety checks were carried out on all systems and equipment. Some areas of the home needed attention; there was a development plan to support this.

People told us they enjoyed the meals and their dietary needs and preferences were discussed and met. People were offered a choice of meal and food and drinks were offered throughout the day. People were encouraged to participate in activities of their choice. We observed staff spending time chatting to people, listening and singing to music, taking part in exercises and watching movies.

People and staff were happy with the service provided and considered the service was managed well. People felt they had been involved in decisions and were happy with the care and support they received; they made positive comments about the staff and the manager and about their willingness to help them. People knew how to raise their concerns; the manager was making improvements to increase people’s awareness of the complaints process.

Palace House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Palace House Care Home accommodates 33 people in one adapted building. There were 29 people accommodated in the home on the day of our inspection.

Palace House Care Home is an extended detached older property which has retained a number of original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking was available to the rear of the house.

At the time of our inspection the registered manager was no longer managing the service. A manager had been in post from 16 October 2017 and would be registering with CQC. 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 our last inspection on 22 and 23 March 2017 we found four breaches of legal requirements. We found shortfalls in risk management, staffing, maintaining accurate records and a continued shortfall in ensuring effective quality assurance and auditing systems. We also made recommendations regarding improving the provision of appropriate induction training for new agency staff and recording people's capacity and ability to make decisions about their care.

Following the last inspection, we met with the provider and asked them to complete an action plan to confirm what they would do and by when to improve the key questions Safe, Effective, Responsive and Well Led to at least good.

During this inspection we found improvements had been made to address the shortfalls in risk management, record keeping and quality assurance and auditing systems. However, our findings demonstrated there was a continued breach of the regulations in respect of staffing. You can see what action we told the provider to take at the back of the full version of the report.

We found a number of improvements had been introduced although we found they were in their infancy and needed to be embedded into practice over time. We will check this during our next planned comprehensive inspection.

People’s opinions regarding staffing numbers varied. The staffing levels were now being monitored to ensure sufficient staff were available at all times and additional staff were being recruited. Recruitment processes had improved. Staff training had improved and action had been taken to provide staff with adequate supervision and support.

We found people considered the service was managed well and they were happy with the improvements that had been made. New quality assurance and auditing processes had been introduced to help the provider and the manager to effectively identify and respond to matters needing attention.

The systems to obtain the views of people, their visitors and staff had been improved. People were encouraged to be involved in the running of the home and were kept up to date with any changes.

During this inspection we found there had been an improvement in the records relating to people’s care and support. We found the new care plan format and associated risk assessments had been introduced although we found some of the daily records relating to people’s care had been completed in an inconsistent way. In addition people had not been involved in the review of their care. The manager was aware of the shortfalls and further action was being taken to address them as part of the auditing system. We made a recommendation that people’s involvement in the care planning process and in regular reviews of their care and support were improved.

We found people’s access to appropriate and meaningful activities was limited as the provision of daily activities was dependent on the availability of care staff. We were told an activity person had been recruited. We made a recommendation that the provision of suitable activities needed to improve.

People told us they felt safe and staff were caring; they said they were happy with the service they received. The manager and staff were observed to have positive relationships with people living in the home and people were relaxed in their company. There were no restrictions placed on visiting times for friends and relatives. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were areas of the home that needed improvement and there was a plan in place to support this. The home was clean, bright and comfortable and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. Some people had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

People told us they enjoyed the meals and were provided with a nutritionally balanced diet that catered for their dietary needs and preferences.

People were aware of how to raise their concerns and were confident they would be listened to. Action had been taken to respond to people’s concerns and suggestions.

Palace House Care Home provides accommodation and care and support for up to 33 people. There were 29 people accommodated in the home at the time of the inspection.

Palace House is an extended detached older property which has retained a number of original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift and chair lift access. On the ground floor there is a lounge and dining area with quiet seating areas. There are safe and well maintained gardens and seating areas for people to use. Bedrooms provided single occupancy and some had en-suite facilities. Bedrooms were located near to toilet facilities or were provided with commodes. Car parking was available to the rear of the house.

The service was managed by 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.

At our last inspection on 16 and 17 February 2016 we found the service was not meeting all the standards assessed. We found shortfalls in the management of medicines, recruitment practices and a lack of effective quality assurance and auditing systems. Following the inspection we asked the provider to take action to make improvements and to send us an action plan

We also recommended the service’s improvement plan dates were followed to make sure people lived in a comfortable and suitable environment and that the induction processes were improved.

During this inspection, we found some improvements had been made to the management of medicines, induction processes, recruitment practices, the environment and to the quality monitoring systems. However, we found there were still some concerns regarding the effectiveness of the quality monitoring systems. Our findings demonstrated there were four breaches of the regulations in respect of risk management, staffing, maintaining accurate records and ensuring effective quality assurance and auditing systems. You can see what action we told the 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.

We also made recommendations regarding improving the provision of appropriate induction training for new agency staff and recording people’s capacity and ability to make decisions about their care.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse.

Improvements had been made to ensure people's medicines were managed safely and safe recruitment processes had been followed. Staff were provided with training and professional development and the process of formal one to one supervision was being reviewed. Agency staff were not given any formal induction to the home or made aware of the layout of the building which could place people at risk.

People living in the home and staff told us there were insufficient numbers of staff available to provide their care. We noted calls for assistance, particularly in the morning, were not always promptly responded to. We were told there were some difficulties and recent disagreements between staff members which had created low staff morale. The registered manager was aware of this.

The information in care plans and risk assessments was brief, lacked detail and some information had not been reviewed in a timely way. This meant that staff did not have up to date and accurate information about people’s needs. People were not routinely involved in the care planning review process.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; there were policies and systems in the service to support this practice. Information regarding people’s capacity to make specific decisions about their care and support and about any restrictions in place needed to be improved.

We found the home was tidy, well maintained, clean and odour free. There was a development plan in place to support planned improvements. People were happy with the facilities available in the home.

People had mixed opinions about the meals. Some people told us they enjoyed the meals whilst others thought it was ‘repetitive’ and ‘bland’.

People were supported to participate in a range of daily activities. People’s rights to privacy and dignity were recognised and upheld by the staff.

People had access to a complaints procedure and knew who to speak to if they were dissatisfied with the service. They were confident their complaints and concerns would be responded to.

People were happy about the management arrangements at Palace House Care Home. Feedback was sought from people, their relatives and staff on a regular basis

Quality assurance and auditing processes had been reviewed. However the processes were not fully effective as noted shortfalls had been identified but had not been actioned or followed up in a timely manner. In addition there was a lack of continuous supervision, support and guidance for the registered manager by the providers.

Palace House provides accommodation and nursing and personal care for up to 33 people. At the time of the inspection there were 27 people accommodated in the home.

The home is a large detached property situated on the main road between Burnley and Padiham in Lancashire. It is near to shops, churches, public transport and local amenities. There are safe and accessible gardens and parking is available for visitors and staff.

The service was managed by 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.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, management of people’s medicines and recruitment processes. You can see what action we told the registered provider to take at the back of the full version of the report.

We also made recommendations about maintaining and developing the environment and the induction of new staff.

People told us they did not have any concerns about the way they were cared for. They told us they felt safe and were looked after. They said, “I have not seen anything untoward” and “I am looked after and treated very well.” One relative said, “I’m confident the staff are always the same whether I’m here or not; (my relative) is safe and looked after.” We observed staff responding to people in a friendly, respectful and caring manner. We noted staff showed concern for people’s comfort and well-being.

Staff were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People were happy with the care and support provided. They said, “There is always something going on and always someone to talk to” and “It’s a great place; staff take time to talk and spend time with me.” A visitor said, “I am very satisfied; it’s a nice place, a very happy place.”

Staff were knowledgeable about people’s individual needs, preferences and personalities and people were involved in making choices and decisions about their day. People were encouraged to be involved in the running of the home and were kept up to date with any changes.

People were encouraged to express their views during day to day conversations with management and staff and during reviews and meetings. They were aware of how to raise their concerns and complaints and were confident they would be listened to.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

The service had introduced clear recruitment and selection policies and procedures although we found the safe and fair process was not always followed.

People told us there were sufficient numbers of staff to meet their needs in a safe way. They felt staff had the skills to provide them with effective care and support and were happy with the care they received. We found a number of gaps in the provision of training. However a dedicated trainer had been appointed to help ensure staff were up to date with all training. Staff told us they were supported in their work. Improvements were needed to the induction processes for new staff.

People raised no issues about the cleanliness of the home. They said they liked the accommodation at Palace House and had been able to personalise their bedrooms. They said, “It is a lovely home and they have improved some of the rooms” and “Work needs doing to improve it but otherwise it’s very homely with good facilities.” We found improvements had been made but there were areas in need of attention. However, it was difficult to determine what improvements would be made and the expected timescales for completion without a formal development plan.

Everyone told us they enjoyed the meals. We found various choices were on offer and drinks and snacks were regularly offered. People commented, “The meals are wonderful” and “The food is nice and always well presented; even the pureed meals are in separate portions.” We noted the atmosphere was relaxed with chatter and friendly banter throughout the meals. Staff were aware of people’s dietary preferences, the support they needed and any risks associated with their nutritional needs. Appropriate professional advice and support had been sought when needed.

Everyone had a care plan, which had been reviewed and updated on a monthly basis. Information was included regarding people’s likes, dislikes and preferences, routines, how people communicated and risks to their well-being. People told us they were kept up to date and involved in decisions about care and support.

There were opportunities for people to engage in a range of suitable activities both inside and outside the home. One visitor said, “They go out of their way to make sure people keep up with their faith and with their friends and family.” People living in the home said, “There is plenty going on. I often go out shopping and I can go to Church” and “There is something on to break up the day; it’s good.”

People made positive comments about the management of the home. They said, “Things have improved here” and “It is a good home with a very good name.” We found systems to monitor and improve the quality of the service required further improvement.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

During this inspection we spoke with five people using the service and two visitors. We also spoke with three care staff, a housekeeper, the deputy manager and the acting manager. We viewed records which included, three care plans and daily care records, policies and procedures, training records, staff rotas, menus and records of meals served, minutes from meetings and monitoring records.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

Staff had received appropriate training and had access to 'safeguarding adults' and 'whistle blowing' procedures to help them recognise and respond to any signs of abuse or neglect. The management team was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.

Staff had received training, and there were proper policies and procedures, in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. This should ensure people's best interests were safeguarded.

People told us they were happy with the staff team and said there were enough staff. We found there were sufficient, skilled and experienced nursing, care and ancillary staff to meet people's needs.

Is the service effective?

People told us they enjoyed the food. Comments included, "The food is great and there is always a choice", "The food is very good and I get the diet I need" and "The food is alright". Catering staff were aware of people's dietary preferences and were able to provide specialist diets as needed. Records showed there was a choice of food and drinks available.

There were systems in place to monitor the quality of the service and to monitor staff practice in areas such as medication, care planning, infection control and environment. However, the audits were not completed on a regular and planned basis and it was not clear how improvements had been made where shortfalls had been identified.

There had been no recent customer satisfaction surveys sent to people using the service or their relatives. This meant people's views of the current service were not up to date.

Is the service caring?

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us they were happy with the staff team and one person said, 'Staff are brilliant; I can't praise them enough'.

Most of the care staff had achieved a recognised qualification in care and all had received training to meet the needs of people living in the home. It was clear from our observations and discussions with people that staff had a good understanding of people's needs.

Care records contained useful information about people's preferred routines and likes and dislikes. This should help staff look after people properly and ensure they received the care and support they needed and wanted.

Is the service responsive?

There were opportunities for involvement in a range of suitable activities. People had been involved in discussions and decisions about the activities they would prefer and activities were arranged for small groups of people or on a one to one basis. Comments included, 'There is always something to do but I am happy to do my own thing" and "I get involved if I am interested in what they are doing'.

People had been encouraged to express their views and opinions of the service through meetings and during day to day discussions with staff and management. There was evidence their views had been listened to.

People were confident they could raise any concerns with the staff or managers. However we found that whilst people's concerns had been responded to, they had not always been clearly recorded. This meant it was difficult to determine whether there were recurring problems or whether the information had been monitored and used to improve the service.

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. Records showed some people living in the home, or their relatives had been involved in the planning and review of their care but this was not always clearly documented.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. People told us their health needs were met. Assessments of any risks were recorded, managed and kept under review. This would help to keep people safe from harm.

Is the service well-led?

The current acting manager had been in post since April 2014 and would be forwarding an application to register as manager. We were told an application to de-register the previous manager had been forwarded to the Care Quality Commission (CQC).

We were told the home had been visited by representatives from the organisation. However, without any records of these visits, we were unable to determine how the day to day management of the home and how the manager's practice had been monitored.