Advent House

Advent House is a residential care home providing personal care and accommodation to seven adults living with a learning disability, were on the autism spectrum, or had other complex needs at the time of the inspection. The service can support up to ten people. Advent House accommodates people in one specially designed and purpose built building.

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

People were very happy and settled, and staff clearly knew them very well. Safeguarding concerns were dealt with robustly and thoroughly. Risks were well managed with detailed guidance for staff, and any concerns reviewed and analysed promptly. Amendments to support plans were completed if needed. People were supported by well trained and supported staff who promoted a consistency of approach which was important for some people. Medicines were administered safely, and the home was very clean.

People enjoyed freshy prepared home cooked meals with their peers and were supported by attentive staff who offered discreet assistance at mealtimes, if needed. Staff understood people’s health and social needs well and sought external help when necessary. Visiting professionals commented on the positive atmosphere within the service.

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. People enjoyed many outings and trips including holidays and pop concerts.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff were kind and considerate, always ensuring people were included in conversations and their input was encouraged. Staff followed people’s lead where people used non-verbal communication. People helped shape their days and how they liked their care being delivered. Privacy and dignity were respected.

Care documentation was accurate and reflective of people’s needs which we saw supported in practice. End of life wishes needed further discussion with some people although no one was at end of life at the time of inspection. The service was person-centred and quality assurance systems ensured all feedback was integrated into plans for the future. People enjoyed a fulfilled life, accessing the local community regularly.

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 (published 20 December 2018) with one breach of regulation. 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.

At the previous inspection we found the provider had not submitted all relevant notifications to the CQC. We found this was a breach of Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. We found improvements had been made and the provider was no longer in breach of this regulation.

Since the last inspection Advent House no longer provides nursing care and has updated their registration with the CQC to reflect this.

Advent House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Advent House accommodates up to ten people in one adapted building.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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

Staff were kind and patient. It was clear they knew people well and how to meet their needs. The systems and processes in place to manage medicines were safe. Risks associated with people's care were identified and managed. However, these were not always documented.

People were supported by sufficient numbers of staff to meet their needs. Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny.

The service followed the principles of the Mental Capacity Act 2005. 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.

New members of staff did not receive appropriate training and supervision. There was no clear record of what training staff had undertaken and when it was due to be refreshed. We concluded this was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care plans contained up to date information regarding people’s care and support needs. People enjoyed meaningful activities.

Staff felt supported and had seen improvements in the home. Staff told us they were asked to provide feedback on the service and felt listened to.

The registered manager and deputy manager completed regular audits in areas such as, Deprivation of Liberty Safeguards (DoLs), finance, accident and incidents, medication, infection control and safeguarding. They had begun to complete audit action plans to ensure issues identified were addressed.

The provider’s audits were contained within the registered manager’s supervision notes. They did not always record the exact information they had checked. Any outstanding actions were recorded so they could be followed up at the next supervision. A monthly operations report was emailed to the provider by the registered manager. However, there was no area within the form for comments or to record any action taken by the operations manager or directors in relation to the information in the report. In addition, the operations reports were not referenced within the registered manager’s supervision record.

We found the audits completed did not identify that body maps were not in place for topical medicines and that people did not have risk assessments in place regarding pressure sores.

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

At the last inspection on 20 January and 7 February 2017 we carried out a focused inspection in response to a specific incident. We looked at the safe and well-led domains. We rated the service as 'Inadequate' and the service remained in 'Special Measures'. We found two regulatory breaches which related to safe care and treatment and good governance. We served a notice of decision to impose conditions on registration. Following the inspection the provider sent us the information we had requested and an action plan which showed how the breaches would be addressed. There were also two outstanding regulatory breaches to follow up from an inspection on 30 November and 12 December 2016. These breaches were in relation to person-centred care and need for consent.

This inspection was to check improvements had been made and to check whether the conditions on the provider’s registration had been complied with.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the first day of inspection. At the time of this inspection five people regularly used the service for respite care.

Since the last inspection, which took place on 20 January and 7 February 2017, the provider had appointed a manager, who was on leave at the time of the inspection. The manager was awaiting an interview with the Care Quality Commission in order to become 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.

We saw Disclosure and Barring Service (DBS) Checks were completed. The DBS helps employers make safer recruitment decisions and reduces the risk of unsuitable people from working with vulnerable groups. However, in one file we looked at there were no references. This is a breach of Regulation 19 HSCA 2008 (Regulated Activities) Regulations 2014.

The provider's recruitment policy stated, ‘Employees may be allowed to commence work before a full and satisfactory Criminal Records Disclosure has been received where the Company has received confirmation that the employee is not on the DBS Barred list.’ The policy detailed the safeguards to be put into place in these circumstances. However, DBS guidance states the practice of carrying out a check on the barred list prior to waiting for a full DBS check should only be used as an exception, rather than routinely. We recommend the provider reviews their recruitment policy.

We found the CQC had not been notified of the granting of two DoLS applications in March and May 2017. This was a breach of Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. The interim manager retrospectively submitted the notifications and put a system in place to prevent this situation happening again.

We saw improvements had been made since the last inspection. Care records and risk assessments were current and up to date. These were regularly reviewed. Fire drills were regularly completed and a list of staff who attended was kept. This was to ensure every member of staff attended a fire drill on at least an annual basis. We saw evidence in the daily records and people’s activity planners that people enjoyed activities. All staff agreed people now had meaningful activities.

Staff received regular supervision and training. Staff had their competency assessed. We recommend the provider introduces a competency assessment for catheter care and infection control.

There were sufficient staff to meet people’s needs. However, there was a heavy reliance on agency staff.

We looked at a sample of Medication Administration Record sheets (MARs). We found there were no gaps and the medication reconciled with these records. For medicines prescribed on an ‘as required’ (PRN) basis, protocols were in place.

DoLS were applied for appropriately. The provider was in the process of arranging review meetings to ensure best interest processes were recorded and all relevant people were involved in these decisions.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We observed staff asking permission before delivering care and spoke to people whilst supporting them. We saw staff interacted in a respectful, kind and caring way. Staff used appropriate methods of communication to ensure people understood them.

We looked at the quality monitoring systems in place. Incident reports were reviewed and action was taken where appropriate. Patterns and trends were also looked at which enabled any triggers to be identified and therefore reduced. This was also overseen by the interim manager as an additional safeguard.

The area manager now regularly audited the service, looking at areas such as training, maintenance, complaints and supervisions. We saw any action identified was followed up by the area manager at the next audit. The operations manager audited recruitment files. We questioned why they had not identified the issue with one recruitment file not containing references. We were informed this file had not been audited but was due to be audited at the next monthly audit. We recommend the provider has a system in place to ensure recruitment checks and records are audited prior to a member of staff commencing employment.

We concluded the service had made improvements to the governance and audit systems. Whilst it was clear the service was on a journey of improvement, it was too early for the provider to be able to demonstrate that the new processes were fully embedded and that these improvements could be sustained over time.

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

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

This inspection was prompted by an incident whereby a person who used the service sustained a serious injury. As this incident may be subject to an investigation the inspection did not examine the circumstances of the incident. However, we did examine how the service managed risk to people in general.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the day. At the time of this inspection eight people regularly used the service for respite care.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service did not have a registered manager at the time of this inspection. The registered manager had de-registered in August 2016; however they continued to work at the service as a registered nurse. The registered provider had deployed an interim manager at the service. A new manager had been appointed in December 2016, but was no longer in post and the interim manager remained in post.

We previously inspected the service on 30 November and 12 December 2016 and at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, person centred care, consent and good governance. We asked the registered provider to make improvements.

At our last two inspections we found risk assessments were not always up to date to reflect current risks to people. This meant staff did not have the written guidance they needed to help people to remain safe. At this inspection we found improvements had not been made.

We found the registered provider had not done all that was reasonably practical to mitigate risks to people and suitable policies were not in place to keep people safe from harm.

We found incidents were recorded but not always analysed for trends, and the registered provider did not maintain an effective overview of incidents to minimise future risks to people.

Emergency plans were not in place in the event of a fire because fire drills had not been regularly completed with all staff to reduce the risks to people.

The above issues were a continuing breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the first day of this inspection CQC issues urgent action to require the service to make improvements. On the second day of this inspection we found the registered provider was taking the required action.

At this inspection we found there were enough suitably trained staff to meet the assessed needs of people who used the service, however nurses didn’t always have time to complete management tasks due to supporting hands on with people with nursing needs.

Staff had a good understanding of safeguarding adults from abuse and knew who to contact if they suspected any form of abuse.

Medicines were managed in a safe way for people.

The provider had not done all that was reasonably practicable to assess, monitor and mitigate risks to people. This was a continuing breach of Regulation 12 and 17 (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Effective systems were not in place to assess monitor and improve the quality and safety of the service. We found continuing breaches of regulation 12 and 17 which had not been addressed. This was a continuing breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our inspection on 21 July 2016 this provider was placed into special measures by CQC. Our inspection on 30 November and 12 December found that there was not enough improvement to take the provider out of special measures and the service remains in special measures following our inspection on 20 January and 7 February 2017.

Following the first day of this inspection CQC issued urgent action to require the service to make improvements. On the second day of this inspection we found the registered provider was taking the required action.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

The inspection of Advent House took place on 30 November and 12 December 2016 and was unannounced on both days. We last inspected the service on 21 July 2016. At that time we found the registered provider was not meeting the regulations relating to person centred care, consent, safeguarding people from abuse, premises safety, staffing and good governance. The service was rated inadequate and placed into special measures and we took action to require the service to improve. The registered provider sent us an action plan outlining the improvements they would make. On this visit we checked to see if improvements had been made.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were four people who used the service permanently and one person who was using the service for respite care on the day. Nine people used the service for respite care.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service did not have a registered manager at the time of this inspection. The registered manager had de-registered in August 2016; however they continued to work at the service as a registered nurse. The registered provider had deployed an interim manager at the service. A new permanent manager had been recruited, and they commenced employment at the service on the second day of our inspection. They left the service two weeks later and the interim manager remained in post.

At our inspection on 21 July 2016 we found risk assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe. At this inspection we found some improvements had been made and risk assessments were in place to provide direction for staff, although risk assessments for one person using the service for respite care had not been updated to reflect current risks.

We found incidents were recorded but not always analysed for trends, and the registered provider did not maintain an overview of incidents to minimise future risks to people.

Emergency plans were not in place in the event of a fire because fire drills had not been regularly completed by all staff to reduce risks to people.

The above issues were a continuing breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

At our inspection on 21 July 2016 we found the registered provider had failed to ensure suitably qualified staff were on duty at all times because some people who used the service had been assessed as needing nursing care; however there was not always a nurse on duty. At this inspection we found improvements had been made and a qualified nurse was now on duty at all times. We found there were sufficient, suitably trained staff to meet people’s needs.

Safe recruitment procedures were in place, although records were not always available and well organised.

Medicines were managed in a safe way for people.

People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when deciding to use a night time monitoring device. Evidence of mental capacity assessments and best interest processes was not present for everyone who lacked capacity to make certain decisions. This was a continuing breach of regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our inspection on 21 July 2016 we found staff had not always had the training they needed to support people who used the service effectively. At this inspection we found improvements had been made and staff received training to enable them to provide effective support to people who used the service. For example, staff were now up to date with training in physical intervention techniques, moving and positioning, and gastrostomy care. Staff had also received supervision or appraisal to support them in their role.

Relatives told us people who used the service enjoyed the meals. We saw a choice of meals, snacks and drinks was available. A range of healthcare professionals were involved in people’s care as the need arose.

Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported.

Relatives told us staff were caring and we observed staff interacting with people in a caring, friendly manner. Observation of the staff showed that they knew people well and could anticipate their needs.

People were able to make choices about their care, however we found some care records did not reflect people’s current needs to provide guidance to staff. At our last inspection we found the registered provider was not meeting the regulations related to person centred care because activities for people were limited. At this inspection we found people were supported to participate in leisure and social based activities; however evidence of activities for some people was still limited. The above issues evidenced a continuing breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider had a system in place to manage complaints. Relatives told us the staff and managers were approachable.

Effective systems were not in place to assess monitor and improve the quality and safety of the service. Whilst issues related to suitability of staffing and support for staff had been addressed, we found continuing breaches of the regulations which had not been addressed. This was a continuing breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

Advent House is a two storey purpose built facility which is registered to provide 24 hour accommodation and nursing care for up to 10 people who have a learning disability. The service is accessible for people with a learning disability and who may need to use a wheelchair. The service is located within a quiet residential area with open views to fields. At the time of our visit there were six people who used the service (four permanently and two people for respite care).

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

The registered provider had failed to ensure that suitably qualified staff were on duty at all times. Some people who used the service had been assessed as needing nursing care; however there wasn’t always a nurse on duty. There had not been a nurse working night duty for two years and more recently some day shifts had not been covered. Insufficient numbers of nurses were employed to cover all shifts. The registered manager told us they would take immediate action and ensure the service was staffed with a nurse at all times.

Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe. Staff failed to recognise when incidents would be considered to be abuse and therefore needed referring to the local safeguarding team. This meant that processes were not in place to prevent people who used the service and staff from abuse. Incidents were recorded, however not analysed to reduce the risk of reoccurrence.

Checks of the building were carried out to ensure health and safety, however some water temperatures were low and below the recommended level for the prevention of legionella. There was no evidence to confirm that servicing had taken place on the fire alarm. This meant it may not work properly in the event of a fire, if regular checks are not carried out.

Staff did not understand the requirements of the Mental Capacity Act 2005 and associated codes of practice. Decision specific mental capacity assessments had not been completed and care records did not describe the efforts that had been made to establish that the least restrictive option for people. There were no records to confirm that 'best interest' discussions had taken place with family, external health and social work professionals.

Staff were not trained to care and support people who used the service. Only 11% of care staff employed were qualified in first aid and only 60% of staff had received training around using physical interventions. This type of training needs to be refreshed on an annual basis, however for many staff this was over a year ago. The registered provider told us further sessions had been booked. From a review of the training matrix we found that only 70% of staff had received moving and handling training and only 37% of staff had received training around gastrostomy care. Staff had not consistently received supervisions and appraisals from 2014 to the date of the inspection.

Two of the three care plans we looked at were person centred and included detailed information on how the person needed to be care for. However, for one person the care records failed to provide sufficient information to enable staff to provide safe care and treatment. We found the lack of information around how to manage the behaviours that were challenge left the person and staff at risk of being injured. The registered provider sent us an updated behaviour management plan after our inspection.

People were supported to participate in leisure and social based activities; however activities for some people were limited.

We looked at the recruitment and selection processes and found that checks were undertaken before staff commenced work. The staff files included evidence that pre-employment checks had been made including written references, the completion of an application form and obtaining proof of identity. We observed that two staff had started work prior to the receipt of a satisfactory Disclosure and Barring Service clearance (DBS). The registered manager told us they would not routinely employ staff prior to the receipt of a DBS check; however a new person had been admitted to the service who required lots of support would have meant a shortfall in staff to support people. They told us that new staff had worked supervised until their DBS check had been returned.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The registered provider had systems for monitoring and assessing the service, however these were minimal and ineffective as they did not identify the concerns we identified at the inspection of the service.

People had access to healthcare professionals and services. In addition people had a hospital passport which contained information that would help hospital staff to ensure that care and treatment was provided in a way that the person would want it to be. In general safe systems were in place to make sure people received their medicines safely. However 'as required' guidelines were missing for some people who used the service. This meant staff did not always have clear instruction they needed to administer medicines. Staff encouraged and supported people at meal times. We saw that people were provided with a choice of food and drinks which helped to ensure that their nutritional needs were met. People had been weighed on a regular basis.

The registered provider had a system in place to manage complaints. Relatives told us the staff and registered manager were approachable.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs.

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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at two people's care records. We saw these gave detailed information about the person's likes, dislikes and personal family information. The assessments and care plans we looked at were person centred and included people's psychological, physical, social and cultural needs.

Staff were kind and supportive to people; they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect.

We saw that people who used the service were happy and comfortable with staff in their interaction with them. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The Registered Manager set the rotas; they took people's care needs into account when making decisions about the numbers, skills and experience required. We found there were sufficient staff to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Records showed that one person was currently subject to a DoL'S and the correct procedures had been followed to ensure people's rights were protected.

Is the service effective?

Staff described how they met and monitored people's health needs. Care records showed that people had regular contact with health and other professionals.

People's health and care needs were assessed with them or their representative. Specialist dietary, mobility and equipment needs had been identified where required.

Staff told us they felt well supported to do their job and maintain high standards.

Is the service caring?

We saw that care practices were good. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and good eye contact. It was clear that staff were well aware of the needs and wishes of the people who used the service. Staff understood people's individual ways of communicating their needs.

Is the service responsive?

We saw that people who used the service were responded to promptly when they asked for any support or assistance or gave any indication that they were in any discomfort. It was clear that staff knew the needs of people who used the service very well.

People were supported in promoting their independence and community involvement. People were involved in a number of activities in and outside the home. The home had a sensory room which was clearly enjoyed by people who used the service.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable and enthusiastic. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

There was an effective system in place to regularly assess and monitor the quality of the service that people received. We looked at reports and records which showed the provider had assessed and monitored the quality of service provision.