Updated 28 September 2025
Date of assessment: 9 October to 28 October 2025. The assessment was undertaken because of complaints we had received with regard to the quality of food, cleanliness of the home, staffing levels and turnover, and medicines management. The service is a residential care home providing support to older people with a range of health conditions, including dementia.
We found 3 breaches of regulations relating to safe care and treatment, fit and proper persons employed and good governance.
People’s risks were not always identified, assessed and managed safely. Risk assessments did not include sufficient information for staff to guide them in how people should be supported to mitigate risk. Some aspects of moving and handling practices by staff were unsafe. Medicines were not always managed safely. Recruitment systems were not sufficiently robust to show new staff had the experience and skills required to care for people safely. When people moved from the home to another service, information about their care and support needs was not always shared to ensure continuity of care. Care was personalised, but we observed occasions when staff appeared rushed and support was task-led. Governance and assurance systems were not sufficiently robust to drive improvement.
Accidents and incidents were documented and reported to senior staff so that lessons were learned at the home. Staff completed safeguarding training and knew what action to take if they suspected a person was at risk of harm. Staffing levels were sufficient to meet people’s care and support needs, and the home provided a safe environment. People were protected from the risk of infection.
People’s needs were assessed before they came to live at the home. The manager met with people and their families to discuss their care and support needs. The home worked well with health and social care professionals. Consent to care and support was gained lawfully.
We observed staff were kind and caring with people, and treated them with dignity and respect. People’s independence was encouraged and promoted. The diverse needs and wellbeing of staff were catered for. Information was provided in an accessible format. Staff were trained in end-of-life care and care plans recorded people’s wishes and preferences.
We have asked the provider for an action plan in response to the concerns found at this assessment.