Bethel/Bethesda Residential Home

Bethel/Bethesda Residential Home is a care home registered to provide accommodation and personal care for up to 34 older people. There were 20 people receiving care at the time of the inspection.

Bethel/Bethesda Residential Home provides care to people from one building, separated into two sides via a keypad entry system. One side of the service is known as Bethel, and the other Bethesda.

All people living at the service had their own bedrooms. Some bedrooms had en-suite facilities, others had sinks only. There was a bath/shower room, dining room and lounge area in each side of the service.

There was no garden at the service, but people could access the courtyard should they wish to spend time outdoors.

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

There had been a change of management since the last inspection. Significant improvements had been made to the safety of the service. The registered manager was passionate about improving the care people received at Bethel/Bethesda and had a good knowledge of the regulatory requirements. A refurbishment plan was underway to further improve the environment. Whilst improvements had been made, further improvements were required. People had been consulted about changes to the environment and had chosen new décor and furniture.

Policies and quality assurance systems had been implemented to enable the registered manager to monitor the quality and safety of the service. These had identified improvements needed and action had been taken to address these or was planned.

Infection prevention and control systems and processes had improved significantly. Staff were observed to wear the correct personal protective equipment throughout our inspection. The service was clean. Professional visitors were not permitted to enter the service unless they could evidence a negative lateral flow test and at least two doses of an approved COVID-19 vaccine. Visits were safely facilitated. Infection prevention and control policies were robust and followed.

There were enough staff to support people with their needs and staff had been safely recruited. They knew how to keep people safe from harm or abuse. Staff had a good knowledge of risks associated with providing people's care and received training relevant to people's needs. We received positive feedback from staff about the new training programme that had been implemented.

People received their medicines on time and as prescribed by skilled and competent staff. Medicines were safely stored.

The service supported people to express their views, preferences, wishes and choices. Staff supported people to engage in their hobbies and interests and promoted people's independence. Improvements were planned to provide more varied activities. People knew how to raise a concern or make a complaint and felt confident this would be addressed.

Staff were observed to deliver kind, compassionate and respectful care to people. People’s privacy and dignity was respected. We received positive feedback about the care staff and management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; the policies and systems in the service supported this practice. People were supported to eat and drink enough and to attend healthcare appointments as needed.

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 inadequate (published 25 August 2021) and there were four breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 24 August 2021. 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

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from Inadequate to good. This is based on the findings at this inspection.

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.

Bethel/Bethesda is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 34 people.

The service is in one building which had been divided into two sides. One side is known as Bethel, and the other Bethesda. All people living at the service have their own bedrooms. Some people had a sink in their bedrooms, while others had a sink and a toilet. Bethel and Bethesda each have shared bath/shower room, a dining room and lounge area. There is not a garden, but there is a courtyard which people could access.

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

People living at the service were not safe. Not everyone had their care needs and associated risks assessed. This meant staff were not aware of how to safely care for people and to minimise risks people were exposed to.

Staff failed to wear personal protective equipment (PPE) in accordance with government guidelines. During our inspection, staff were observed warning others to put face masks on as CQC were inspecting in the building.

Maintenance checks were completed but staff failed to risk assess equipment before it was used. This meant people living at the service were not exposed to unnecessary risks of harm.

The service was not well-led. The registered manager and nominated individual did not have oversight of the service. Governance systems and processes were not in place to ensure care was safe, and opportunities to improve the service were missed.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 30 June 2019).

Why we inspected

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 received concerns in relation to staff not wearing PPE and regarding the safety of the environment. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to providing safe care and treatment to people living at the service; the safety of the environment; and how the service was led and governed at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The 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.

Bethel Bethesda is a residential care home that provides personal care for up to 34 older people. The home is made up of two connected adapted buildings. At the time of our inspection 24 people were using the service.

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

People experienced care and support that was responsive to their needs. People told us they were satisfied with the care and support they experienced. People participated in activities that were of interest to them, but activities were not provided each day. People told us they sometimes felt bored.

People were supported by staff who understood their needs. People told us they felt safe because of the care they experienced. Staff understood and practised their responsibilities to keep people safe from harm.

People were supported by staff who had the right skills and knowledge to provide care that met people’s assessed needs. 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 told us that staff were kind and caring. Staff respected people, treated them with dignity and involved them in decisions about their care.

The provider had procedures in place to monitor the quality of care people received. They used people’s feedback to drive improvements. They had worked closely with the local authority who paid for the care of people to bring about and sustain improvements.

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 overall rating at the last comprehensive inspection was Inadequate (report published 01/11/2018). We carried out a focused inspection on 18 March 2019 (report published 02/05/2019) when we reported only on key questions Safe and Well-led which we found had improved from inadequate to requires improvement. We found 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.

People’s experience of using this service:

• The provider had made improvements to ensure that people lived in a safe and secure environment. They had acted on all the recommendations made by the local fire and rescue service following an inspection they had carried out.

• The provider and registered manager had made improvements to systems that kept people safe from avoidable harm and to how the service was run. However, it was too early to say whether all the improvements were embedded.

• People had personal emergency evacuation plans that staff were familiar with which meant they would be safely evacuated in the event of an emergency such as a fire.

• Staff did not always lock doors to the laundry or a room with cleaning equipment when these rooms were unattended.

• A door to a passageway connecting the two buildings was left unlocked. This area was unmanned. Relatives told us they accessed the home this entrance instead of via reception where they signed a visitor’s book. They were concerned that unauthorised visitors could do the same.

• The provider increased their checks to ensure the doors to those areas were locked.

• The provider had improved the arrangements for the maintenance of the premises and equipment such as heating and hot water systems. People told us they were warm in their rooms and communal areas.

• People were provided with enough healthy and nutritious food. The provider had arrangements for ensuring that there was always enough food and drink in store.

• People told us they felt safe living at the home and when staff supported them.

• People had their medicines at the right times because the provider and registered manager had improved arrangements for managing medicines safely.

• The provider employed enough staff so that they could meet people’s needs in a timely way. Staff responded quickly when people used their call alarms.

• The provider and the registered manager were clear about improvements they wanted to make. They were working on a plan to include people, relatives and staff in improving the service.

• The provider had arrangements for monitoring the quality and safety of the service.

• At this inspection, whilst we saw improvements had been made, it was too early to say whether the improvements were embedded. However, the provider was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations.

Rating at last inspection: At our last inspection on 15 August 2018 (report published 31 October 2018) we rated the service as Inadequate. We placed the service in special measures.

Why we inspected: After our last inspection we issued a warning notice because the provider had failed to make improvements to how they assessed, monitored and sought to improve the quality, health, safety and welfare of service users. This was a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations, regulation 17 (2a and b) - Governance. We placed the service into special measures.

We inspected the service against two of the five key questions we ask about services; is the service Safe and is the service Well-led? Those the key questions were rated as inadequate at our last inspection. We followed-up on the actions the provider had taken in relation to the warning notice.

Follow up: We will continue to monitor the service and we will carry out a comprehensive inspection of all five key questions as per our re-inspection programme. We will decide then whether to remove the service from special measures.

This was the fourth comprehensive inspection carried out at Bethel/Bethesda Residential Home. At the last inspection in August 2017 the service was rated as requires improvement. At this inspection we found there were areas that still required improvement.

Bethel/Bethesda Residential Home 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. The care home accommodates up to 34 people in one adapted building. On the day of our visit, there were 25 people using the service.

The service had 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 and associated Regulations about how the service is run.

The provider had not ensured there were sufficient processes in place to assess, monitor and improve the quality of the service to maintain the health, safety and welfare of service users. The provider had not ensured that people were always protected from health and safety risks associated with accessing areas such as the kitchen and laundry; or ensured there were adequate systems in place to make repairs to the home or the hot water system.

People could not be assured there were enough staff to meet their needs. Staff did not receive all the support they required to carry out their roles.

People could not be confident their complaints would be responded to appropriately.

The provider did not ensure that people could access all areas of the home as two communal areas were used for storage.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People received care from staff that had received training to meet their needs. Safe recruitment processes were in place.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to be involved in their care planning and reviews. Their care and support was delivered in the way that people chose and preferred.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

At this inspection we found that Bethel/Bethesda Residential Home were in breach of four regulations relating to staffing, safe care and treatment, receiving and acting on complaints and governance of the home.

This is the third consecutive time the service has been rated Requires Improvement. The actions we have taken are reported at the end of the full report.

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.

Further information is in the detailed findings below.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bethel/Bethesda Residential Home on our website at www.cqc.org.uk

Bethel/Bethesda Residential Home provides care and support for up to 34 older people. At the time of our inspection 19 people were using the service.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 our previous comprehensive inspection carried out on 26 August 2016 and 1 September 2016 we asked the provider to make improvements. We asked them to improve their practices in relation to safeguarding people from abuse and assessing risks. We also asked them to improve their practices in relation to their arrangements for monitoring the quality of the service and notifying CQC of significant events at the service. We asked them to display their most recent rating given by us as this was not in place and is a requirement. Following that inspection the provider sent us an action plan detailing what improvements they were going to make. During this inspection we found that some improvements had been made.

People felt safe living at Bethel/Bethesda Residential Home. Staff knew their responsibilities to help people to remain safe. They took action where they had concerns that a person was at risk from abuse or harm. Risks to people’s health and well-being were mainly assessed and reviewed to provide guidance for staff. The registered manager told us they would make improvements to the care records where this was required. Staff took the appropriate action when an accident or incident occurred. The registered manager analysed any accidents or incidents to prevent a reoccurrence where possible.

The provider had not always checked the environment and the equipment people used to help people to remain safe. They were planning to implement further checks to maintain the security of the home.

Staffing numbers were suitable to offer people the care and support they required although we received mixed feedback about this. The organisation of staffing required improvements and the provider told us that they would undertake this. The provider carried out checks on the suitability of new staff to make sure that people were supported by those who had been verified as safe.

People received their medicines by staff who knew their responsibilities for handling them safely.

People received support from staff members who received training and on-going guidance on their work. New staff did not receive a formal induction when they started work. Staff generally felt supported by the registered manager.

Where there were concerns about people’s ability to make decisions for themselves, the registered manager had undertaken assessments to determine people’s level of understanding. Decisions made in a person’s best interest occurred in line with the Mental Capacity Act 2005. Staff understood their responsibilities under the Act.

People were not always satisfied with the food available to them. The provider had employed a new cook who had spent time asking people about their preferences.

People had access to a range of health care services to help them to remain healthy. Staff took action where there were concerns about a person’s health or well-being.

People were cared for by staff who were generally kind. People’s privacy and dignity was respected by staff. People were involved in decisions about their care. Information about advocacy services was not available to them. Staff knew the people they supported and encouraged them to retain their skills.

People received care and support that was mainly centred on things that mattered to them. They had opportunities to take part in activities that they were interested in. The provider was working with the local authority to improve activities for people who were living with dementia.

The environment and some staffing practices were not always helpful for people with memory difficulties. The provider was making changes to improve this.

People contributed to the planning of their care where they wanted to. People’s care was reviewed although the recording of people’s involvement was an area the registered manager said they needed to improve upon. People had care plans that were centred on them as individuals.

People and their relatives knew how to make a complaint or to raise a concern. The provider took action when one was received.

People and staff had opportunities to give feedback on the quality of the service. People and their relatives told us that some improvements had occurred at the service since our last comprehensive inspection. We found that further improvements were required.

The provider’s quality checking of the service had not identified some of our concerns that we found during our visits. The provider had implemented and were developing a range of checks to drive improvement.

The registered manager was aware of their responsibilities. They had submitted the required notifications to CQC.

We carried out an unannounced comprehensive inspection of this service on 26 August 2016 and 1 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. We issued a warning notice in relation to the breach of Regulation 11; need for consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bethel/Bethesda Residential Home on our website at www.cqc.org.uk.

At the last inspection we carried out on 26 August 2016 and 1 September 2016 we found that where people lacked the capacity to consent to their care and treatment, the provider had failed to act in accordance with the provisions of the Mental Capacity Act 2005 (MCA). We also found that staff did not understand their requirements under the Act. At this inspection we found the provider had made some of the required improvements.

Bethel/Bethesda Residential Home provides care and support for up to 34 older people. At the time of our inspection 18 people were using the service and some were living with dementia or similar conditions.

There was a registered manager in place. It is a requirement that 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.

People were not always supported in line with the Mental Capacity Act 2005 (MCA). People were not always asked for their consent before staff carried out care and support. Where there were concerns about people’s ability to make decisions, the provider had not completed assessments in line with the MCA. Decisions made in people’s best interest were not recorded to show how these had been agreed. Staff understood their responsibilities under the Act. The provider had made applications to the appropriate body where they had sought to deprive a person of their liberties.

Staff received training and guidance relevant to their role. The guidance they received was not always effective. For example, staff did not always communicate with people when offering their support.

People had mixed views on the food available to them. The registered manager was taking action to make sure improvements were made. Where there were concerns about people’s eating and drinking, people’s care records were not always full completed to provide guidance to staff. The registered manager told us they would review people’s records where the information was not complete to make improvements. Staff knew what actions to take should they have concerns about people’s eating and drinking.

People had access to health care services such as their doctor and district nurse visits.

Bethel/Bethesda Residential Home provides care and support for up to 34 older people. At the time of our inspection 22 people were using the service. The accommodation was offered over one floor. There was a communal lounge and two dining areas. There was also a courtyard for people to use should they wish to.

At the time of our inspection there was a registered manager in place who had recently returned to work after an extended period of leave. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People were not always supported in line with the Mental Capacity Act 2005 (MCA). People consented to their support where they could. However, the provider had not assessed people’s mental capacity where this was necessary and best interest decisions were not in place. Some people did not have the capacity to make certain decisions. It was not clear how some decisions had been made and whether people should make the decision for themselves. We saw some people may have restrictions placed upon them as they were not able to go out alone and may not have had the capacity to make a decision about their safety. Applications to ensure these restrictions were lawful had not been made for all these people. Staff did not fully understand their responsibilities under the Act.

Staff understood their responsibilities to protect people from abuse and avoidable harm and to remain safe. However, the provider’s policy to safeguard people was not followed on one occasion in relation to an allegation of abuse. The provider had a system for recording accidents and incidents but it did not include a robust analysis to reduce their reoccurrence where possible. Although people mainly felt safe, risks to people’s health and well-being were not always regularly assessed. For example, where people were at risk of falling, staff did not always have information available to them.

The provider had not always checked the environment for risks that people could have been exposed to. Fire safety checks had not always occurred and where there were actions identified by trained professionals to protect people’s safety these were not always completed. Staff did not have an emergency plan available to them to provide support to people in the event of, for example, a fire.

The provider had a suitable recruitment process in place for prospective staff which included relevant checks. However, people and staff had mixed views on whether the provider had enough staff to offer safe care. We found that on occasion people had to wait to receive care.

People received their prescribed medicines in a safe way. Staff followed national guidance when offering people their medicines and received training to understand their responsibilities. Medicines were stored appropriately. However, the provider’s checks on people’s medicines were not completed correctly which meant that mistakes that may have occurred would not have been picked up in a timely way.

People did not always receive care and support from staff with the appropriate knowledge and skills. Staff had received regular training in topic areas such as fire safety but not in specific conditions that people were living with including dementia. New staff did not always receive an induction when they started to work for the provider. They did not have regular meetings with a manager so that they could receive feedback and guidance on their work.

The provider had not always sought the support of specialists where there were concerns about people’s nutrition and hydration. People had access to other healthcare services such as to their GP.

People had mixed views on the quality of the food and drink offered to them. Some people’s nutritional preferences were recorded within their care records and we found that food was served hot.

People received support from staff who were generally kind and compassionate. Staff did not always protect their dignity and privacy. Staff were largely task focused and did not always spend time talking to people about things that mattered to them. People’s care records were not always stored safely as their care records were left unattended by staff on occasion. People’s friends and relatives could visit without undue restriction.

People were supported to be as independent as they wanted to be in order to retain their skills. People were not always, where they could, involved in decisions about their care. People did not have information on advocacy services available to them to support them to speak up where this may have been required.

People did not always receive care when they required it. People had not always contributed to the planning of their care where they were able to. People’s care plans were not regularly reviewed and did not always contain information specific to all areas of their care requirements. People’s care records were not always complete and accurate. Staff knew about some people’s preferences and personal histories but did not know fully the needs of people who had recently moved into the home. Some people took part in activities that they enjoyed including gardening.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place which was displayed so that people and visitors knew the process. The provider had received five complaints in the last eighteen months. However, actions were not always recorded to show how the provider was dealing with them.

The provider did not meet the requirements of their registration with the CQC. Statutory notifications about significant events that occurred at the service as required in law were not always submitted. The provider did not display their rating from the latest CQC report. This is a legal requirement to inform people about our judgement about the quality of the service provided. The provider told us they would make sure the rating was displayed.

The provider’s quality checks were not always suitable to ensure people received good care. The provider had not always took action to make improvements where deficiencies were found by other professionals. The provider's own audits had not identified the range of our concerns that we found when we visited. People had opportunities to give feedback to the provider. However, actions were not always taken where feedback was received.

Staff did not always feel supported and processes were not routinely in place to guide them and to offer feedback on their work. Staff knew how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

We found breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with people about the hygiene of the service and they told us that they were happy with their rooms as they were cleaned regularly. We saw improvements had been made in creating systems to ensure the home was clean and cross infection was minimised.

People using the service and staff told us that they were pleased with the improvements. We saw that building work had started and some improvement had been made to the fabric of the building such as a new shower room and communal areas were decorated. As the work is not yet finished we will continue to monitor the service.

People using the service and staff told us that they thought things had improved in the last few months but there was still areas that could be improved such as the environment. People told us that on the whole they liked living at the home but that the activities at the home were limited.

We looked at five care plans and saw that four of the five had been improved and were fit for purpose.

We looked at training records and although not yet completed we saw that staff were being booked on future training course to ensure that they had the skills and abilities to meet people's needs.

We toured the premises and found that it was badly maintained and in need of serious refurbishment.

We found that care plans lacked detail and people using the service were at risk of not receiving their assessed and planned care. Records showed some people had lost sufficient weight to indicate there may be underlying health concerns but this had not been followed up with a referral to an appropriate specialist.

We saw that despite their being dignity champions at the home people were not always treated with dignity and respect such as staff speaking too loudly and people left in an unkempt state of dress.

Although there were infection control systems in place, due to the lack of maintenance there was risk of cross contamination in key communal areas such as toilets and bathrooms.

People were placed at risk because arrangements for recording, storage and administration were poor. People using the service told us that even staff who had not worked at the home for very long soon administered medication raising their concerns about standards.

We looked at staff rotas and training records. Rotas were confusing and did not always ensure that were sufficient well trained staff on duty. Staff also told us they did not feel supported or receive quality training.