Archived: Quality Care Management Limited

Quality Care Management Limited is a care home which provides personal and nursing care for up to 38 people, aged 55 and over. Most people living at the service are living with dementia or another cognitive impairment. At the time of the inspection the service was supporting 30 people.

The care home accommodates people in one adapted building.

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

At this comprehensive inspection we found five breaches of regulations. There were systemic failings identified during this inspection that demonstrated a significant deterioration in the quality and safety of the service since its last focused and comprehensive inspections.

The provider failed to ensure effective oversight of service provision. Quality and safety monitoring systems were ineffective in identifying and directing the service to act upon and mitigate risks to people who used the service and ensure the quality of service provision.

People were at risk of neglect and unsafe or inappropriate care or treatment. We observed staff ignoring people and poor moving and handling practices.

People were not always treated with dignity and respect; some people told us staff were not always kind to them. Although family members were positive about the service, we observed occasions when staff treated people without compassion and kindness.

Staff said they knew how to prevent and report abuse. We were concerned however, that staff practice which amounted to omissions of care had not been considered as neglect.

There were not enough sufficiently skilled staff to meet people's needs. There was a high reliance on agency staff; we observed the staff on duty lacked the skills and knowledge to care for the people living at the home. People therefore did not receive person centred care.

Not all staff had received all necessary training and there were no formal supervision processes occurring. We were not assured of quality of training received given the widespread failings found at this inspection.

Medicines were not always administered as prescribed and there was a lack of guidance for staff in respect of topical creams. Infection prevention and control measures were not always followed by staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use restrictive practices.

Staff, people and visitors gave varied feedback about the service. Our observations of how care was provided to people were reflective of the varied feedback.

We found errors and discrepancies that had not been identified by the quality assurance systems in place. Care plans and risk assessments had not been updated, were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way. Risk assessments that related to people’s health, safety and the environment did not ensure all risks were effectively assessed.

Staff were positive about the management team. The provider had appropriate staff recruitment procedures. The management team sought advice and guidance from external professionals where required.

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 inspection (report published 23 October 2020) was a focused inspection covering safe and well-led. Although these key questions were rated good the overall rating remained Requires Improvement as the ratings from the previous inspection (published 17 October 2019) for the remaining key questions were used to calculate the overall rating for the service. This service has been rated requires improvement for the last seven consecutive inspections.

At this comprehensive inspection the service has been rated inadequate.

At our last focused inspection in September 2020 we recommended the registered person consider contingency arrangements to ensure records can be maintained during difficult times. At this inspection we found that some care plans and risk assessments had not been updated to fully reflect people’s changing needs.

In July 2019 we also recommended the registered person seek advice from a reputable source to ensure the application of the Mental Capacity Act 2005 is applied and recorded consistently and accurately. At this inspection we have found continuing concerns with the application of the MCA.

In July 2019 we also recommended the provider seek advice and guidance from a reputable source about creating a stimulating environment for people who are living with dementia. At this inspection we found further work to ensure the environment is suitable and stimulating for people living with dementia was required.

At our last comprehensive inspection in July 2019 we recommended the registered person review the deployment of staff to ensure this met the needs of people, especially those who were unable to use a call bell. We did not find any concerns with the deployment of staff at this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed, to seek assurance about this decision and to identify learning about the DMA process.

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 found evidence the provider needs to make improvements. Please see the relevant key question 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 Quality Care Management limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in risk assessment, medicines management, infection control, staff training, the Mental Capacity Act 2005, treating people with dignity and respect and quality assurance at this inspection.

We have cancelled the provider's registration.

Quality Care Management Limited is a care home with provides personal and nursing care for up to 38 people, aged 65 and over. Most people living at the service are living with dementia or some other cognitive impairment. At the time of the inspection the service was supporting 17 people.

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

The management of medicines was safe, however some improvement was needed to ensure creams and lotions were monitored more closely. Immediate action was taken by the registered manager to address this. Risks to people were well understood by staff and plans of care had been implemented with clear mitigation measures. Appropriate systems were in place to protect people from the risk of abuse and staff and the registered manager understood their role in safeguarding. Staffing levels and deployment met the needs of people and a contingency plan was in place if staffing levels were to drop below the requirements of the service. Infection control measures were in place and clearly understood by staff. Additional measures had been implemented as a result of the COVID-19 pandemic including additional training, additional personal protective equipment and clear procedures for visiting the service. It was evident that incidents and accidents were used to identify changes required to help ensure people’s safety and the registered manager was working to improve the recording of this.

The service had a clear management structure in place. The ability to keep care plans updated had been difficult due to a significant outbreak of COVID-19 in the home. Whilst the impact on people was low from this because of staff’s knowledge of people, the registered manager was aware of the need to ensure these were maintained. We have made a recommendation about this. Quality assurance systems were in place and covered a variety of subjects including medicines, care plans, infection control, safeguarding and complaints. Joint working with the local authority was taking place to ensure governance processes recording was clearer. People using the service and other relevant persons were consulted about the service. The registered manager demonstrated an open and transparent approach to their role.

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 17 October 2019). This service has been rated requires improvement for the last six consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This inspection was prompted in part by concerns we had received. We received concerns in relation to the management of falls, infection control and the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe 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 not changed at this inspection. We found no evidence during this inspection that people were at risk of harm from the concerns we had received as appropriate action had been taken.

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.

Quality Care Management Limited is a residential care home providing personal and nursing care to 29 people aged 60 and over at the time of the inspection. The service can support up to 38 people.

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

People were not always supported to have maximum choice and control of their lives. However, staff attempted to support people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this. We have made a recommendation about these areas.

Although we observed some kind, caring and positive interactions between people and staff, we also observed some less positive interactions on occasions. The registered manager assured us they would take action to address these with staff.

There were enough staff available to support people. The environment was clean and people had access to appropriate equipment where needed. Medicines were administered safely and as prescribed. Risks associated with people needs had been assessed, were understood and managed by staff, which meant people were safe from harm.

Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

Staff’s knowledge of people’s preferences was good. Activities were provided, and the registered manager was working towards improving these for people living with dementia. People knew how to raise concerns and complaints had been managed well.

People had confidence in the registered manager. The registered manager was open and transparent. They understood their regulatory responsibility and engaged people, relatives and staff. Systems were in place to monitor the quality and safety of the service.

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 1 August 2018). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Quality Care Management 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. Quality Care Management provides nursing and personal care. It is registered to provide support for up to 38 older people, most of whom live with dementia. At the time of our inspection there were 22 people living at the home. Support is provided in a large home that is across three floors. Communal areas include two lounges and a dining room.

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 2008 and associated Regulations about how the service is run.

At our last inspection we had seen significant improvement made but they were still in breach of Regulation 17, Good governance. This was because the care plan auditing process needed further development to ensure it identified all issues that needed actioning. At this inspection further improvements have been made and we found no breaches of the Regulations.

People mostly provided positive feedback about staff. Observations reflected staff were kind and showed them compassion. People’s privacy and dignity was respected and they were encouraged to be involved in making decisions about their care. Although people were supported to maintain some independence this needed further consideration to ensure this met people’s needs. We made a recommendation about this. People were not provided with the support they needed to ensure they received adequate nutrition and hydration.

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated. Medicines were managed safely. Risks associated with people’s needs were assessed and action was taken to reduce these risks. People and their relatives felt the home was always clean and well maintained. Equipment was managed in a way that supported people to stay safe and people were supported to maintain good health and had access to appropriate healthcare services. The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. Staffing levels met the needs of people although at times the deployment of these was not effective. The registered manager told us they would look at this.

Prior to people moving into the home, assessments were undertaken to ensure the home and staff could meet the person’s needs. Staff were aware of the need to treat people as individuals and ensure care reflected their individual needs. People told us that how they felt staff had the skills and knowledge to care for them. Staff received supervisions and training to help them in their role. Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services. People told us they were always asked for their permission before personal care was provided. Where needed people’s ability to make decisions was assessed in line with the Mental Capacity Act, 2005 (MCA).

Work had been done on the environment to ensure this was well lit and flooring helped to reduce the risk of falls. However, further work could be done to ensure that the environment was supportive to those living with dementia. We made a recommendation about this.

Care plans were in place, detailed and person centred. End of life care plans had started to be developed but these tended to focus on the person’s support needs now rather than considering what they might want at the end of their life. Some further work was needed to develop these. Staff reviewed their practices to ensure they were appropriate for people.

People said they had not needed to complain but were confident to do so. There was a process in place to deal with any complaints or concerns if they were raised. We saw complaints were investigated and outcomes shared with people and staff.

The service aimed to ensure good quality care was delivered and there were systems in place to monitor the quality and safety of the service provided. People, their families and staff had the opportunity to provide feedback about the service. Everyone spoke positively about the registered manager’s approach who encouraged suggestions to make improvements.

Quality Care Management Ltd is a registered care home and provides accommodation, support and nursing care for up to 38 people, some of whom live with dementia. Support is provided in a large home that is across four floors. Communal areas include two lounges and a dining room. At the time of our inspection there were 16 people living at the home.

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 2008 and associated Regulations about how the service is run.

The service has a history of breaching legal requirements. Following an inspection in May 2015 CQC served three warning notices for failing to ensure safe care and treatment, good governance and appropriately skilled and trained staff. In addition to these, requirement notices were issued for failure to ensure safeguarding of people, safer recruitment process, person centred planning and ensuring appropriate consent was sought. A second inspection in December 2015 was carried out to follow up the warning notices. This inspection showed improvements had not been made to the assessment and management of risks for people, staffing and governance systems. CQC took further enforcement action and placed a condition on the registration of the provider which stopped them from admitting any people to the home without CQC's permission. We also placed the service in special measures. A third inspection in September 2016 found ongoing concerns in relation to gaining consent and applying the Mental Capacity Act, understanding Deprivation of Liberty Safeguards, reporting and investigating safeguarding concerns and governance processes. We imposed a condition on the provider requiring them to undertake regular audits and report to the CQC on a monthly basis. The service remained 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.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned. Staff were aware of risks associated with people’s care and knew the action to take if the risks presented. The thickening of drinks when this was needed to ensure peoples’ safety required improvement and the registered manager agreed a formal analysis of behaviours would be beneficial.

The management of medicines was safe. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Staff received training and supervision to make sure they had the skills and knowledge to support people. People had access to health professionals when they needed it and enjoyed their meals.

People were supported to make choices by staff who were kind, caring, and mostly communicated well. Where people were unable to make decisions for themselves the principles of the Mental Capacity Act 2005 were followed. Where Deprivation of liberty safeguards imposed conditions on the provider, these had been met. Support plans provided guidance to staff and people and/or their loved one were involved in the development of these. People received personalised care and support, which was responsive to their current and changing needs. People were supported to eat an adequate diet although those who had modified diets may have benefitted from staff regularly offering them modified snacks.

Systems and processes to monitor and assess the service, and to drive improvement had improved. However the recording of the actions needed was not fully effective in ensuring care records were accurate and up to date. Concerns were listened to and dealt with promptly. A system was in place ensuring any complaints were dealt with.

The registered manager was open and transparent. They were described as always approachable, supportive and willing to listen. All notifiable incidents had been reported to CQC.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The condition imposed by the CQC following the inspection in September 2016 requires the provider to submit a monthly report to us about the action they have taken to address any concerns identified as a result of audits of care records, incidents and accidents. At this inspection CQC considered this condition remained appropriate to support the provider to demonstrate continued and sustained improvements.

Quality Care Management Ltd is a registered care home and provides accommodation, support and nursing care for up to 38 people, some of whom live with dementia. Support is provided in a large home that is across four floors. Communal areas include two lounges and a dining room. At the time of our inspection there were 23 people living at the home.

The home did not 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. An acting manager was in post and had applied to the Commission to become registered. Throughout the report we refer to this person as the acting manager.

Following an inspection in May 2015 the Commission served three warning notices for failing to ensure safe care and treatment, good governance and appropriately skilled and trained staff. In addition to these requirement notices were issued for failure to ensure safeguarding of people, safer recruitment process, person centred planning and ensuring appropriate consent was sought.

A second inspection in December 2015 was carried out to follow up the warning notices. This inspection showed improvements had not been made to the assessment and management of risks for people, staffing and governance systems. The Commission took further enforcement action and placed a condition on the registration of the provider which stopped them from admitting any people to the home without CQC's permission. At this inspection we found that sufficient improvements had not been made and there were still multiple breaches of the regulations.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. This service has a rating of inadequate in the well-led question. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. 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.

At this inspection staff and the acting manager had received training in safeguarding adults at risk. They were able to describe what action they would take if they were concerned. However we found incidents continued not to be reported or investigated. We found a number of unexplained injuries for one person that had not been reported to the Commission and there was no evidence of any investigation into these. We also found records which showed an incident that should have been reported to the Commission and it had not. We referred these concerns to the Local Authority Safeguarding team.

Recruitment checks were not consistently received to the service before staff commenced work and we have made a recommendation about this. Staffing levels enabled staff to respond promptly to people most of the time. However the system used to determine staff levels and skills was not used effectively and we have made a recommendation about these.

The assessment and management of risks associated with people's needs had improved. These were better known by staff and records were clearer however, we did find examples of where this still required improvement. The management of medicines had improved but records required further improvement.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We continued to have concerns regarding this. Whilst staff could tell us this was to ensure people made their own decision this was not reflected in their practice. Consent was sought from people who did not have the legal authority to provide this and mental capacity assessments were not decision or time specific.

There was a lack of understanding of DoLS. Applications had been made for people who had capacity to make their own decisions and some staff told us they would restrict people who had capacity. Where applications had been approved and conditions set, we saw these conditions had been met.

Staff had been provided with more training and supervisions were taking place. However staff did not always apply the training they had received into practice. We have made a recommendation about this.

People’s nutritional status was regularly assessed and monitored to ensure no concerns. Additional support was provided to help people gain weight when this was a concern. However care plans were not clear about how much staff should encourage people to eat and drink. People were supported to access a range of health care services to ensure their needs were met.

People said they felt safe and relatives confirmed this. Observations showed staff had a good understanding of people's right to privacy and dignity but also showed they did not know how to effectively communicate with people. At times their interactions were not respectful and choice was not always provided.

Some care records reflected people's likes, dislikes and preferences. The personalisation of care plans had improved and people’s representatives were involved. Activity provision had improved for people.

Feedback was sought from people and action taken to address any complaints.

Staff spoke positively about the acting manager and provider of the service. They expressed how they felt supported and confident that they were now listened to and concerns acted upon. They felt the acting manager was making improvements in the home. However, the nominated individual, acting manager and a director were unable to demonstrate a consistent understanding of how the regulations applied to people using the service.

Systems were in place to monitor the quality of the service. However these systems remained ineffective in identifying all concerns and making improvements. Records relating to the care of people remained inaccurate at times.

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

We undertook this follow up inspection on the 30 December 2015 to check the registered provider had met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Quality Care Management t/a Aquarius Nursing Home on our website at www.cqc.org.uk

Quality Care Management t/a Aquarius Nursing Home is a nursing home where personal and nursing care is provided for up to 38 older people, most of whom live with dementia. The home consists of three Victorian houses linked by a corridor. During our inspection 37 people were living at the home.

A registered manager was 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.

At this inspection we found the service had not met all the requirements of the Regulations to meet the fundamental standards.

Risks associated with people’s specific care needs had not been assessed. Plans of care did not identify how risks to people could be reduced.

Medicines were not always administered in a way which ensured the safety and welfare of people.

Systems were in place to reduce the risk of cross infection as the registered manager had implemented a robust system of audit and review for this.

Staff had not always accessed or completed training to ensure they had the appropriate skills to meet the needs of people.

Whilst the registered provider had systems in place to review the quality of the service they provided and ensure their service met the needs of people, these were not always fully implemented.

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

At this inspection we reviewed the progress the provider had made in relation to meeting the regulation. We spoke to the registered manager, two trained nurses and three people who lived at the home. We looked at the care plans for four people, medicines records for six people and all records relating to controlled medicines. The home had investigated the concerns we had identified and taken action to ensure staff were trained and competent to administer medicines safely. People who lived in the home were satisfied with the way their medicines support was provided. We found improvements had been made.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Recruitment practices were safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

Results from quality surveys showed that people were very happy with the care provided. People expressed their views and were involved in making decisions about their care and treatment. They were given appropriate information and support regarding their care and treatment. People were supported in promoting their independence and community involvement and their diversity, values and human rights were respected. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. The provider had sought advice and assessment from the GP where they felt the person lacked capacity. We saw documentation of the assessment by the GP and consent forms signed by the relatives.

Is the service caring?

We found the home had a very friendly and calm atmosphere. The staff were friendly and people who used the service appeared relaxed and happy in their company. People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person who used the service told us they were very happy at the home. They said the staff were caring and respectful and that they took time to support them to do as much as they could for themselves. Relatives of people who used the service told us they were impressed with the manner in which their families were cared for and they could visibly see how happy they were at the home and how much their relatives' condition had improved in the time they had been there. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy. The manager had an open door policy and relatives praised the management and their proactive, responsive approach to providing care.

We saw that incidents had been investigated, resolved and care adjusted as a result demonstrating the staff were responsive to incidents and accidents that occur within the home.

During the visit, we noted there were gaps in recording on the medication charts. Wefound that during our second visit and the service had taken appropriate action to ensure this did not occur again. This meant that the provider learnt from mistakes and took action to prevent them from reoccurring.

Is the service well-led?

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

The service worked well with other agencies and services to make sure people received their care in a joined up way. This included a six monthly review with the GP, continuing care team and social services.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls in evidencing relative involvement in care plan reviews was addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We observed staff treating people in a dignified and respectful way. We saw that during a mealtime the environment in which the meal was served caused difficulties for staff in respecting people as individuals. We fed this back to the manager. They told us they would look at this as a team to address how positive changes could be made for people.

We saw that care plans reflected people's individualised needs. People we spoke with told us they were satisfied with the service they received and that felt their needs were met.

Staff we spoke to told us they felt the information that was provided about people helped them to meet people's needs. Staff told us that they felt people's needs were met.

One person told us, 'The staff are gentle and hardworking'. Another told us, 'Staff are smashing, super'. People we spoke with told us they felt safe at the home.

Staff we spoke to told us they felt supported and that any suggestions they made would be taken seriously.

We found that the provider had effective systems in place to monitor the quality of the service and that people's views were taken into account and acted upon.

We found that the provider had an effective complaints system in place and any complaints were responded to appropriately.

We visited the home at 0930 on the 10 December 2012 and did not find evidence to support the concerns raised.

We spoke with five people who told us that they were treated well by staff and that they were happy living at the home. They told us that staff gave them the help and support they needed.

We used our SOFI tool and observed that people were treated as individuals and staff used people's preferred form of address. We saw that their privacy and dignity was maintained and that staff knocked on the door before entering people's rooms. We also saw that people received appropriate care.

We spoke with five members of staff and also two nurses who were on duty. Nurses and care staff said that the care provided for people was good. Staff told us that they worked well together and that there was a good working relationship between staff.

During our visit we took the opportunity to tour the home. We found that the home was clean and in a reasonable state of repair. There were no unpleasant odours.