Morley Manor Residential Home

Morley Manor is a residential care home providing personal care for to up to 33 people. At the time of our inspection there were 22 people using the service. The service provides support to people with a range of needs, including those living with dementia.

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

There was no effective leadership or oversight in place to monitor the quality of care delivered. The providers action plan did not support improvements at the service. Quality assurance systems had failed to identify the areas of concern we highlighted during our inspection around management of medicines, recruitment and provision of safe care.

Medicines were not always administered safely as prescribed. The provider had not always followed their medicines management policy to ensure staff administering medicines were competent.

People’s risks were not always effectively managed. Risk assessments and guidance in place for people at risk of choking was not always followed by staff. Staff deployment was not effective to ensure people's needs were met in a timely way.

People were supported to make decisions about their care. People living at the home had appropriate DoLS and decision specific best interest decisions in place. Care plans and risk assessments reflected people’s needs. Care plans were reviewed regularly to ensure accurate records of people's care was maintained. Relatives were informed about and involved as and when people's care needs changed.

People were supported to have enough to eat and drink. Relatives were positive about the care their loved ones received. People and relatives told us staff were kind and responded well to people's needs and preferences. The provider worked with a variety of health care professionals to help improve and meet people's care needs.

We observed staff interactions between people to be positive and respectful. Communication tools were used to communicate with people where needed.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported 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 and update

The last rating for this service was inadequate (published 28 September 2022) and there was breaches 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviews their application of the principles of The Mental Capacity Act 2005 (MCA) and applies relevant best practice guidance. At this inspection we found the provider had made improvements in relation to the principles of MCA.

Why we inspected

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

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.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk management, staffing, recruitment and good governance at this inspection.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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, 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.

Morley Manor Residential Home is a care home which provides personal care to people. The home is registered to support 33 people. At the time of the inspection, the home was providing personal care to 22 people, most of who were living with dementia.

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

People and relatives shared positive feedback about the care provided. However, during this inspection, we were not assured the service provided was always safe and we found widespread shortfalls in the way the service was managed and we were not assured the service was safe.

The provider failed to implement effective processes to assess and monitor the quality of the service and to identify the issues found during our inspection. Records related to people’s care were not always complete or contemporaneous. Management were not following regulations, best practice guidance or their own policies and procedures.

We found several issues with the management of medication and risks to people’s care were not fully assessed, planned for or documented. We identified environmental hazards, including fire safety concerns. We found examples of incidents not being investigated or reported to the safeguarding team. During this inspection, we identified and asked the registered manager to submit safeguarding referrals, as appropriate.

Staffing levels and staff deployment was not effective to ensure people's needs were met in a timely way. We received mixed feedback regarding staffing levels at the service.

Staff were not always recruited in line with requirements. Staff had not always received the appropriate training to care for people safely.

We found examples of unnecessary restrictions on people’s movement. The registered manager took immediate action when we raised these concerns. We found inconsistency in the application of the principles of the Mental Capacity Act. 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. There were policies and systems in place, but these weren't always being followed in practice. We made a recommendation for the provider to review their practice.

People did not always receive person centred care. There were a lack of meaningful activities and interaction being offered to people.

Care plans lacked detail in relation to specific areas of people's care. People and relatives shared positive feedback about staff being caring and kind in their approach. Staff spoke kindly about people and knew about their preferences and needs. We found examples of staff's recording not being centred on people's needs.

We saw evidence of good partnership work with other professionals, to meet the needs of people living at the service.

The registered manager was receptive to the inspection findings, told us they were willing to learn and improve and shared the actions that had taken or would take to address the issues found at this inspection. People, relatives and staff shared positive feedback about the management 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 good (published on 7 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, person centred care and the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, safe care and treatment, safeguarding, good governance, staffing and fit and proper person’s employed 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

We found the following examples of good practice.

We found clear infection prevention control signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

The home was accessing regular testing, which had assisted them in identifying and managing an outbreak of COVID-19. All staff and people had received both their COVID-19 vaccinations.

Risks in relation to visitors had been assessed and action taken to minimise risks. At the time of the inspection the home was closed to visitors.

Staff were seen to be correctly wearing personal protective equipment (PPE).

Staff said they had been well supported by the provider during the pandemic and had been kept up to date with all the government guidance. The registered manager had moved in on the premises through COVID-19 to support staffing in the home.

The service is registered to provide care and support for up to 31 people, some of whom are living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. At this inspection there were 24 people living at the home, one of whom was in hospital.

This comprehensive inspection took place on 14 December 2017 and was unannounced. At the last inspection in August 2017 we rated the service as 'Requires Improvement'. Although the provider had made significant improvements and was no longer in breach of the Regulations, we found further improvement was required to make sure new work practices were embedded and sustainable.

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

At this inspection we found further improvements had been made and these had been sustained.

There was 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.

People told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

The systems in place to make sure that people were supported to take medicines safely had been improved and were effective.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. 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.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People’s needs were regularly reviewed and appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a concern if needed.

The manager had good oversight of the service and there was a clear ethos of care. The registered manager had made improvements at the service since they started in post and these had been sustained. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified. The provider was actively involved in service development.

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

Morley Manor Residential Home is registered to provide care and support for up to 31 people, some of whom are living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. At this inspection there were 24 people at the service.

At this inspection we found the provider had made significant improvements and was no longer in breach of the Regulations. However, further improvement was required to make sure new work practices were embedded and sustainable.

At the time of our inspection, there was not a registered manager in place. However, the manager became registered shortly after the inspection. 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 told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

The systems in place to make sure that people were supported to take medicines safely were more robust, but needed further improvement to become safe.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. 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.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans had been rewritten and showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People’s needs were regularly reviewed and appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a concern if needed.

The manager had good oversight of the service and there was a clear ethos of care. The manager had made improvements at the service since they started in post. However, some aspects of service provision, such as medicines administration, required closer monitoring. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

At this inspection we found the provider had not made sufficient improvements, and remained in breach of the three regulations identified at the last inspection. In addition we identified further breaches.

Morley Manor is registered to provide care and support for up to 31 people living with dementia. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. There was a manager in post when we inspected. They had not applied to register with us. 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 found risks associated with peoples’ care and support was not always robustly assessed. In addition we found there were no environmental risk assessments in place. We had raised this with the provider at our last inspection.

There was a lack of training in place to ensure staff were clear about how to evacuate the building in the event of a fire.

Recruitment of staff was not always carried out safely. We saw some files contained only one or no employment references. We did see checks had been made with the Disclosure and Barring Service, however.

People told us they felt safe, and that staff were present in sufficient numbers to meet people’s needs. We saw the manager used a dependency tool to calculate the numbers of staff required to meet people’s needs, however this was not being used correctly or kept up to date. In addition we found staffing rotas did not always accurately reflect the number of staff on duty.

Most staff we spoke with understood the principles of safeguarding and said they had received training in this area. We saw 15 out of 24 staff had received training, meaning we could not be sure all staff had the knowledge necessary to keep people safe from the risks of abuse.

People’s medicines were managed and stored safely, and we saw records relating to the administration of medicines were up to date and correctly completed. Staff practice with medicines was observed to be good, however we received some conflicting information about whether one person received medicines without their knowledge

We saw the provider had made improvements to the décor of the home, and we saw certificates showing maintenance of fixtures and fitting s was kept up to date. We saw large amounts of people’s clothing waiting in the laundry which had not been returned to people. We found the sink unit in the dining room still required attention relating to cleanliness and repair..

We found people’s capacity to make decisions was still not being assessed in accordance with the Mental Capacity Act 2005. Care plans lacked evidence of best interest decisions and consent to care and support, although people told us they were asked for consent before receiving assistance from staff.

We found levels of training received by staff was often low, and this impacted on their ability to provide effective care for people.

People gave good feedback about meals served at Morley Manor, and we saw people were offered choice. Staff had good understanding of people’s dietary requirements, and we saw the chef was actively getting feedback from people about the food so that new menus could be devised.

Information which personalised people’s care plans had been removed since our last inspection, and we did not see evidence that people had been involved in writing them.

We observed good staff practice throughout the inspection, and saw there was a caring approach to providing care and support to people. We saw staff reassured and encouraged people when this was needed, and dealt effectively with situations when people were upset or annoyed by others.

Although the provider was assessing people’s needs before they started using the service, this information was not always used to produce care plans in a timely way. In addition we found that changes in people’s care and support needs were not always documented in their care plans.

There was a lack of information in the home about the provider’s complaints procedure. Although we saw some evidence complaints had been responded to, the manager could not locate all the information relating to complaints received.

People had opportunities to participate in a range of daily activities.

There was a manager in post; however they had not applied to register with the CQC. We found a lack of clear delegation and leadership in the home.

The provider was not providing formal supervision for the manager, although we had asked them to take action about this at our last inspection. We saw evidence some management meetings had taken place; however there was no mechanism in place to ensure the manager received support to be effective in their role.

Audit processes were still not robust and well-managed, and information was not always accurate. There was no defined programme of audit in place, and activity was ad hoc.

The overall rating for this service is ‘Inadequate’ and the service remains 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 identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will report on the action taken in relation to five of these when it is complete. We dealt with the breach related to display of ratings outside of the inspection process.

Our inspection took place on 5 May 2016 and was unannounced. At our last inspection on 30 October 2015 we rated the service as requires improvement and identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always being treated with dignity and respect, medicines were not always managed safely, infection control practices were not always well managed, staffing levels were not planned to meet the care and support needs of people using the service and we found staff were not supported to be effective through planned training, supervision and appraisal. At this inspection we found the provider had made improvements in these areas in line with their action plan.

Morley Manor is registered to provide care and support for up to 31 people living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. Accommodation is arranged over two floors connected by a lift. There are two communal lounges in use, a dining area and a conservatory. There were 26 people using the service on the day of our visit.

There was 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.

There was an inconsistent approach to documenting and managing risks associated with people’s care and support needs. Some health monitoring systems such as those designed to assist with the management of pressure sores were out of date or not being used effectively.

Some aspects of people’s personal hygiene was not well managed. We saw cloth flannels were used when assisting people to wash their bodies and faces. These were not kept unique to one person or body area. When they were dirty they were sent to laundry and re-used when needed. We asked the provider to stop this practice on the day of our inspection.

We found a fire door was secured with a coded lock to protect people from the risk of falls down the staircase at the other side of the door. Only one member of staff on duty when we arrived knew the code to unlock the door. Three of the four staff on duty when we arrived told us they had not taken part in a fire drill and the fourth said they had not received any evacuation training but had taken part in an evacuation when the fire alarm had been triggered accidentally. Fire extinguisher checks were out of date.

Staff understood their responsibilities in remaining vigilant for and reporting any evidence of abuse. They told us the registered manager would act on what they were told.

We found there were enough staff on duty to meet people’s care and support needs. People who used the service said they were not kept waiting when they needed assistance.

The provider ensured that recruitment of new staff was safe, and we saw evidence checks such as references being taken and checks being made with the Disclosure and Barring Service.

Medicines were managed safely and records were kept up to date. We noted the temperature in the medicines storage room had occasionally risen above the maximum recommended level to ensure the safe storage of medicines, and asked the provider to take action to prevent this happening again.

We found that consideration was not always given to whether people who used the service needed a Deprivation of Liberty Safeguard. We found a lack of structure in the approach to assessing people’s capacity to make decisions, and evidence that staff did not always understand these processes thoroughly.

Staff files showed there was an induction programme in place; however staff were not always confident this had been thorough. Staff we spoke with told us many of the assessments to measure their competence in key areas were in the form of workbooks which they completed at home.

We saw there was a plan in place to ensure staff had regular supervision meetings and appraisals with line managers to discuss their performance and training needs.

People gave good feedback about the meals provided at the home, and we saw the lunchtime service was relaxed and enjoyable. Staff had time to support people effectively, and knew people’s likes and dislikes.

People who used the service told us they had a good relationship with the staff. We saw staff practice relating to people’s privacy and dignity was good and we observed people were given reassurance when they were upset and staff were patient and caring when giving assistance.

Reviews of care plans did not always evidence the service was responsive to changes in people’s care and support needs. Some changes in risk were not documented in care plans Some people did not have care plans for up to eight weeks after moving to Morley Manor.

We saw improvement in the activities on offer to people, with evidence a varied programme was led by the activities co-ordinator.

The provider had policies and procedures in place to ensure any complaints or concerns raised were well managed.

Staff we spoke with told us there had been improvements in the home since our last inspection. They said they felt less pressured and enjoyed working in the service.

The registered manager did not have effective supervision in place, and the provider agreed during the inspection to seek a registered manager from another service who could provide this support. A new post had been created to support the registered manager but we found their role was not clearly defined.

There were systems in place to monitor and improve quality in the service; however some audits were not always sufficiently robust and we discussed improvements with the registered manager during the inspection. Staff had opportunity to contribute to the running of the home through regular meetings, and we saw plans in place to improve engagement with people who used the service and their relatives.

The rating for the ‘Safe’ domain was inadequate at our last inspection, and remains inadequate after this inspection. This means the service has been placed 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 or 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.

During the inspection we identified 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 the report.

Due to the complex needs of people using the service we were unable to speak with many people. To help us understand the experiences of people using the service, we observed the care being provided, spoke with staff and spoke with the relatives of three people who used the service. The three relatives we spoke with were very happy with the care provided by staff. One relative said; 'The staff are brilliant. They ring me and keep me informed. I'm involved in the care planning and met with [my relative's] key worker.' Another relative told us; 'The staff are nice. I'm happy with the care.' One relative commented that they had seen a massive improvement with their relative.

We found improvements had been made since the last inspection. For example, new care plan documentation had been introduced and staff were more focused on people's needs. However, we found there were still areas of non-compliance but because of the improvements made, the risk to people had been reduced. We will continue to monitor this location and to work in partnership with the Local Authority Contracts team and the Local Safeguarding Authority.

Due to the complex needs of people using the service we were not always able to speak with people. To help us understand the experiences of people using the service, we observed the care being provided, spoke with staff and spoke with the relatives of one person who used the service.

We observed that people appeared clean and dressed appropriately. We saw people were able to wander freely around the home. One relative told us; 'My [relative] is settled here. The staff are absolutely brilliant. They show so much care and keep me informed.'

We looked at three care records and found care plans were very basic and lacked sufficient detail to show how a person wished to be cared for. We found that where people did not have the capacity to consent, the provider did not act in accordance with legal requirements.

We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found evidence that the provider had not notified the CQC of incidents that had occurred within the home. This included safeguarding incidents, which had not been referred on to other appropriate agencies.

People we spoke with told us they received care that was appropriate to their needs. One person told us "Staff are nice; I can do as I please here."

People living at the home told us their individual needs were met. One person told us "I can get up and go to bed when I like here".

Visitors told us they were involved in making decisions about their relatives care and treatment. They also said they were kept informed of any changes in the needs of their relatives. One person told us "If anything happens they let us know straight away, they keep us well informed."

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at the home. One staff member said "I like coming to work; it is like coming home from home".