Roseberry Court

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

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 they felt safe with the staff who supported them. Staff had received training in safeguarding and felt confident in the processes in place to report any concerns. Risks to people's health, safety and wellbeing had been assessed and staff understood how to help keep people safe.

Medicines were managed and administered safely, with regular checks completed. We were assured by the measures in place to help ensure the prevention and control of infection.

Staff were attentive to people’s needs. The registered manager monitored staff deployment and ensured enough staff were on duty. Processes in place ensured staff recruitment was safe with a range pre-employment checks completed.

People were supported by caring, friendly staff who knew their needs well. People told us staff were skilled in their roles. Staff received required training and checks to ensure they followed best practice guidance.

People received an initial assessment of their needs. Care records included up to date information which evidenced people’s involvement with their care, support and regular reviews. Care provided was personalised and supported people’s preferences and wishes.

People’s health needs were being met. The service worked closely with other health professionals and external agencies to support them with their health and wellbeing. A health professional told us the service worked well with them to ensure people’s needs were met and responded positively to any guidance provided. We saw improvements in managing people’s nutritional needs and the service has worked with partner agencies to build staff knowledge in this area.

People and staff spoke positively about the management of the service and their openness to feedback. The management team was approachable, maintained regular communication, and listened to the views of others.

A range of audits and checks were completed to maintain and where required, implement any required improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at least inspection and update

The last rating for this service was requires improvement (published 26 January 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Follow up

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

Roseberry court is a residential care home providing personal care for up to 63 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 60 people using the service.

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

Records and documentation were disorganised, not always up to date, insufficiently detailed or missing. Quality assurance checks were undertaken regularly and identified issues within the service however, the issues found continued to occur.

Records regarding risks to people were not always robust. The provider did not always have effective systems in place to ensure that accurate and up to date records were kept for people who used the service. Some care plans held conflicting or had missing information recorded. Medicines were not always managed safely and in line with best practice guidelines. Infection control guidance was not always followed.

Staff had relevant training to support the needs of people in the home. Deprivation of Liberty Safeguards (DoLS) were in place for people, however, people were not always supported in their best interests because conditions of their restrictions were not complied with. We have made a recommendation about this.

The home had been recently decorated and had a homely feel.

People were supported by kind and patient staff. People were encouraged to follow the routines of their choice. Their dignity and privacy were respected.

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 requires improvement (published 21 July 2021) and there were 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 regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 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 good governance and safe care and treatment 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 and 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.

Roseberry Court is a purpose-built residential care home in Redcar and Cleveland. Personal care is provided for up to 63 people aged 65 and over across three floors in the service. At the time of the inspection there were 42 people living at the service.

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

Staff understood people’s risk, however staffing levels did not allow for sufficient oversight of risk. Continued improvements were needed to fully oversee risk in the home. Accidents and incidents were monitored. Medicines were safely managed. Good infection prevention and control procedures were in place. People were happy with their care.

Quality assurance measures had been inconsistent in identifying where improvements needed to be made. A small number of notifications about events taking place at the service were not submitted in a timely manner.

Staff said they enjoyed working in the service. They were positive about the support they received from the manager.

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 requires improvement (published 12 May 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 and 11 March 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Roseberry Court 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 staffing levels and quality monitoring. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an improvement plan from the provider to show what changes they will make to ensure they improve their rating to at least good. 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.

Roseberry Court is a residential care home providing personal care to 63 people aged 65 and over. At the time of the inspection 50 people were living at the care home. It is a purpose built building and care is provided over three floors.

We found the following examples of good practice.

Good procedures were in place for visitors to minimise the risks of infection. Staff had completed training in infection control and personal protective equipment (PPE). Regular checks of practice had taken place.

Staff were observed wearing PPE correctly. It was readily available throughout the home. People and staff had participated well in testing. Where needed, best interest decision making had taken place.

People’s well-being was supported. They were supported to keep in contact with their loved ones. Good practices were in place to support staff well-being.

Staff had been flexible with their working hours to ensure there were enough staff on duty to safely support people. Staff had been supportive of each other.

A review of the building had been carried out to consider how social distancing could be achieved. Good practices were in place to ensure high risk touch points were regularly cleaned.

Risk assessments were in place for staff where needed. Policies and procedures to manage the risks of infection had been reviewed. Feedback from an infection prevention and control team had been addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Roseberry Court is a residential care home providing personal care to people aged 65 and over, including people living with dementia. The service can support up to 63 people; 56 people were using the service when we inspected.

The care home accommodates people in one adapted building over three floors. One of the floors specialises in providing care for people living with dementia.

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

Since the last inspection there had been changes in management and the provider had not sustained good governance at the service, which meant there was an increased risk of people receiving inconsistent care. The provider’s audits had not always been effective in identifying and monitoring issues in the service. This included shortfalls in care records, environmental risks and fire safety. The provider was aware of issues within the service and was working with the new manager to understand these in more detail and address them.

People were at increased risk as staff were not always deployed effectively to keep them safe and provide quality care. At times people were left unsupervised and were able to access objects that could pose a risk to them. Improvements were seen on day two of the inspection and were welcomed by the staff team, but these had yet to be fully embedded.

People received effective care; they and their relatives were involved in developing their care plans and reviewing these. Work was ongoing to improve staff training.

Staff understood the importance of consent and supported people to make decisions about their care. 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 were supported by kind and patient staff. They benefited from these interactions. People received a consistently caring approach by staff, who provided them with reassurance. People were encouraged to follow the routines of their choice. Their dignity and privacy was respected.

People were treated as individuals. Staff worked to promote social inclusion and provide people with stimulation. Activities were led by a skilled activities coordinator, this had a positive impact on people’s wellbeing. People and their relatives felt able to raise any concerns, which were listened to.

Staff were passionate about providing people with good quality care. Feedback from people and their relatives was encouraged by the provider and used to improve and develop the service.

The service was well established within the community. The provider and manager were working to improve communication with community professionals to support their plans to improve the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance. Please see the action we have told the provider to take at the end of this report.

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.

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities are available within each unit. There is an enclosed garden/patio area for people to use. At the time of our inspection there were 61 people who used 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present on the day of our inspection, however we spoke with them after our inspection visit.

The registered manager and staff displayed clear enthusiasm to make a positive difference to people's lives. Activities were stimulating, outings and events were well thought through, varied and in plentiful supply. There was a ‘Three wishes campaign’. People who used the service were asked to write down things they wanted to accomplish over the coming year. Staff then worked hard to make sure at least one of their wishes came true. People who used the service told us this had happened and their wishes had been granted. There were meaningful activities for people living with a dementia and thought had been given to the layout of Grace Unit to ensure it enhanced the life of people living with a dementia. Themed areas had been created in corridors which encouraged people to stop, look and interact with the surroundings and others.

People were protected by the services approach to safeguarding and whistle blowing. People told us they felt safe and could tell staff if they were unhappy. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This enabled staff to have the guidance they needed to help people to remain safe. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked.

There were sufficient staff on duty to meet the needs of people who used the service. There was a system in place to ensure that staff recruited had the appropriate skills and experience and were of good character.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

People were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks.

Care plans detailed people’s needs and preferences and were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and provider, to monitor and improve the quality of the service.

Further information is in the detailed findings below.

We visited the service again on 19 May 2016 when the Care Quality Commission and the local authority received safeguarding concerns in relation to the care of people who used the service and about staff's lack of understanding of positional changes when people were in bed and pressure area care was required. There were also concerns of inconsistency in care records such as positional charts, fluid balance charts and end of life care plans. After receipt of the concerns there was a multidisciplinary team meeting chaired by the local authority to consider the serious concerns protocol and we attended this meeting. At this meeting the multidisciplinary team concluded that there were serious concerns about Roseberry Court. The registered provider developed an action plan detailing the steps they were to take to address the concerns. After the initial meeting the local authority placed a block on all new admissions, however, this was quickly lifted as the registered provider worked swiftly to make improvements. During this time, representatives from the local authority visited the service to review people who used the service and to check for improvements. Following their visits, representatives from the local authority gave us feedback and told us there was much improvement.

The focused inspection on 19 May 2016 was to check the service had sustained improvement. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. At our inspection on 19 May 2016 we found that the registered provider had followed their action plan and improvements had been made in all areas.

At the end of October 2016 the Care Quality Commission and the local authority received further information of concern in relation to the care and welfare of people who used the service. Allegations were made that the call bells used by people to summon the help of staff had been unplugged on occasions, staff ignored people who used the service, medicines had not been given at the right time and there was secondary dispensing of medicines. This is when one care staff member removes the medicines from the original dispensed container, puts this into a pot then gives to another care staff member to give to the person who used the service. Other concerns included people missing meals and inappropriate food being given to people who had been assessed as needing a soft diet. Allegations were made that staff shouted at people and staff were rushing people to bed early.

The local authority is currently undertaking an investigation into the concerns and allegations made. However, we undertook a focussed inspection of the service on 13 December 2016 to make sure people were safe, happy and well cared for. This report only covers our findings in relation to those/this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseberry Court on our website at www.cqc.org.uk”

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities were available within each unit. There is an enclosed garden/ patio area for people to use. At the time of our inspection there were 57 people who used the service.

People told us they felt safe and that staff were kind, caring and attentive. Staff were able to tell us about different types of abuse. Staff were aware of action they should take if abuse was suspected and were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures. All staff we spoke with told us abuse and safeguarding was discussed with staff on a regular basis and that the registered manager encouraged staff to speak up if they had any reason for concern.

We spent time with people on all units and looked in bedrooms. We saw that the call bells used by people to summon the help of staff were plugged in as they should be with a green light showing they were active. When people called for help they were attended to in a timely way.

We spent time with people living with a dementia who were unable to use the call bell to summon the help of staff. We saw that staff were visible during the inspection and attentive to people’s needs. We saw that staff checked on those people who wanted to spend time alone in their bedroom.

People told us they were able to make choices about when they wanted to get up or go to bed. Relatives confirmed that they were involved with care planning for those people who were living with a dementia and they had been asked for the person’s routine and preferences prior to moving into the service. This helped to ensure the person received the care that was acceptable to them.

Generally, there were good systems in place for the management of medicines. People we spoke with during the inspection told us they received their medicines as prescribed. Some improvement was needed to ensure that waste medicines were stored in line with the homes own policy or national guidance and to make sure people received their inhalers as prescribed. The registered manager assured us at the time of the inspection that they would take immediate action to address this.

We spoke with staff about secondary dispensing of medicines. Staff told us only senior staff were responsible for the administration. Care staff told us they were not aware of any secondary dispensing of medicines.

Staff were aware of those people who used the service who required a specialist diet. Staff were very knowledgeable about the people they supported and were able to tell us about people who were diabetic, or on a soft, altered consistency or fortified diet. A fortified diet is where meals are adapted by adding small quantities of everyday foods, such as cream, butter, milk, and milk powder, which increases the calorie and nutrient content without increasing portion size. Staff told me that this information would be available in the persons care plan also.

After receipt of the concerns there was a multidisciplinary team meeting chaired by the local authority to consider their serious concerns protocol and we attended this meeting. At this meeting the multidisciplinary team concluded that there were serious concerns about Roseberry Court. Other meetings were held to manage and monitor the serious concerns about the service. The registered provider developed an action plan detailing the steps they were to take to address the concerns. After the initial meeting the local authority made the decision to place a block on all new admissions and the registered provider agreed and complied with this, however, this was quickly lifted as the registered provider worked swiftly to make improvements. During this time representatives from the local authority visited the service to review people who used the service and to check for improvements. Following their visits representatives from the local authority gave us feedback and told us there was much improvement.

We undertook a focused inspection on 19 May 2016 to check the service had sustained improvement. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. At our inspection on 19 May 2016 we found that the registered provider had followed their plan and improvements had been made in all areas. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Roseberry Court on our website at www.cqc.org.uk”

Roseberry Court provides care and accommodation to a maximum number of 63 people. Accommodation is provided over three floors. The ground floor of the home can accommodate a maximum number of 18 people who require personal care. The first floor of the home can accommodate a maximum number of 24 people who require personal care. The second floor can accommodate a maximum number of 21 people living with a dementia. Communal lounge and dining facilities were available within each unit. There is an enclosed garden/ patio area for people to use. At the time of our inspection there were 59 people who used the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was on sick leave at the time of the inspection; however a registered manager from another home in the organisation was managing the service on a day to day basis.

At the time of the inspection there wasn’t any person who used the service who was nearing the end of their life; however we were shown a standard set of end of life documentation which was to be used by staff at the service. This included positioning charts, body mapping charts and food and fluid charts. The end of life plan had space to record information important to the person such as any wishes, a personal cleansing care plan and any relevant risk assessments. Management and staff told us how they regularly checked people’s pressure areas and quickly reported any deterioration to district nurses. The end of life care plan was also to include a document called Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), this is a document that informs staff and other professionals not to make efforts to restart breathing and / or the heart in cases of respiratory / cardiac arrest.

We saw records which confirmed people’s pressure areas were regularly checked and people’s risk of developing pressure damage was regularly assessed. Staff spoke knowledgeably about providing pressure area care to people and told us they had received training, guidance and support from the management team. When people were identified at risk of developing pressure ulcers specialist pressure relieving mattresses were placed on their bed.

At the end of each shift senior staff did a handover report detailing important information on people who used the service. This now included new information or updates on those people identified at risk or who had any pressure damage to their skin. At the end of each day management checked the handover sheets and if there were any reports of redness to the skin or pressure ulcers they checked the persons care plan to make sure this had been updated.

Where needed, staff also kept a record of people’s food and fluid intake and this included detailed information on the portion size people had eaten and how much fluid taken orally.

The registered provider has also reviewed their training in tissue viability, dying death and bereavement and end of life.

An expert by experience spoke with people who used the service, relatives and staff. The inspector spoke with people who used the service and staff. We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People told us that they felt comfortable in raising a concern or complaint with the manager or staff.

The inspection team was made up of one inspector and an expert by experience. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that their rights and dignity were respected.

Care plans and risk assessments were in place and were updated as people's needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

People were cared for in safe, accessible surroundings that promoted their wellbeing.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and there was evidence to show that these had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed and where possible people and their relatives were involved in writing the plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends were regularly asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

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 knew how to make a complaint if they were unhappy. Discussion with the manager and operations manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

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

What people told us.

During the inspection we spoke with 12 people who used the service and two relatives. We also spoke with the manager, the operations manager, the head chef, the head of care, the activity co-ordinator and with care staff.

People who used the service told us that they were very happy with the care and service received. One person said, 'People treat me with such kindness.' Other people said, 'Staff can't do enough for you.' 'Care couldn't be better.' 'Happy with the care I get.'

People told us that they were happy with the food that was provided. One person said, 'Excellent food, good choice.' Another person said, 'We even get supper.' People told us that they felt safe. One person said, 'I sleep better here than at home.'

People told us that they felt comfortable and spoke to staff if they were concerned or had a complaint. One person said, 'Would go to the horse's mouth.' A relative we spoke with said that they were not aware of the complaints procedure but that they would speak with a care staff member who was in charge if they had a problem. The relative told us that they had not needed to raise any concerns with staff in the last five years.

The activity co-ordinator told us that 'We are one big happy family; everyone knuckles down to help when an activity is planned.'

The head chef told us about a dining experience that they had created on the second floor for those people living with a dementia. At tea time staff took people who used the service to their rooms to freshen up. People who used the service, who were able, then helped staff to set the tables. During this time staff talked to people about the meal. People were given a drink and encouraged to converse with each other. Food was then served whilst soft music is played in the background. We were told that this experience was started for people who lived with a dementia as they were at the highest risk of weight loss. The head chef told us this had helped people to gain weight and to be discharged from the dietician.

You can see our judgements on the front page of this report.

We found the home had improved the medication records and systems to make sure people's medication was managed in a safe way.

We used a number of different methods to help us understand the experiences of people who used the service, because some people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two relatives who said, I am happy with everything.' Another relative said, 'I'm quite impressed with the home and staff are good at communicating with me.'

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

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 that appropriate recruitment procedures were in place.

We found people expressed their views and were involved in making decisions about their care and treatment. Also care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

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

We observed staff interacting well with people. We saw staff singing along to music and encouraging people to join in. We saw one member of staff brought in newspapers and magazines for people to read. We observed one member of staff sat and read through a magazine with one person when she was getting restless. We saw that these interactions had a positive impact on people's wellbeing. We saw that not all of the people were involved in activities; therefore for some people this interaction was limited. It was clear from talking to staff that they were aware of people's needs and support required, however we found this was not always documented sufficiently in the care records.