Archived: Aveland Court Care Home

Aveland Court is a residential care home providing personal and nursing care to 11 people aged 65 and over, some of whom were living with dementia and mental health conditions, at the time of the inspection. The service can support up to 30 people.

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

The provider’s wider quality assurance and governance systems had not always ensured actions were taken to address any issues and risks in a timely manner.

The provider had failed to sustain improvements in the service. The provider had failed to act upon known areas of concern, non-compliance and risk to improve the quality of care for people at Aveland Court. This had exposed people to on-going poor care and risk of avoidable harm.

The provider had not properly maintained the premises to ensure people and staff were protected from risks associated with their environment. We found some aspects of the environment unsafe and parts of the building in need of extensive refurbishment. This put the health and safety and well-being of people using the service at risk. We asked the provider to take immediate action to address these concerns during the inspection.

We were not assured that safe infection prevention and control (IPC) measures were being followed. Whilst we observed cleaning taking place during the inspection, the premises did not look clean or hygienic because of the general disrepair and poor condition of the carpeting, paint work and wallpaper. We were not assured that the provider was preventing visitors from catching and spreading infections as staff were not following government guidelines in relation to visitors coming into the service.

People's monitoring charts were not being completed consistently to ensure staff had sufficient oversight of each person's needs and changing risks. For example, repositioning charts did not always show people had been repositioned as documented in their care plan to avoid the risk of skin damage.

Medicines had not always been administered as prescribed to support people's well-being. People did not always have access to their medicines when they needed them. Medicines were not being stored safely.

We received negative feedback from relatives about how the service was managed. Relatives told us they did not have confidence in the management at the service.

People and their relatives had limited opportunities to express their views about the service or influence changes. Relatives told us they had not been asked for feedback and reported a lack of communication and information from the provider.

People told us they were happy living at Aveland Court and relatives felt that people were safe. Staff spoke confidently about how they would protect people from harm and said they were confident any concerns raised about poor practice and/or people’s safety, would be addressed promptly by the manager.

There were enough staff on duty to meet people's needs. We observed staff were attentive and responsive and call bells were answered promptly. Robust recruitment practices ensured the right staff were available to support people safely.

Accidents and incidents were recorded and reviewed by the new manager. Where people had accidents, involvement from health care professionals was sought when required.

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 16 December 2020). The service remains rated requires improvement.

Why we inspected

The inspection was prompted due to concerns received about infection prevention and control practices within the service. As a result, we undertook a focused inspection to review the key questions of safe and well led.

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 and well led sections of this report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aveland 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 monitor the service.

We have identified breaches in relation to risk management, infection prevention and control, medicines and the governance and leadership of the service at this inspection.

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

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

Follow up

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

Aveland Court is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

We last inspected this service on 3 and 4 March 2020, the service was rated as Inadequate because we found the registered provider to be in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action to impose conditions on the providers' registration to help ensure that people were no longer exposed to the risk of harm.

Following the last inspection, we asked the provider to complete monthly action plans to show what they would do and by when, to improve.

During this focused inspection on 24 and 25 November 2020, we found that significant improvements had been made towards meeting the requirements to help ensure that people received safe, effective care.

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

The provider had appointed a new management team providing stable, consistent leadership and support. The management team demonstrated a commitment to driving continued improvement to develop the service and provide people with person centred, high-quality care.

People, their relatives and staff told us the managers were open, supportive and displayed good management skills. Robust systems had been developed to assess and monitor the quality of service offered to people.

People told us they felt safe living at the service and our observations found they were comfortable in the presence of staff. Since the last inspection the management team had developed robust safeguarding policy and procedure. Safeguarding training had been implemented and all staff had been trained to recognise and protect people from the risk of abuse.

Risks to people’s health and well-being were being assessed, mitigated and managed. All care plans had been reviewed and now accurately reflected people’s individual needs.

People were supported to eat and drink enough to maintain their health and reduce the risk of dehydration and malnutrition. People's nutritional needs were assessed and there was information in care plans detailing people's nutritional needs.

People were supported to maintain good health and access healthcare services. When people required extra support from health professionals, staff were seeking advice and support and following guidelines to keep people safe and well.

Medicines management had improved since our previous inspection. People received their medicines as prescribed for them.

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 being cared for by staff that had the necessary skills, knowledge and understanding. Since the last inspection the management team had introduced a comprehensive training programme in a range of subjects to ensure staff knew how to care for people safely and reduce the risk of harm.

There were enough staff working at the service and we saw that recent recruitment files contained the records necessary to evidence that people were protected by staff that had been safely recruited.

The home was clean and tidy on the day of our inspection and the provider had appropriate systems in place to prevent the risk of infection.

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 29 May 2020) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 March 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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, Effective 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 coronavirus 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 has changed from Inadequate to 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 Aveland Court on our website at www.cqc.org.uk.

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.

Aveland Court is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

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

Since the inspection in August 2019, frequent changes of management led to a lack of leadership, and oversight of the service. This had impacted on the quality of the service provided and resulted in risks to people's safety not being identified and managed effectively. At the time of this inspection the provider had taken steps to strengthen the leadership at the service and had appointed an experienced head of operations. They were also in the process of recruiting a new manager.

Systems and processes to monitor the safety and quality of the service continued to be ineffective. The provider had failed to act following our last inspection and had also not identified the additional concerns we identified during this inspection.

People were not always being safeguarded from the risk of abuse. Staff were not all following the safeguarding process and staff did not always recognise potential safeguarding concerns, as a result these were not appropriately escalated.

People were not always safe and were at risk of harm. We continued to observe staff using unsafe moving and handling techniques. Risks were not always identified, assessed, or include sufficient guidance for staff. People's monitoring charts were not being completed consistently; such as, charts monitoring food and fluid intake and repositioning.

People were not always supported to eat and drink enough to maintain their health and reduce the risk of dehydration and malnutrition.Sufficient risk assessments or management plans were not in place to support staff to effectively manage the risk.

Care plans did not always contain enough information to ensure staff knew how to deliver appropriate person-centred care based on people's needs and preferences. Where information was recorded this was not always accurate, up-to-date and did not provide evidence of staff interventions.

Medicines had not always been managed safely, and we were not assured people received their medicines as needed and as prescribed.

People did not always have access to health care professionals to support them with their care and when healthcare advice had been given, this was not always followed.

Staff were not sufficiently trained to provide effective safe care. Staff had not received all the training and support they required. Reliable records were not kept of staff training.

There was not always a caring culture at the service, as people were not always supported in a respectful and caring way. Some people told us about interactions and conversations they had with staff that did not demonstrate care, compassion or understanding. However, we did see some caring interactions between staff and people and staff told us they were trying their best.

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 least restrictive practice.

Accident and incidents were not appropriately managed and there was no system in place to learn from incidents and prevent reoccurrence.

People were not always supported to engage in meaningful activities. For example, people being cared for in bed did not have access to organised activities or one to one activity.

At the time of this inspection the provider had taken steps to strengthen the leadership at the service and had appointed an experienced head of operations and an experienced manager. The service was continuing to be supported by and work with, the local authority safeguarding and quality teams to improve care.

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 7 September 2019) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of risks to people, medicines management, meeting people's eating and drinking needs, staffing levels, staff training, person-centred care and the governance of the service at this inspection.

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. At the last inspection we required the provider to update us on improvements being made. This will continue.

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

The overall rating for this service is 'Inadequate' and the service is therefore '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 six 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.

Aveland Court is a residential care home providing personal care for up to 30 older people. The home is registered with CQC to provide accommodation and care for older people who may be living with dementia, have a physical disability, a sensory impairment or an eating disorder. At the time of the inspection 24 people were living at the service.

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

Although some improvements had been made since the last inspection, people were not always protected from the risk of harm. Medicines were not always managed safely. Risks to people's safety had not always been assessed and detailed guidance was not always available. People were placed at risk from unsafe moving and handling techniques and from aspects of their environment.

People were not always protected by safe recruitment processes. The provider had not always obtained the necessary pre-employment checks before new staff started working at the service.

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 training records available did not evidence specific training was undertaken by staff to keep people safe and provide safe care and treatment.

Systems and processes to monitor the service had not been operated effectively to assess, monitor and mitigate the risks to people's health, safety and welfare. The provider’s quality assurance processes did not identify the issues we found at this inspection.

The registered manager understood their responsibility to be open and honest when things had gone wrong. They welcomed our inspection feedback and took action in response to the issues we found.

People, relatives and staff spoke highly of the registered manager and the positive culture they created. People told us they were happy living at Aveland Court and said they felt safe. There were enough staff to meet people's needs.

People had the opportunity to take part in activities and we saw people enjoying quizzes and musical entertainment during our visit. We made a recommendation about activities for people who may be at risk of social isolation.

Most of the service was designed to meet people's needs. However, we found improvements were required to promote people’s independence and safety. We made a recommendation about the environment.

People were supported by staff who were kind, caring and understood their likes, dislikes and preferences. Staff understood how to respect people's privacy and dignity and promote their independence. Care plans contained information to support staff in providing personalised care.

People told us they enjoyed the food, chose where they wanted to eat their meals and their food preferences were considered when menus were planned. Staff knew peoples' preferences and dietary requirements.

People's health care needs were monitored and responded to promptly. Staff worked with healthcare professionals to ensure people received positive outcomes.

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 18 August 2018) and there were multiple 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 improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 18 August 2018). The service remains rated requires improvement. This was the third consecutive inspection where the service has been rated as 'requires improvement'.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, recruitment processes, the Mental Capacity Act 2005, the provision of staff training and governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The home is in a residential area of Babbacombe, close to the town of Torquay. The home is close to local amenities and a transport network. Accommodation is provided over two floors, with a passenger lift providing access to the first floor. Bathrooms and toilets have been fitted with aids to support people with impaired mobility. There is an enclosed garden area which is private and not overlooked.

Aveland Court 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.

This inspection took place on 17 and 18 July 2018 and the first day was unannounced. The home was last inspected in June 2017 when it was rated as ‘Requires Improvement’. At that time, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to the safe management of medicines, the environment, record keeping and out of date policies and procedures.

At this inspection, we found improvements had been made to the environment and the home’s policies and procedures. However, we identified further improvements were required to the safe management of medicines as well as the quality of assessments, information and guidance provided in people’s care records.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Some people had not received their medicines as prescribed and their medicine administration records (MARs) were not accurate. We found that three people had not had their medicines on more than one occasion as their medicines had not been dispensed from the blister packs. However, the MARs had been signed indicating each person had received their medicines. There was no indication whether people had refused their medicines or had not been present in the home at the time the medicines were due to be taken. This meant it appeared these people had received their medicines when they had not. We also found the storage arrangements for medicines that required stricter controls did not meet the recommended standard as advised by the Royal Pharmaceutical Society. The registered manager addressed both of these issues immediately following the inspection.

People told us they felt safe living at the home. They described the staff as kind and caring. One person said, “I’ve got a great team here” and another person said the staff were “great”. A relative told us they felt “lucky” to have found Aveland Court and described the staff as “kind and considerate.”. Another relative told us their relative was well cared for, but felt some staff were kinder than others. Our observations throughout the two days of the inspection showed staff’s’ interaction with people was kind and caring.

People were supported by sufficient numbers of safely recruited staff. However, at times we observed people being unsupervised for long periods of time. While people did not show any signs of requiring assistance, we saw one person became distressed and shouted at other people. We have made a recommendation that the registered manager review how staff are deployed during their shift to ensure people have the supervision they require to respond to their needs and protect their safety.

Staff told us about the people they cared for and it was clear they knew people well. They were able to describe to us how they met people’s needs and minimised risks to their health, safety and well-being. However, people’s care plans and risk assessments did not contain this level of detail and forms used to monitor the care people received had not been fully completed. This meant it was not possible to ascertain from people’s care records what their specific care needs were or whether they had received appropriate care to meet their needs and mitigate risks.

Where people lacked capacity to make specific decisions about their care, assessments had not been completed appropriately and best interest decisions had not been recorded. However, throughout our inspection we observed staff seeking people’s consent before providing care and respecting people’s decisions about how and when they wished to be supported. A relative told us they were fully involved in making decisions about their relations care.

To protect people’s belongings and ensure people’s rooms were secure, bedroom doors had been fitted with locks. However, some of these locks would not lock open and for those people living with dementia, it had not been assessed whether people consented to their use or had the ability to open the lock and the door handle to leave their room when they wished to do so. This placed people at risk of not being able to leave their room without staff support. Following the inspection, the registered manager confirmed that people’s ability to use the bedroom door handle and lock had been reviewed and adjustments had been made for some people.

People told us they enjoyed the food provided at the home. We saw the lunchtime meal on both days of the inspection. These were well presented and people told they always had enough to eat. One person said, “You’d never go hungry with this cook.” While staff were aware of people’s nutritional needs, care records did not provide sufficient guidance about how to support people who were at risk of not eating or drinking enough to maintain their health.

People received support with their healthcare needs. Records showed people had regular contact with their GP and the community nursing service as well as having optician and dental checks. A visiting health care professional told us people’s care needs were well met by competent staff who communicated well and sought advice promptly.

The home organised a number of social activities during the week which people told us they enjoyed. During the second day of the inspection we observed people enjoying musical entertainment. We saw people singing and clapping and one person dancing with a member of staff. One person who participated in the singing told us, “I’ve had a lovely day.”

Staff told us they enjoyed working at the home and they received the training and support they required for their role. Regular staff meetings and supervision sessions provided staff with the opportunity to discuss their work performance and make suggestions for improvements.

People, relatives and staff told us they had faith in the registered manager and found them approachable. One relative told us the registered manager communicated well and kept them fully up to date with their relation’s care needs. People and relatives said they felt able to raise any concerns they might have about the quality of care with the staff and registered manager but had had no reason to do so. The registered manager told us the home had not received any complaints since the previous inspection.

The registered manager sought feedback from people and their relatives about the quality of the care and support provided at the home and acted upon suggestions for improvements. They were aware of their responsibility to keep CQC up to date with important events affecting the people’s well-being.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Aveland Court is a care home for up to 30 people some of whom were living with dementia. At the time of the inspection there were 24 people living at the service. At the last inspection in March 2015 the service was meeting the requirements of the regulations and was rated overall ‘Good’. At this inspection the service is rated ‘Requires Improvement’.

The service is in a residential area of Babbacombe close to the town of Torquay. The service is close to local amenities and a transport network. The service is set over two floors. It has been adapted to accommodate people who may require specific aids and adaptations for their health and wellbeing. There is an enclosed garden area which is private and not overlooked. Access is facilitated by a ramp for people with limited mobility or who require mobility aids.

Medicines requiring stricter controls were not being managed safely. The level of stock of these medicines did not reconcile with the records. Temporary secure storage facilities for medicines requiring stricter controls did not meet current safe guidelines. In that it was not fixed to a wall or floor. Prescribed creams were not being dated on opening and one person was having cream applied which was prescribed for another person. This meant people were not protected from the risks associated with unsafe medicine management.

One person required monitoring at specific times for their safety and welfare. There were gaps in these records where staff had not documented when the monitoring had taken place. This meant there was no clear audit record of what support they had received and when they had received it.

The service policies and procedures were out of date and had not been reviewed as specified in the services own records. This meant the service did not have current guidance on how it should operate in accordance with legislation.

The service was not always being maintained to a satisfactory level. One room had a damaged wall behind the door which exposed the wall cavity. Five of the eight rooms looked at had overhead lights which were not working. One of the rooms where an overhead light did not work also had a bedside lamp which was also not working. This meant some people did not have independent access to lighting when in bed.

There was not enough signage to support people with dementia move around the service and identify where they were. We have made a recommendation about this.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service and people’s needs were met in a timely manner. Staff were friendly and compassionate in their approach to people. People commented; “All the staff are very good. I feel well cared for” and “I am very satisfied with the staff team. I feel confident (name) is well cared for.”

People were assessed in line with the Mental Capacity Act 2005 (MCA) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made appropriately.

We observed staff supporting people in a safe way when they were helping to move them from their chair to a wheelchair. People’s assessments were reviewed and updated regularly to help ensure they reflected their changing needs.

Care plans were well organised and contained information covering all aspects of people’s health and social care needs. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate and when available, relatives were included in the reviews. A family member told us, “We are very happy with the care here. The staff contact me when there are any issues. Yes I feel confident.” People had access to healthcare professionals and their healthcare needs were met.

There was a relaxed approach to activities. Staff were familiar with the types of activities people liked either as a group or individually. People liked to take part in television quizzes which occurred on the day of the inspection and it was clear this was popular. In addition entertainers visited the service on a regular basis. Where people wanted to stay in their rooms this was respected by staff.

Staff were supported by a system of induction training, supervision and appraisals. Staff meetings were held to share information and encourage staff to make suggestions regarding any issues or ideas they may have.

We observed regular drinks and snacks were provided between meals to ensure people received adequate nutrition and hydration. Comments from people who lived at the home were generally positive about the quality of meals provided. One person said, “I like the food here. It’s homely and if I don’t like something there is always another choice.”

People told us they knew how to complain and would be happy to speak with the provider if they had any concerns. No concerns had been reported since the previous inspection.

People’s views were taken into account through satisfaction surveys, face to face discussions and formal meetings. This gave people and their relatives the opportunity to have their say and give their views about how the service was run and the quality of the service. The most recent survey showed people were satisfied with the service.

People using the service described the management of the service as open and approachable and thought people received a good service. Comments included, “I can always speak with the manager and they are always around to speak with” and “I’m confident with the manager and how the home is run.”

Equipment and supply services including electricity, fire systems and gas were being maintained. However on the day of the inspection a boiler failed resulting in lack of hot water in some rooms. This was addressed immediately by a contractor.

We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take in order to meet the requirements of the regulations at the end of this report.

At the previous inspection in February 2013, we found shortfalls in relation to staff training and supervision and quality assurance. During this inspection we found that improvements had been made.

Staff had received appropriate training to ensure they knew how to meet people's needs. Staff were well supported and received regular supervisions and appraisal.

People who lived in the home were asked about the quality of the service. People told us that their comments were listened to and acted upon. People told us "nothing could be better' and 'I'm very happy'. Regular checks and audits were in place to identify, assess and manage risks.

We toured the home with the manager, looked at bathrooms, toilets, dining rooms, lounges, the kitchen, hallways and bedrooms. We found that the home was clean and had processes in place to maintain a clean environment.

The manager checked the environment to ensure that cleanliness of the home was maintained. We saw that on every shift the care staff had cleaning duties and responsibilities. We saw that these had been completed and that the manager had checked that the required standard had been met.

All care staff (employed to provide care) had received training in infection control prevention. We saw from records that staff had completed training. Staff were able to explain to us what they would do if there was an infection control outbreak.

The home had policies and guidance in place that adhered to the department of health code of practice on the prevention and control of infections. The home had followed best practice.

People told us they were happy. One person said 'I'm very happy. I get well looked after here.' Another person said 'I am very lucky. It is very good indeed.' People told us they were happy with their care and support. We found that staff administered and recorded medicines safely.

We were told that food at the home was good. One person said 'The food is very good. There is a very good choice.' We found people were supported to access different areas in the home. One person said 'I do more or less what I want.'

People told us they were able to make choices. We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected. People told us that they felt safe and knew what to do if they had concerns. Staff knew what to do if they suspected abuse or poor practice. One person said 'I couldn't be any safer. The staff always check on me.'

We toured the home with the deputy manager looking at all areas of the home including bathrooms, toilets, bedrooms and communal areas. We found that some of the rooms were cluttered and not clean. We found thick dust in places.