Meadow's Court

Meadow's Court is a purpose built home, and registered to provide personal care and support for up to 60 adults with physical or age-related care needs. At the time of the inspection the home was supporting 48 people, some of whom were living with dementia.

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

Although we found improvements to the overall management of medicines, further improvements were needed to ensure people received their time critical medicines as prescribed. Quality systems were not always effective in identifying issues relating to the management of time critical medicines, risk assessments and mental capacity assessments.

Overall, 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. However, mental capacity assessments required further development to ensure these were decision specific and provided clear evidence as to when best interests should be followed and who should be involved. We have made a recommendation around this.

Staff were trained to recognise potential risks and signs of abuse. Staffing levels were safe. Staff used personal protective equipment (PPE) appropriately when supporting people and infection prevention and control processes were in place.

Staff and people told us there was a positive culture in the home and everyone spoke positively of the registered manager. People and staff were engaged in the running of the home, and people benefited from the home's partnership working with external agencies.

The provider and registered manager were responsive to concerns raised at the time of the inspection. They made some immediate improvements and had plans in place for further improvements.

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 22 April 2023) 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 improvements had been made but the provider remained in breach of a regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 26 January 2023 and 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 safe care and treatment and 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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Meadow's Court on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified a breach of regulation in relation to medicines at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation that the provider consider current guidance to ensure they were working within the principles of the MCA.

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.

Meadow's Court is a purpose built home, and registered to provide personal care and support for up to 60 adults with physical or age-related care needs. At the time of the inspection the home was supporting 45 people, some of whom were living with dementia.

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

The provider’s governance systems continued to fail to ensure people’s care in relation to their medicines, support and documentation was accurate and up to date. Quality assurance systems had failed to ensure people were supported by trained and well supported staff. There were limited opportunities for people and their relatives to provide feedback on the quality of care provided.

There was a lack of consistent leadership at the home. The service did not have a registered manager, though the provider had appointed a manager who had started on 16 January 2023.

People's prescribed medicines were not always administered safely and some medicines processes remained unsafe.

People did not always have care plans and risk assessments in place which reflected their changing needs and gave staff clear guidance on how to meet these.

People were protected from potential abuse and avoidable harm. 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 safely recruited staff. People were supported by enough staff to meet their needs in a timely way.

People lived in an environment that was clean and hygienic. Staff followed infection prevention control measures to ensure the risk of infection was managed. There was ongoing refurbishment and decoration. The health and safety of the environment, premises and equipment was maintained.

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 20 May 2022). 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. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 April 2022. Two 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 relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this unannounced focused inspection to check whether the provider had met the requirements for Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection was also prompted in part due to concerns received about management of risks to people, medicines, staffing and the management.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider still needs to make improvements in relation to people receiving safe care and treatment and governance arrangements.

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

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment and governance oversight systems at this inspection.

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

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

The provider had developed a range of audits following the last inspection but some related to people's care and the management of the service, had not been not fully embedded and were ineffective to drive improvements. There were limited opportunities to seek views about the quality of care provided from people, their relatives, staff and professionals and to influence changes.

Some areas of improvements were found in relation to managing risks to people and plans were in place to review their care needs. However, further improvements were needed to ensure key aspects of people's care were met. Information in people’s care plans and the guidance for staff to follow using the handheld devices was inconsistent, limited or not recorded. People’s care was not always monitored and there were gaps in daily care records.

People’s prescribed medicines were not always administered safely and some medicines processes remained unsafe.

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. However, there were no care plans in place to enable staff to support people where restrictions had been placed on their lives. The manager assured us this would be addressed immediately.

Staff recruitment had improved. Most staff had received training for their role such as medicines administration and topics related to managing risks to people, and health and safety. The manager had set dates for staff to complete the required training for their roles to provide effective care. There were enough staff and deployment of staff had improved. However, at busy times of the day people did not always received prompt support from staff.

People told us they felt safe. Staff knew what abuse was and were confident the manager would act on concerns. Safeguarding processes were followed.

Staff followed infection control procedures to keep people and visitors safe from the risk of contagious diseases including COVID-19 transmissions. There was ongoing decorating and refurbishment throughout the service.

Systems were in place to monitor incidents, accidents and falls and these were followed up appropriately. Lessons had been learnt and shared with the staff team when things went wrong and improvements made.

Rating at last inspection and update

The last rating for this service was inadequate (published 28 March 2022) 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 some improvements had been made and the provider was no longer in breach of some regulations.

This service has been in Special Measures since our last inspection in December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 7 December 2021. Four 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 Regulation 13 and Regulation 18. We also served a Warning Notice in relation to Regulation 17 (Good governance).

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have identified breaches in relation to people receiving safe care and treatment and governance arrangements.

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

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.

Meadow's Court is purpose built and registered to provide personal care and support for up to 60 adults with physical or age-related care needs. At the time of the inspection the service was supporting 44 people, some of whom were living with dementia.

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

People were at risk of serious harm. Medicines storage, administration and management were unsafe. Infection control procedures were not always followed to keep people, staff and visitors safe from the risk of contagious diseases including COVID-19 transmissions.

Risks to people were not always identified, managed or monitored to ensure people were safe and protected from harm. Care plans were not up to date and lacked guidance for staff to provide safe care. Guidance provided by health care professionals was not always clearly recorded or followed by staff. Systems to monitor and review risks to people and their care plans was not effective.

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. Further action was needed to ensure the policies and systems in the service were followed. Systems and processes to protect people from the risk of abuse and improper treatment was not robust.

There were not enough staff to meet people’s needs safely. The deployment of staff was not managed. Systems to ensure staff were trained and supported in their roles and were not effective.

The provider did not have robust oversight and audits were ineffective as these failed to identify issues which placed people at risk of harm. Lessons had not always been learnt when things went wrong.

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 rated good (published 6 March 2021). At this inspection the service deteriorated to inadequate.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The inspection was also prompted in part due to concerns received about risks to people, medicines, infection control, staffing and the management of the service. We decided to inspect and examine those risks.

This report only covers our findings in relation to 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. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadow’s 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 safe care and treatment, service users from abuse and improper treatment, staffing and governance and quality monitoring good 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the provider's 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.

Meadow’s Court is purpose built and registered to provide personal care and support for up to 60 adults with physical or age-related care needs. The accommodation is provided over two floors, with communal facilities which include lounges and a dining room being located on the ground floor. At the time of the inspection the service was supporting 53 people, some of whom were living with dementia.

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

Staff were seen to be wearing PPE; however, many staff were observed not wearing their mask appropriately. This was highlighted to the registered manager at the time of our site visit. The service had a ‘visiting pod’ which provided independent access for family members to visit their relatives. All visitors to the service were required to wear personal protective equipment (PPE). Service users and staff were routinely tested for COVID, and all service users and staff had been offered their first COVID vaccination.

People’s records identified the care and support they required to maintain their safety and wellbeing. Potential risks were assessed. However, some people’s records did not consistently document information between differing records which detailed people’s care needs. Accidents and incidents were recorded; however, the cause was not always analysed to help prevent further occurrences.

People said they felt safe at the service. Checks were carried out as part of staff recruitment. Staff undertook training in topics related to the promotion of people’s safety, health and welfare. Staff were knowledgeable about their role in reporting concerns, both internally and externally.

People and staff views were sought and were considered as part of managerial meetings to develop the service.

Quality monitoring of the service was a key part of the providers commitment to developing the service, this had included the commissioning of an independent audit. Improvements in some areas had already been implemented, and an action plan for further improvements was in place, with timescales set for achievement.

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 the service under the previous provider was good,(published 18 May 2018).

Why we inspected

We received concerns in relation to the safe care of people. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

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 Meadow’s 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Assessed risks to people regarding any area of their lives were reduced or eliminated to support the safety of people using the service. Staff understood their responsibilities about reporting any seen or suspected abuse. Staff were employed, after robust recruitment procedures, in sufficient numbers. Medicines were administered by appropriately trained staff. These methods supported the safety of people using the service.

People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible. Policies and systems in the service also support this practice. Staff understood and followed the Mental Capacity Act 2005 guidance. Staff asked for people's consent before providing any support.

Staff had completed required training and this was updated to ensure people's needs were met appropriately. People’s cultural choices were observed in the development of individual support plans.

People we spoke with told us that staff were always caring and respected people’s privacy and dignity at all times. Staff supported people’s choices and fully included and encouraged independent choices to enable full involvement in daily routines and activities.

People’s support plans reflected their individual choices and goals. People were then supported to achieve their aims and potential. People expressed their confidence about raising any concerns, should they have any. People felt that these would be handled correctly and that they had the information they needed to contact external agencies.

There was a registered manager in post. There were audits and spot checks in place to make certain staff worked correctly and that people received the appropriate support at a good standard. People using the service and their relatives had various ways of sharing their views and this was encouraged by staff.

Further information is in the detailed findings below.

Meadow's Court provides residential care for up to 60 people many of whom are living with dementia. At the time of our inspection there were 50 people in residence. Meadow's Court has a number of communal areas for people to sit, relax and watch television. In addition the service has a dining room and activities room. There is a garden which is accessible and provides areas of interest, which includes an aviary and seating area.

We carried out an unannounced comprehensive inspection of Meadow’s Court on 20 January 2016. After that inspection we received anonymous concerns in relation to the quality of people’s care during the night. We were informed that staff were getting people out of bed from 5am in the morning. Night staff were not appropriately trained, which compromised people’s safety as staff did not use the appropriate equipment to move people safely. People’s dignity was compromised as their personal care needs were not being met in a timely manner. As a result we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Meadow’s Court) on our website at www.cqc.org.uk.

The overall rating of good, which was awarded following the CQC's previous inspection of 20 January 2016 was displayed.

Meadow’s Court had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found people’s safety was promoted as staff followed the information provided within people’s records, which included risk assessments and care plans. This ensured the care and support people received was safe and reflective of their needs and wishes. People were regularly checked throughout the night as detailed within their care plan to ensure they were safe and staff completed charts to provide information as to whether people were awake or asleep and what assistance had been provided when required.

Staff implemented the instructions given by the registered manager and management team to promote people’s safety, which were provided on a range of documents, which included policies and procedures. Staff had access to information as to how they should respond to an untoward event or emergency, which included contact details of the management team and relevant external services.

Staff communicated to meet people’s needs, which included their participation in the handing over of information about people and the day to day running of the service. Staff were reminded of the importance of promoting people’s safety and the action to take as a result of the extreme hot weather currently being experienced.

People’s experience as to the care they received was monitored by members of the management team, as part of the overall quality monitoring system. This had included unannounced visits by a manager during the night. These visits were used to ensure people were safe and that the care and support they received met their needs and wishes.

We arrived at Meadow’s Court and entered the service at 5.45am. We found there to be three members of staff on duty, at the time of our arrival there were six people who were up and about. People were observed to be involved in activities of their choosing and a majority of the people we spoke with told us as to why they were up and about. Others who did not speak with us were seen to be supported by staff reflective of their needs and staff we spoke with had a good understanding as to the people living at the service.

People were supported by staff who had received training to keep them safe and meet their needs. Staff’s competence to perform their role were assessed by observations carried out by a member of the management team.

Improvements to the call bell monitoring system had been implemented since our previous inspection, which improved the ability of the registered manager and staff to monitor and respond appropriately when the system was activated.

Meadow’s Court provides residential care for up to 60 people many of whom are living with dementia. At the time of our inspection there were 46 people in residence. Meadow’s Court has a number of communal areas for people to sit, relax and watch television. In addition the service has a dining room and activities room. There is a garden which is accessible and provides areas of interest, which includes an aviary and seating area.

This inspection took place on 20 January 2016 and was unannounced.

Meadow’s Court did not have a registered manager in place. A manager has been appointed and they have submitted an application to the Care Quality Commission to become registered. We will monitor this situation to ensure that a registered manager is in post to ensure the service is managed well.

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 who used the service told us they felt safe. Relatives of someone using the service told they believed their relative was safe and well cared for. People were supported by staff in a timely and sensitive manner, which meant people’s needs were met and that there were sufficient staff on duty.

People’s medicines were in the main managed well. Staff had received training and had their competency to manage and administer medicines regularly assessed. However we found there were no written protocols in place for staff to follow with regards to the administration of medicine, which is taken as and when required. The provider agreed to take action in consultation with health care professionals.

Staff were able to tell us what action they would take should they believe somebody was being abused and were aware of the provider’s policies and procedures, which included whistleblowing. Records showed staff had received training to support them in recognising potential abuse and this provided them with guidance as to their role in promoting people’s welfare.

People were supported by staff that had access to training which enabled them to meet people’s needs. All staff within the service were aware of their role in ensuring people received good quality care and their individual role in promoting this.

Potential risks to people were assessed and measures put into place to reduce risk, which included the use of equipment and the provision of personal care which were reflected within people’s plans of care.

People were protected under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA 2005 DoLS). We found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions themselves about receiving personal care and leaving the service without support.

People we spoke with were complimentary about the meals provided at the service. The dining experience for people was relaxed and calm with people receiving support with their meals where required.

People we spoke with told us they had good access to healthcare and visiting relatives told us that the service contacted health care professionals on behalf of their relative when required. Records showed people were referred to the appropriate health care professionals when necessary and that their advice was acted upon. This meant people were supported to maintain good health.

There were positive relationships between people who use the service, their relatives who visited and staff. This created a friendly, calm and welcoming environment for people to live in and visit. People were supported by staff who sought to provide companionship and social interaction in a caring manner. Where people became distressed or anxious staff offered reassurance.

Staff had a good understanding as to the needs of people and told us how they supported people in making day to day decisions about their lives. We observed staff supporting people in a way that respected their privacy and dignity.

People we spoke with were positive about recent improvements to the environment which had been put into place to support people living with dementia. The environment was interactive and enabled and encouraged people to take part in activities. The garden was accessible and provided areas of stimulation, which included hens, quail and an aviary.

People spoke positively about the activities provided and told us they were encouraged to take part. Activities were organised both within the service and externally and information about these were made available in the service and via the provider’s website. The service had a dedicated activities organiser and room.

The manager and staff had a clear view as to the service they wished to provide which focused on promoting people’s rights and choices, and the provision of a stimulating lifestyle. Staff were complimentary about the support they received from the management team and commented that they provided positive feedback.

The manager and other members of the management team undertook effective audits to check the quality and safety of the service, which included assessing staff competency to provide care and support to people.

People, relatives and staff had the opportunity to influence the service by attending meetings and sharing their views through one to one discussions and through the completion of feedback forms and questionnaires, this enabled the provider to review and develop the service. The provider used its website to share information about the service, which included people’s views.

Information we received from commissioners, who contract with the service to provide care to people, were complimentary about the service provided.

People had a positive dining experience and those who required assistance to go to the dining room were assisted in a timely manner. People who required support were supported on a one to one basis by a member of staff. People were seen to enjoy their lunchtime meal and we observed that staff were mindful of people's right to choose and were polite and courteous when speaking with them.

We spoke with three people who used the service. They told us they were happy with the care they received and said that they regularly took part in the activities provided at the home. One person's comments included: 'I've lived here for sometime, I'm quite settled and there's nothing more they could do for me.'

People's care plans and records were regularly reviewed and their needs were reassessed where changes to their health and welfare had been identified. People had their health care needs met as the service was timely in making referrals to a range of external health care practitioners. We found there to be sufficient staff to meet the needs of people who used the service. Records showed staff had training in a range of topics which promoted the health and welfare of people. However we found some evidence of institutional practices in the delivery of care which impacted on some of the care people received and there daily life experiences.'

We found people received a balanced and nutritious diet, which met their needs and promoted there health. Staff who were involved in the preparation and cooking of food were aware of the specialist diets of people and provided tailored diets to meet people's individual needs. We found there were sufficient staff to support people in the eating of there meal which was managed in a way that met their needs and promoted their dignity. We observed that the dining experience for some people was not as positive as others in that they were seated in the dining room for a long period of time before the meal was served.

People told us they were satisfied with the care and support they received and that the staff were helpful and kind. People's comments included: - 'I'm happy with the care and the staff are very friendly.' 'I like living here, I get the help I need but I'm still independent in most things.'

Records relevant to the management of the service were accurate and fit for purpose and appropriate checks were undertaken before staff began work. Records showed staff had access to a range of training which enabled them to promote the health and welfare of people who used the service.