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Pentrich Residential Home Good

Reports


Inspection carried out on 20 February 2018

During a routine inspection

This inspection took place on 20 February 2018 and was unannounced. At our last inspection of the service on 23 November 2016 the registered provider was rated as 'requires improvement', but was compliant with regulations. There were recommendations in the last report that were followed up during this inspection.

Pentrich Residential Home is a care home.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 service provides accommodation and support to a maximum of thirteen people over the age of eighteen who have a mental health condition. The service is situated in a residential area of the coastal town of Bridlington in East Yorkshire and has three floors. The property does not have a passenger lift so is only suitable for people who are able to use the stairs. At the time of our inspection there were eight people using the service.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were recruited safely and at this inspection there were sufficient staff on duty to meet people's needs. Staff had received training which allowed them to meet people's needs and received support through supervision from the registered manager.

Staff had received safeguarding adult training and were aware of types of abuse. Alerts to the local authority safeguarding team were made as appropriate.. People told us they felt safe at the service.

Accidents and Incidents were recorded and analysed by the manager and action taken where any health and safety issues were identified following an accident.

Medicines were managed safely.

The service was clean and tidy and people had personalised bedrooms. The environment had not been specifically adapted for one person with dementia but they had lived at the service so long they were familiar with their surroundings and so this had no impact.

People told us that staff were kind and caring. They had time to get to know people and treated them with respect. They worked within the principles of the Mental Capacity Act.

Care plans were detailed and person centred. They were reviewed regularly and checked by the registered manager and regional manager.

Social isolation was minimised because staff encouraged people to access the local community either by themselves or with support.

The registered manager was well supported. They followed a clear quality assurance process and further checks were carried out during visits by the provider and regional manager. This ensured the quality of the service.

Feedback was received from people who used services, relatives, [professionals and staff and used to make any improvements using the 'You said/we did' system.

Inspection carried out on 23 November 2016

During a routine inspection

This inspection took place on 23 November 2016 and was unannounced. At our last inspection of the service on 22 October 2015 the registered provider was rated as ‘requires improvement’, but was compliant with all the regulations in force at that time. There were a number of recommendations in the last report that were followed up during this inspection.

Pentrich Residential Home provides accommodation and support to a maximum of thirteen people over the age of eighteen who have a mental health condition. The service is situated in a residential area of the coastal town of Bridlington in East Yorkshire. The property has three floors. The accommodation consists of two shared bedrooms and nine single bedrooms, two of which have en-suite facilities. Bathing and toilet facilities are available on each floor of the property. There is a dining room and two lounges are located on the ground floor. The property does not have a passenger lift so is only suitable for people who are able to use the stairs. Parking is available to the front of the building, although space is limited to around three vehicles. At the time of our inspection there were eight people using the service.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 saw improvements had been made to the service in the last year, but there remained areas of the service that did not offer people a good quality environment. One bathroom/shower room required remedial work to the tiling and floor coverings to ensure people had safe and hygienic facilities. We have made a recommendation in the report about this.

During our inspection we found that staff were working in a variety of roles to maintain the staffing levels in the service. Whilst people’s care needs were being met this was reliant on the goodwill of the workforce. We have made a recommendation about this in the report about.

Staff had completed some basic mental health training, but more in-depth training would ensure they had the knowledge and skills to meet behaviour that challenged the staff in regard to certain people who used the service. We have made a recommendation about this in the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Where people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty, the registered manager had completed a standard authorisation application for them and these had been reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals such as the Community Mental Health team and Community Psychiatric Nurses.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People spoken with said staff were caring and they were happy with the care they

Inspection carried out on 22 October 2015

During a routine inspection

This inspection took place on 22 October 2015 and it was unannounced.

The last inspection took place on 1 June 2015. We asked the provider to take action to make improvements to ‘Staffing’; ‘Need to consent’; ‘Safe Care and Treatment’; ‘Dignity and Respect’ and ‘Good Governance’ and these actions have been completed. After the comprehensive inspection on 1 June 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breaches of regulation.

Pentrich Residential Home provides accommodation and support to a maximum of 13 people over the age of 18 who have a mental health condition. The service is situated in a residential area of the coastal town of Bridlington in East Yorkshire. Pentrich is conveniently located for all of the main community facilities including the public transport network. Parking is available to the front of the building.

The property has three floors. The accommodation consists of two shared bedrooms and nine single rooms, two of which have en-suite facilities. Bathing / toilet facilities are available on each floor of the property. A dining room and two lounges, one designated for use by people who smoke, are located on the ground floor. The property does not have a passenger lift so is only suitable for people who are able to use the stairs.

The registered provider is required to have a registered manager in post and one was registered with the Care Quality Commission in October 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Improvements were made to the number of staff employed in the service. Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service and the registered provider anticipated that this would be completed by December 2015.

We have made a recommendation about the management of staffing levels in the service.

People received their medicines safely and appropriately. Staff had received training on medicine management and the medicine policy and procedure was updated in March 2015. However, we found the policy and procedure did not follow best practice.

We have made a recommendation about the reviewing of policies and procedures on the subject of medicine management.

Improvements were made to the Control and prevention of infections systems within the service and we found the service to be clean and hygienic. However, further work was needed to ensure this progress was maintained.

We have made a recommendation about the management of infection prevention and control practices.

Improvements had been made to the way that care and treatment of people who used the service was provided with the consent of the relevant person. We found that people were receiving appropriate care and support and in accordance with their wishes, but the documentation of people’s changing care needs could be improved.

We have made a recommendation about documentation and record keeping.

New staff were given a two day induction to the service. From the paperwork made available and comments received from the staff we found that this was not in depth, but did cover the basics of health and safety and working in the home.

We have made a recommendation about staff induction.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision and staff meetings.

People told us the quality of the food was improving. We looked at the menus on display in the kitchen. These were varied and reflected the wishes and choices of people using the service. However, there was no evidence that the menus had been assessed by anyone with sufficient dietary knowledge to say if the meals being provided were nutritionally balanced and met the dietary needs of people who used the service.

We have made a recommendation about the management of nutrition in relation to menus.

Improvements to staff practice had been made to ensure that people were treated with respect and dignity by the staff. There had been no formal complaints made to the service during the previous twelve months but there were systems in place to manage complaints if they were received.

Improvements had been made to the quality assurance system including the safety of the service, the risks relating to the health, safety and welfare of people who used the service and the way feedback from people who used the service and staff was obtained. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards.

Inspection carried out on 1 June 2015

During a routine inspection

Pentrich Residential Home provides accommodation and support to a maximum of 13 people over the age of 18 who have a mental health condition. The service is situated in a residential area of the coastal town of Bridlington in East Yorkshire. Pentrich is conveniently located for all of the main community facilities including the public transport network. Parking is available to the front of the building.

The property has three floors. The accommodation consists of two shared bedrooms and nine single rooms, two of which have en-suite facilities. Bathing / toilet facilities are available on each floor of the property. A dining room and two lounges, one designated for the use of people who smoke, are located on the ground floor. The property does not have a passenger lift so is only suitable for people who are able to use the stairs.

This inspection was unannounced and took place on 1 June 2015. Our last inspection took place on 29 January 2015 when we found the registered provider was breaching 14 of the essential standards of quality and safety (the regulations) relating to care from regulations 9 to 26, The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

After the comprehensive inspection on 29 January 2015 the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation. Their action plan stated that the service would be compliant by 31 May 2015.

In April 2015 the legislation changed and the above breaches now correspond to regulations 9 to 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including Person Centred Care; Good Governance; Safeguarding service users from abuse and improper treatment; Safe care and treatment; Meeting nutritional and hydration needs; Premises and equipment; Dignity and respect; Need for consent; Receiving and acting on complaints; Staffing.

This inspection found that the provider had met 10 of the 14 breaches of regulation and sufficient improvements were seen to indicate that the level of impact on people who used the service was reduced from major to minor impact or compliant. Further improvements were needed around staffing, infection control, consent, respecting and involving people and assessing and monitoring of the service to fully meet the legal requirements. You can see what action we told the provider to take at the back of the full version of this report.

There has not been a registered manager at this service since July 2014. We followed this up with the registered provider and a new manager was appointed in May 2015, but they have yet to submit an application to register with the Care Quality Commission. 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.

During the inspection we spoke with the manager, two care staff and an ancillary worker. We also spoke in private with eight people who used the service. At the time of the inspection on 1 June 2015 we were told by the manager and senior staff that there were nine people living in the service, all of whom had been diagnosed with a mental health condition and some had additional physical health problems. Three people also had a dual diagnosis of a Learning Disability. The people living at Pentrich Residential Home had a wide range of needs including prompts and support with personal care, nutrition and hydration, emotional and mental health, medication and behaviours that challenge. This meant the people who used the service were extremely vulnerable and reliant on care to be provided in accordance with their mental, physical, emotional and social needs.

We saw that cleaning schedules were in place and being completed by the domestic staff on duty.

Four out of the seven staff had completed infection control training and the other staff members were booked to complete this on Wednesday 3 June 2015. Further work was needed to ensure robust infection control systems were in place and further improvements to some aspects of the environment were needed to ensure people were protected from the risk of acquired infections. You can see what action we told the provider to take at the back of the full version of this report.

There were insufficient numbers of suitably qualified, skilled and experienced persons employed in the service to enable people to take part in outings / activities and receive their funded one to one care. Care staff were expected to cover any vacant duty shifts, including kitchen, domestic and laundry duties. This meant staff were working long hours and people did not always have their needs met. You can see what action we told the provider to take at the back of the full version of this report.

Checks of people’s financial records and the money held for them in the service showed there were some discrepancies in adding up totals and in the cash held. We have made a recommendation in the report about this.

We found evidence of institutionalised practice that restricted four people’s rights around smoking. You can see what action we told the provider to take at the back of the full version of this report.

Fire exits to the front and rear of the property had two or three steps for people to negotiate before they could leave the property. The steps at the rear of the property were quite steep and there was no hand rail fitted. We have made a recommendation in the report about this.

People were not always spoken with respectfully by staff. Staff did make efforts to offer people choice, but people were not enabled to be fully independent in their actions or decisions. You can see what action we told the provider to take at the back of the full version of this report.

Some improvements to the quality monitoring system were seen with audits being carried out for some aspects of the service. However, further work was needed to ensure this was a robust system which assessed, monitored and reviewed the quality of people’s experience of the service and took action when risks to people living and working in the service were identified. You can see what action we told the provider to take at the back of the full version of this report.

Everyone who used the service had received a review of their mental health needs and care needs from the local authority between January 2015 and May 2015 and behaviour management plans and risk assessments had been reviewed and updated in the care files we looked at. This meant people were protected against the risks of unsafe or inappropriate delivery of care and treatment.

Care staff had received training on safeguarding of vulnerable adults and displayed an understanding of the action they needed to take if they became aware of a safeguarding incident. The safeguarding policy and procedures had been updated and the local authority’s new safeguarding tool was in place. Staff had attended training with East Riding of Yorkshire Council (ERYC) and alerts were now being reported to CQC and the authority.

Information in the accident records and care files indicated that falls and incidents relating to behaviours were being documented appropriately and action taken as needed. Relevant organisations were being notified.

People received their medicines safely and appropriately. Staff had received training on medicine management and a new policy and procedure had been developed. However, further work was needed to ensure the policy and procedure was robust. The medication policy and procedure did not always document current practice in the service and did not reflect the NICE guidance on managing medicines in care homes.

Repairs and refurbishment work had been carried out on the property to ensure it was safe and fit for purpose.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home. People were provided with a range of snacks, as well as hot and cold food and drinks, during our inspection.

Care records contained assessments, which identified risks and described the measures in place to ensure the risk of harm to people was minimised. The care records we viewed also showed us that people’s health and wellbeing was monitored and referrals were made to other health professionals as appropriate.

The provider had introduced a new induction and supervision programme for the staff. This was in its early days of development but new staff had gone through the process. The amount of training accessible to the staff was slowing improving. This meant care staff were gaining skills, confidence and knowledge to help them meet people’s needs.

Inspection carried out on 29 January 2015

During a routine inspection

Pentrich Residential Home provides accommodation and support to a maximum of 13 people over the age of 18 who have a mental health condition. The service is situated in a residential area of the coastal town of Bridlington in East Yorkshire.

Pentrich is conveniently located for all of the main community facilities including the public transport network. Parking is available to the front of the building. The property has three floors. The accommodation consists of two shared bedrooms and nine single rooms, two of which have en-suite facilities. Bathing / toilet facilities are available on each floor of the property. A dining room and two lounges, one designated for the use of people who smoke, are located on the ground floor. The property does not have a passenger lift so is only suitable for people who are able to use the stairs.

This inspection was announced and took place on 29 January 2015. We notified the person in charge of the service, of the visit on 27 January 2015. The reason for this was that we were aware that the manager of the service was on sick leave. As we knew the inspection would impact on the staff on duty it was reasoned that short notice of the inspection would give the senior care staff the opportunity to arrange cover for the day so they could focus on the inspection.

There has not been a registered manager at this service since July 2014. 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 last inspection took place on 28 February 2014. At that inspection we found the provider was meeting all the essential standards that we assessed.

During this inspection we spoke with seven people who used the service, three members of staff, one relative and the registered provider. At the time of the inspection on 29 January 2015, we were told by the registered provider and senior care staff that there were nine people living in the service, all of whom had been diagnosed with a mental health condition and some had additional physical health problems. Three people also had a dual diagnosis of a Learning Disability. The people living at Pentrich Residential Home had a wide range of needs including prompts and support with personal care, nutrition and hydration, emotional and mental health, medication and behaviours that challenge the service. This meant they were extremely vulnerable and reliant on care to be provided in accordance with their mental, physical, emotional and social needs.

The home was not safe as people were not protected against the risks of unsafe or inappropriate delivery of care and treatment as there was no detailed assessment of their mental, social and physical health needs completed.

We found there was no evidence that any safeguarding alerts were made to the local authority or to the Care Quality Commission during 2014, even when there was clear documented evidence of incidents taking place. We found that the registered provider did not have systems in place to monitor and manage the prevention and control of infection and where people did acquire infections the staff failed to provide appropriate treatment. The registered provider also failed to maintain appropriate standards of cleanliness and hygiene in relation to equipment used within the service.

The registered provider failed to protect people who used the service against the risks associated with the unsafe use and management of medicines. Staff were not trained to administer medicines and this put people at risk of harm or actual harm by being given the wrong medication or by medicines being administered incorrectly by staff.

We saw that the premises had not been made safe in all areas of the service, despite the registered provider being aware of maintenance issues raised by the staff over the last two years and highlighted in the service’s weekly building maintenance records. Poorly fitting fire doors, poor maintenance of equipment and a lack of staff training in fire safety meant that the registered provider failed to meet the requirements of the Regulatory Reform (Fire Safety) Order 2005.

There were insufficient numbers of suitably qualified, skilled and experienced persons employed in the service to enable people to take part in outings and activities in the community. Care staff were expected to cover any vacant duty shifts, including kitchen, domestic and laundry duties, in addition to one to one support for service users. This meant people were isolated in the home and staff worked long hours.

Staff did not receive appropriate induction, supervision and training. We found there was a lack of training relevant to mental health, safeguarding of vulnerable adults from abuse and the Mental Capacity Act 2005 (MCA) and staff displayed a lack of knowledge in respect of Deprivation of Liberty Safeguards (DoLS), capacity assessments and Best Interest meetings. This meant that staff who were in charge of managing the service did not have the necessary skills and knowledge to assess if people had capacity to consent to care and treatment. People who used the service were put at risk of harm as staff failed to ensure people had comprehensive assessments for their mental and physical health needs. Individuals were not well supported with eating and drinking so their state of health deteriorated.

People were not always spoken with respectfully by staff. Staff had made efforts to offer people choice, but people were not enabled to be fully independent in their actions or decisions. People were not consistently treated the way they wanted to be treated.

Some people told us they were concerned about speaking to us for fear of reprisals, which indicated that there was not an open culture within the service that actively sought out people’s views about the service and their care.

We found that people’s care plans and risk assessments did not always represent their needs or ensure staff had the information to help meet people’s needs. The complaint procedure was not readily available to people and cooperation with other organisations, such as health care professionals, was inadequate so that people did not always receive the care and treatment they required in a timely manner.

We found that the quality monitoring system was ineffective and had not been used to ensure the safety of people who used the service and staff. We asked the registered provider and the senior care staff for evidence of how quality monitoring and assessing of the service was carried out. We were told that this was not formally documented. Staff reported that the service had been running for long stretches of time without a manager. This lack of leadership had an impact on staff. Staff told us they were not confident of speaking up at supervisions meetings as their conversations were not kept confidential by the management team.

We found that the registered provider was breaching 14 of the essential standards of quality and safety (the regulations) relating to care from regulations 9 to 26, The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These included: Care and Welfare; Assessing & Monitoring the quality of the service provision; Safeguarding people who use services from abuse; Cleanliness and infection control; Management of medicines; Meeting nutritional needs; Safety and suitability of premises; Respecting and involving people who use services; Consent; Complaints; Records; Staffing; Supporting workers and; Cooperating with other providers. You can see what action we asked the registered provider to take at the back of the full version of this report.

Inspection carried out on 28 February 2014

During an inspection looking at part of the service

We carried out an inspection in October 2013 and found four areas of non-compliance. These were in respect of infection control, safety of the premises, staff development and quality assurance. We received an action plan from the registered provider that told us when they would be compliant with these outcomes. We visited the home again on 28 February 2014 to check if the home had achieved compliance.

We found that improvements had been made to infection control procedures. Staff had completed training on the control of infection and the home was being maintained in a clean and hygienic condition.

Improvements had also been made to the environment; the repairs that we had identified had been carried out although we noted that one carpet still needed to be replaced. There was a gas safety certificate in place and a fire safety test had been undertaken by a qualified contractor. Staff had undertaken fire safety training.

Staff had also completed other training since our previous inspection; this included health and safety, food hygiene and the control of substances hazardous to health (COSHH). Staff had continued to have supervision meetings with a manager.

Staff and resident meetings had been held and satisfaction surveys had been distributed to relatives to gain their views about the service provided. We have asked the provider to inform us about the action taken following a visit from a local authority health and safety officer.

Inspection carried out on 22 October 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with some people who used the service and members of staff and looked at documentation.

From what people told us, what we observed and noted as part of the inspection staff cared for the people who used the service appropriately. One person said �They look after me well� and another person told us �They know me and what I like�. People had their medicines at the time they needed them and in a safe way.

There were effective recruitment procedures in place which ensured staff were of good character. There were suitable numbers of experienced staff. However, staff had not received appropriate training to ensure they could meet the needs of the people who used the service and look after them safely.

During our visit we noted a number of areas of concern regarding the safety and maintenance of the premises that could have caused harmed to staff and people that lived at the home. We also saw that people were not protected against the risks of infection as the appropriate standards of cleanliness and hygiene were not maintained.

The provider did not have systems in place to fully assess and monitor the quality of service that people received.

Inspection carried out on 27 February 2013

During a routine inspection

Pentrich Residential Home did not have a registered manager at the time of this visit. We have referred to the person who is acting in this role as "The manager" throughout our report.

People who used the service were supported to take part in a range of activities both within the service and out in the community. One person told us �I am waiting to go out shopping with the staff. I might have a coffee whilst in town.�

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was risk assessed and records were up to date.

People told us that staff discussed their care and treatment with them and that they were involved in the reviews of their care. Four people told us that their interactions with staff were positive and they were treated as individuals.

People who spoke with us had a good understanding about keeping themselves safe from harm whilst in the home and out and about in the community. They told us they felt safe in the service and could talk to the staff or manager about anything.

We found little evidence of a formal quality assurance programme, however people and staff said their opinions were listened to and action was taken to address any issues raised.

Inspection carried out on 25 January 2012

During an inspection looking at part of the service

People using the service told us that they liked living at Pentrich and that the staff were supportive. People said, �I have settled in well� and �Everything is fine and I�m alright.�

People told us that they liked the meals and that the quality of food was acceptable. However, they also told us that the level of activities had decreased and commented, �There is not much going on�, �We used to go out on trips, but not recently� and �The staff are too busy, I think we need some more.�

People also told us that their privacy and dignity was maintained. Their views were listened to and that they felt safe in the home and were able to make choices about aspects of their lives. People commented, �The staff are alright� and �They are very supportive and they listen.�

People using the service told us that they were able to access the health care support they needed.

People told us that they thought the environment was clean and commented, �It�s �Ok� and �I like my room.�

Inspection carried out on 23 August 2011

During a routine inspection

People using the service told us that they liked living at Pentrich and that the staff were supportive. People said, �I like it here�, �I have lived here for 22 years� and �The staff are nice�.

People also told us that they had their privacy and dignity maintained. That they had their views listened to and that they felt safe in the home and were able to make choices about aspects of their lives. Some commented, �I have a key and come and go when I want to�, �I go to work and have everything I need here� and �Yes I do feel safe here�.

People using the service told us that they were able to access the health care support they needed.

People told us that they liked the meals and that the quality of food was good. Some comments received, �The food has improved, it is a lot better� and �We have a new cook and he is very good�.

Inspection carried out on 30 March 2011

During a routine inspection

People using the service told us that they liked living at Pentrich and that things had improved over the past few weeks. People said, �I like it here, but it�s not permanent� and �the new manager is always available�.

People also told us that they had their privacy and dignity maintained and that they had their views listened to and that they felt safe in the home and that they had access to their own money when they needed it.

People using the service told us that they were able to access the health care support they needed and the food offered was of a satisfactory standard.

People also told us that there was sufficient staff on duty, who were kind and helpful and that they were able to make complaints and that their views and concerns were listened to.

Reports under our old system of regulation (including those from before CQC was created)