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Pearson Park Care Home Inadequate

We are carrying out a review of quality at Pearson Park Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 8 September 2021

During an inspection looking at part of the service

About the service

Pearson Park Care Home is a residential care home providing personal care to 19 people, some of whom may be living with dementia and mental health needs. The service can support up to 24 people. It accommodates people in one adapted building and bedrooms are both single and double occupancy.

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

Some people remained at risk of harm from unsafe moving and handling practices and a lack of robust investigation following safety-related incidents.

The provider had made improvements to the safety and cleanliness of the premises and the guidance given to staff to manage the risks of people developing pressure ulcers. People benefitted from improvements to the support they received to maintain their personal care.

The provider acknowledged further improvements were required to their systems for identifying and managing risks to the quality of the service.

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

Rating at last inspection

The last rating for this service was inadequate requires improvement (published 1 September 2021).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safety of care. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

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

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

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Inspection carried out on 18 June 2021

During an inspection looking at part of the service

About the service

Pearson Park Care Home is a residential care home providing personal care to 19 people, some of whom may be living with dementia and mental health needs. The service can support up to 24 people. It accommodates people in one adapted building and bedrooms are both single and double occupancy.

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

The provider had failed to implement systems and processes to assess the risks to people’s safety which put people at risk of harm. Care and support was task-based and people were subjected to degrading care as a result. There were not enough staff to keep people safe and standards of hygiene had not been maintained. Safety-related incidents had not been investigated to prevent reoccurrence.

Not all staff had kept up to date with their mandatory training and not all staff had not received training in key areas such as dementia and mental health. The premises had not been properly maintained and some people were unable to use the bathroom and shower facilities due to a lack of suitable equipment.

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.

Not all staff treated people with dignity and respect and people had not been involved in writing their care plans. Care plans lacked person-centred information for staff to engage people in a meaningful way and to support them to maintain hobbies and interests.

The provider did not always take responsibility to engage with other healthcare professionals to ensure people received the right care.

Medicines were managed safely, and people gave positive feedback about the staff caring for them.

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 good (published 4 November 2019).

Why we inspected

We undertook this focused inspection to follow up on specific safeguarding concerns which we had received about the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the maintenance of the premises and the management of the service, so we widened the scope of the inspection to become a comprehensive inspection and looked at all five key questions.

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 improvement. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pearson Park Care Home 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 person-centred care, consent, safety, safeguarding, the premises, staffing and the running of the service at this inspection.

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 for the pr

Inspection carried out on 17 August 2020

During an inspection looking at part of the service

Pearson Park Care Home is a residential care home, providing personal care to up to 24 people who may be living with dementia or have a mental health problem.

We found the following examples of good practice:

• The provider had adapted aspects of the environment to reduce the risk of infections spreading. For instance, they had replaced the external doorbell with a motion sensor system to alert staff when visitors were approaching the main door. This meant visitors did not have to touch the door or doorbells. There were also sensor operated light switches in the bathrooms to reduce the number of switches (high touch areas) in the home.

• There were well managed visitor arrangements; relatives were able to visit their loved ones by prior appointment with good safety measures in place.

• There was a consistent and dedicated staff team, who were aware of the importance of robust infection control procedures and followed these. The provider was proactive with regards to the use of personal proactive equipment.

Further information is in the detailed findings below.

Inspection carried out on 25 September 2019

During a routine inspection

About the service

Pearson Park Care Home is a residential care home providing personal care to 22 people at the time of the inspection. The service can support up to 24 people who may be living with dementia or have a mental health problem. It accommodates people in one adapted building that has been extended. Bedrooms are both single and double occupancy, some with en-suite facility.

People's experience of using the service and what we found.

People were protected from harm and risks were well managed. Sufficient numbers of suitable staff were employed and they safely managed medicines and infection control and prevention practices.

People's needs were effectively met. Their lives were comfortable and they enjoyed nutritious meals. The premises were safely maintained. Staff worked well with other care and healthcare professionals. 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.

Staff were caring and compassionate. People's equality, diversity, privacy, dignity and independence were respected. Their views on care and support were listened to.

People received personalised care. They experienced good support and had their communication needs met. Their concerns were satisfactorily addressed and complaints responded to. People were assured a good end of life experience when the time came.

The registered manager promoted a positive culture. They and the staff team understood their duty of care responsibilities. Staff were clear about their roles and sought to improve the care people received. They engaged and involved people in deciding the care they wanted. Partnership working was well established with other organisations.

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

Rating at last inspection

The last rating for this service was requires improvement (published 29 September 2018). At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pearson Park Care Home on our website at www.cqc.org.uk.

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.

Inspection carried out on 24 July 2018

During a routine inspection

This inspection of Pearson Park Care Home took place on 24 July 2018 and was unannounced. Pearson Park Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection the provider was in breach of the regulation on safe care and treatment because they had failed to ensure people’s safety from potential hazards. They were in breach of the regulation on person-centred care because they had failed to ensure people’s needs were fully recorded and their needs met to maintain good health. They were also in breach of the regulation on good governance because they had failed to carry out effective audits on the premises and care plans. In addition, there were poor systems in place to maintain the cleanliness of the building.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions on the service being safe, responsive and well-led, to at least good.

Pearson Park 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. The service accommodates 24 people in one adapted building, some of whom may be living with dementia. There are a mixture of single and shared bedrooms. There were 18 people receiving the service at the time of the inspection.

The provider holds an individual registration and therefore does not require a registered manager in post. Mrs K Crosskey manages the service herself and is referred to throughout the report as the provider/manager. She is a ‘registered person’ in her own right. 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 provider/manager was not available on the day of our inspection and so we were assisted by the administrator and the deputy manager. The deputy manager was training to become a registered manager in the future.

At this inspection we found improvements in the provision of safe care and treatment as work to landscape the rear of the property was complete and the garden was now accessible to people. People’s care plans had been revised and afforded improved accountability with instructions to staff on how to meet their needs and reduce or remove safety risks. Improvements had been made regarding quality assurance system and action plans, but further development of systems would ensure greater effectiveness in further identifying shortfalls and aiding improvement to service delivery. Improvements were found in the cleanliness of the premises since our last inspection and there were systems in place to maintain this.

We found that notifications were made to the CQC, with the exception of approvals for 'deprivation of liberty safeguards' having been missed. This was a breach of the regulation on sending notifications to the CQC, but we are addressing this outside of the inspection process.

Review of the medicine administration systems revealed some very minor shortfalls that had potential to become detrimental to people if not checked.

People were safeguarded from harm and recruitment systems were safe. Care staffing levels were safe. The premises and equipment used was safely maintained.

People’s needs were assessed and staff were suitably trained. People’s needs were met in respect of nutrition and hydration, staff were adhering to mental capacity legislation and the premises were suitably designed for the people living there.

Staff demonstrated a caring approach to people and understood and enabled their preferences and wishes to be met. St

Inspection carried out on 31 May 2017

During a routine inspection

Pearson Park Care Home is registered with the Care Quality Commission (CQC) to provide care and accommodation for 24 older people some of whom may be living with dementia. The accommodation is provided over two floors and a lift is available to access the first floor. There are communal areas for people to use and accommodation is provided in shared and single bedrooms.

This inspection took place on 31 May 2017 and was unannounced. The service was last inspected April 2016, recommendations were made about the safety of the garden area, the use of bed rails, environmental risk assessments, people’s care plans and the quality monitoring of the service. This resulted in the service being rated as requires improvement.

At the time of the inspection 19 people were living at the service.

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

People were not protected from potential hazards which posed a risk of harm. The garden area was still cordoned off, was in-accessible and contained items of plant machinery, for example, a metal work bench, sewer pipes and a cement mixer which posed a risk of harm to the people who used the service. One person had breached the cordon which the provider had erected and had sustained a fall in the garden area which had resulted in them sustaining a fractured femur.

Areas of the building still required refurbishment and redecoration. For example, bedrooms were in need of repainting and carpets replaced. Some of the rooms were dirty and bed linen was stained. Paper towels and soap were not available for staff or the people who used the service in some rooms and toilets. This exposed people and staff to the unnecessary risk of cross infection.

People’s care plans did not describe the person or their actual needs, for example, one care plan indicated the person was mobile, could eat and drink independently and sometimes displayed behaviour which put themselves and others at risk. However, the provider told us the same person was on bed rest and receiving end of life care and had been since April 2017.

People were not always provided with the level of fluid required to keep them healthy and ensure their wellbeing. For example, one person should have been consuming 1950mls of fluid in a 24 hour period but records showed they only received 450mls. One person’s care plan did not contain information which instructed the staff in how to manage their catheter or how to prevent the risk of cross infection when dealing with the catheter. There was no effective audit, monitoring or quality assurance systems in place which identified shortfall in the service and put in place time limited actions plans to address these. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the end of this report.

People were cared for by staff who had received training in how to recognise abuse and how to report this to the investigating authorities. Staff had been recruited safely and were provided in enough numbers to meet the needs of the people who used the service. People’s medicines were handled safely by the staff and their training was updated in this area.

People were provided with a wholesome and varied diet which was of their choosing. Staff received training which equipped them to meet the needs of the people who used the service, and were supported gain further qualifications and experience. People who needed help with make informed choices and decision were protected by the use of relevant legislation. People were supported by staff to access health care professionals when needed.

People wer

Inspection carried out on 8 April 2016

During a routine inspection

Pearson Park Care Home is situated within the boundary of the park and is close to local shops, amenities and bus routes into Hull city centre. The service is registered to provide accommodation and personal care for to up to 24 people with a mixture of shared and single occupancy bedrooms. However, the registered provider has made some of the shared bedrooms into single occupancy so the current total of people that can be accommodated is 21; there are 13 bedrooms for single occupancy and four shared bedrooms. Refurbishment is currently underway to change an unused room into two en suite bedrooms.

The registered provider is also the registered manager and will be referred to as the registered provider/manager throughout this inspection report. 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 undertook this unannounced inspection on the 8 April 2016; there were 19 people using the service at the time of the inspection. At the last inspection on 6 and 7 November 2014, we issued a compliance action to ensure the registered provider acted within the principles of the Mental Capacity Act 2005 (MCA). We found at this inspection there had been improvements in the way the registered provider/manager worked within MCA. Most people were able to make their own decisions but assessments of capacity and best interest meetings had taken place to discuss decisions to be made on people’s behalf when they lacked capacity.

We found potential risk areas had not always been identified and recorded. For example, the rear garden area was accessible to people and there were some areas of the garden and the external environment that were potentially unsafe. These had not been included in the environmental risk assessment. Some people had bed rails in place but assessments of need for them and risk assessments had not been completed. We have made a recommendation about these points. There were other areas where the registered provider/manager had identified risk and taken measures to minimise it.

Most people received care tailored to their needs although we found this could be improved in some areas. People had plans of care to guide staff but on occasions these lacked full information about specific issues. We also found the layout of the environment did not take into account the needs of people living with dementia. For example, there was a lack of signage to help people locate their way about the service. We have made a recommendation about this.

We found people’s health needs were met and they had access to community health care professionals when required. We found medicines were managed well and people received them as prescribed. One person received a medicine when required to support with their anxieties and although we saw staff did not administer this very often, the guidance regarding its use was not very clear.

People liked the meals provided to them and they told us they had enough to eat and drink. Staff referred people to dietetic services when they had concerns about their nutritional intake or weight loss. We found the choice of desserts for people with diabetes was limited. This was mentioned to the registered provider/manager to discuss with catering staff.

People told us staff treated them well and were kind and caring. We observed this in practice. We found staff were recruited safely and deployed in sufficient numbers to safely meet people’s current needs. Staff received access to training, supervision and support. We found staff were able to raise concerns with the registered provider/manager.

There were some activities for people to participate in and some people chose not to join in and preferred to ‘do their own thing’. Some peopl

Inspection carried out on 6 and 7 November 2014

During an inspection looking at part of the service

We undertook this unannounced inspection on the 6 and 7 November 2014.

Pearson Park Care Home is situated within the boundary of the park and is close to local shops, amenities and bus routes into Hull city centre. The service can provide personal care to up to 24 people, some of whom may have dementia care needs. At the time of the inspection there were 17 people resident in the service. There was a mixture of single and shared bedrooms, a dining room, a sitting room and bathrooms on each floor.

The service has a registered manager who is also the registered provider. 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.

At the last inspection on 21 August 2014 we asked the registered provider to take action to make improvements to cleanliness and infection control, respecting and involving people who use services, assessing and monitoring the quality of service provision and records. We received an action plan which stated the registered provider would be compliant by 18 October 2014. We saw during our inspection that this action plan had been completed.

Some people who used the service were living with dementia which meant they may be unable to make important decisions for themselves. Staff had consulted with relatives about decisions and made them in their best interest. However, they had not involved other professionals and had not followed legal guidance about assessing people’s capacity to make their own decisions. You can see what action we told the registered provider to take at the back of the full version of the report.

The induction that new members of staff received, could be more thorough so their skills in completing care tasks were checked out. We recommend that the registered manager/provider seek information from Skills for Care regarding the common induction standards (CIS). Skills for Care is an organisation recognised for promoting the skills and competence of staff in the care sector.

There were enough staff to provide care and support to people and we saw staff were recruited safely. Staff completed essential training and also completed more specific training in order for them to feel confident when supporting people.

Staff completed safeguarding training and carried out risk assessments which helped to protect people who used the service and safeguard them from abuse and potential harm.

People had their health needs met and had visits from professionals for advice and treatment. Staff administered medicines in a timely way so that people were not left waiting for their tablets.

Staff approach was seen as caring; they took time to speak to people, they respected privacy and dignity and they involved them in day to day decisions. We saw the care plans could be improved to include more personalised care and to show staff were flexible in their approach when people required specific support.

People told us they enjoyed their meals and, when required, we saw staff assisted people to eat and drink in a sensitive way.

The staff monitored the quality of the service and completed checks of the environment to ensure it remained safe and clean. People’s views were sought in meetings and via questionnaires about the service. This helped to identify shortfalls so they could be addressed.

Inspection carried out on 11, 13, 21 August 2014

During an inspection looking at part of the service

The inspection was completed on three separate days by one inspector. On the third day we were accompanied by an Environmental Health Officer and arrived at the service at 5.30am. This was because we had received information of concern about people getting up too early and we wanted to check this out.

We considered all the evidence we had gathered under the outcomes we inspected for this follow up inspection. We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

If you want to see the evidence supporting our summary please read the full report. This is a summary of what we found �

Is the service safe?

There was no system in place to make sure the manager and staff learned from events, concerns and complaints. This increases the risk of harm to people and fails to ensure lessons are learned from mistakes.

Although there were some improvements noted regarding infection prevention and control such as refurbishment of the dining room and laundry, there were still areas of concern. There were areas of the home in need of a deep clean and systems were required to manage infection prevention and control.

We found some improvements had been made regarding the information held in care records but more work was required to ensure they contained full information about how staff were to support people.

Is the service effective?

We found that people were not consulted about aspects of their care or were given limited choices, for example in areas of meal provision and where to sit when having their meals.

Is the service caring?

People who were able to talk with us told us staff promoted their privacy and dignity. They also said staff spoke to them in a kind way.

Is the service responsive?

We were not completely reassured that staff adhered to people�s preferred time of getting up in the morning. Information about this needed to be written in plans of care, made known to staff and respected by staff.

We were unable to audit that a concern made by a member of staff to the registered manager had been dealt with. The written concern had not been saved and there was no record of the action taken.

Is the service well-led?

There had been some improvements in how the quality of the service was monitored by ensuring people who used the service, their relatives, staff and visiting professionals had the opportunity to complete surveys.

Although new policies and procedures and audit paperwork had been obtained, checks of the environment and systems used in the service had not been completed.

What people who used the service and those important to them told us about the care and support they received: -

People who used the service told us there were limited choices for the main meal. They were not aware of what the meal was for lunch on the day of inspection and told us that no-one had asked them if they liked it or whether they wanted an alternative choice. They said the hot meal at lunch was just delivered to them when then they went into the dining room. Comments about meal choices included, �There is no choice at lunchtime; they just give us the meal�, �If I don�t like what�s on offer I don�t what I would have�, �If you don�t like it, you do without� and �There is a good selection of sandwiches at tea-time.�

People told us care staff cleaned the service. They said, �Staff come and clean my room and the toilets. Sometimes paper towels are missing from the toilets.�

Inspection carried out on 2, 3 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

� Is the service caring?

� Is the service responsive?

� Is the service safe?

� Is the service effective?

� Is the service well led?

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

This is a summary of what we found-

Is the service safe?

People told us they felt safe. There were safeguarding procedures and staff understood how to safeguard people they supported.

The service had areas that were not clean and hygienic. There were concerns with how soiled laundry was collected and transported through the service and also damp areas in the dining room and the laundry.

People received their medicines as prescribed by their doctor and told us they received medicines in a timely way.

The manager sets the staff rotas and they made sure there was sufficient numbers of staff with the right skills and experience to meet people�s needs.

Some of the information in care records was inaccurate and other records were not maintained effectively. This meant there was a risk they could be misplaced.

Comments from people included, �I like to be independent and do my own thing; the staff are around if I need them� and �Yes, I feel safe here; there is no reason not to feel safe.�

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a hygienic environment and keeping accurate records.

Is the service effective?

Staff made sure they gained consent from people before delivering care and support. People spoken with confirmed this and said they were able to make their own choices about aspects of their lives.

People�s health needs were met in the service and they access to a range of health and social care professionals to provide advice and treatment when required. Comments included, �Last year, twice I had a bad cold and each time they got the doctor out.�

Is the service caring?

People told us staff supported them in a kind and caring way. We observed care workers speak to people in a patient way and in discussions they demonstrated knowledge of people�s needs. People commented, �The staff are kind to you� and �The staff are quite good. I feel settled here and I feel much better.�

Is the service responsive?

Some records in care files indicated people�s preferences, likes and dislikes, and people spoken with told us staff listened to them and respected their wishes.

People had identified key workers who supported them with activities of daily living. People had access to activities that were important to them and friends and family relationships were encouraged. Comments included, �There are enough staff as far as I can make out.�

Is the service well-led?

There was a system of sending out surveys to people who used the service and visiting professionals but this had not been extended to relatives and staff. The manager told us the issues identified in surveys had been addressed but this had not been documented anywhere.

One team meeting was held in 2013 and staff supervision meetings had slipped. Staff told us they could see the manager on a day to day basis if they needed to raise concerns.

Some policies and procedures had not been reviewed and updated. This meant that staff may not have full and up to date guidance about what is expected of them in their roles.

There was no system organised to complete regular checks on the quality of the service provided to people. This meant that shortfalls in the service were not identified and action plans not produced to address them in a timely way.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

Inspection carried out on 12 April 2013

During a routine inspection

People spoke appreciatively about their experience of the service. Comments included, �They look after you well here,� �The room itself is nice,� and �I do like it here.� Recent survey responses included, �The home is a nice and peaceful place for all residents� and �We are very pleased with what we have seen so far.�

We looked at menus and meals provided for people and their choices. One person told us, �I�ve never bothered with breakfast, that is my choice. The dinners are nice but there is not much variety at teatime.� Another person said, �The food is quite adequate. There is a choice of what to eat if I ask. I get a small portion and I�m quite happy with it. We are asked if we want more.� Vegetarian meals were provided.

People were complimentary about the cleanliness of the service. One person said, �I think the place is clean.� Another person told us, �They are always clean here, and vacuuming up all the time. You see staff with aprons and that on.� Recent survey responses confirmed that people felt the service was clean and well presented.

An annual survey was issued to people who used the service and other stakeholders in January 2013 and we reviewed the responses to this survey, which were positive. Meetings for residents were held regularly in 2013. The manager undertook regular audits of the service so that risks to people's health and safety were managed appropriately.

Inspection carried out on 23 November 2012

During a routine inspection

People told us they were respected, their dignity was upheld and their privacy was maintained. People�s comments included, �They are very good,� and �It�s all very nice.� People and their relatives spoke positively about their care. One person told us, �They still keep their eye on you and if you need something they are there straight away. There is no waiting. We do have an input to the care plan and attend a review meeting.� Relatives told us they had no concerns with care. People spoke positively about the staff that worked with them. One person told us, �I think the staff are brilliant,� and another person said, �The staff are very nice.� A visitor commented, �The staff are really nice with my relative.�

People we spoke with said they felt safe in the service. However, we found that there were not effective systems in place to maintain and monitor cleanliness and risk of infection. A relative we spoke with said, �It is obvious they don�t clean properly.� We also found there were issues with maintenance of the physical environment. Risks to the safe care of people were not identified, monitored or managed appropriately. This may compromise the health and safety of people who used the service.

Inspection carried out on 6 May 2011

During a routine inspection

One person who used this service said that she gets a little bored at times. She said that she does go and sit in the garden and goes for short walks. We spoke to another lady who was able to understand and gave consent to her care. However, the majority of people who used this service had complex needs and were not able to comment on this outcome.

We spoke to one resident who said that the carers were �lovely� and would do anything for you.

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