Brentwood Care Centre

Brentwood Care Centre is a residential care home providing personal and nursing care to up to 112 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 67 people using the service. The home is split over three separate floors, each with communal lounges and dining areas.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

The provider had not always ensured staffing levels, or the deployment of staff across the service, adequately met people’s needs. People told us staff were not always available when needed and we observed people waiting for staff to support them. The provider’s processes for monitoring the quality and safety of the service were not always effective in addressing concerns and driving improvements.

People’s care plans and risk assessments were not always personalised or up to date and some contained contradictory information. People’s daily records and monitoring charts had not always been completed and this meant we could not be assured people had received appropriate support. The provider had implemented end of life care plans following on from our last inspection; however, these still lacked detail.

The provider had a process in place to manage people’s medicines and guidance was available to support staff in administering medicines safely. However, during the inspection we observed staffing levels had impacted on the timely administration of medicines.

The provider had recruited an activities coordinator since our last inspection, and we found people were more engaged and able to participate in a wider range of pastimes. 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; however, the policies and systems in the service did not always support this practice.

Staff were aware of how to report safeguarding concerns and the provider had sent notifications and shared information with the relevant authorities when appropriate. People and relatives told us they knew who to speak to if they had any concerns or complaints.

There had been changes in the management of the service since the last inspection and there was a new interim manager in post. People and staff spoke positively about the new manager and the support they had received from the senior management team. Relatives told us they felt involved in people’s care and able to give feedback and staff spoke positively about the culture and morale of the team. Following the inspection, the provider responded promptly to our feedback, supplying additional information, and identifying actions to address the concerns raised.

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 good (published 01 July 2022).

Why we inspected

There had been an increase in the number of safeguarding concerns raised since our last inspection. We had received concerns in relation to how the provider was ensuring people were kept safe and protected from the risk of harm. We had also received concerns regarding the management oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive, 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.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, 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 Brentwood Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, the management of risk and oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan 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.

Brentwood Care Centre is a care home providing personal and nursing care to up to 112 people. The service provides support to older people and people with dementia. At the time of our inspection there were 72 people using the service. The home is split over three separate floors, each with communal lounges and dining areas.

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

When we last visited the service the registered manager had not been in post very long and we had concerns about the sustainability of the improvements they had started to make. On this inspection we were assured that the registered manager had stabilised the service and made progress with improvements. They had clear oversight of the service and communicated well with people, relatives and staff.

They had support from a quality lead manager and had recently appointed a new deputy manager who was also the clinical lead for the service. Quality checks and audits clearly showed actions with timescales for objectives to be carried out.

On the day of our inspection the newly appointed activity co-ordinator was on annual leave. Despite, the service obtaining interactive devices for people to use which have been proven to be especially beneficial for people living with dementia, they were not being used to their full potential. There were some activities on offer, but these were very limited, and staff commented they felt they did not have enough time to spend talking to people as they were too busy carrying out care tasks.

People received support with their end of life care. However, people’s care plans required more information.

We made a recommendation the service review its end of life care planning process in line with best practice guidance.

Staff understood how to protect people from poor care and abuse. Staff assessed risks people might face and enabled them to take positive risks. The service had enough appropriately skilled staff to keep people safe. Staff supported people to take their medicines safely and as prescribed. The provider had minimised the risks of infection, such as COVID-19.

Most people’s care plans reflected their range of needs. People and those important to them were involved in planning their care. Staff enabled people to access health and social care support. They supported people to eat and drink in line with their preferences. 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 received care from kind and compassionate staff. Staff supported people to make decisions about their care. Staff promoted and respected people’s privacy and dignity.

Staff communicated with people in ways that met their needs. People felt able to raise concerns and were confident they would be listened to and action taken.

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

Rating at last inspection

The last rating for this service was requires improvement. Report published (04 November 2020). The service has now improved to Good.

Why we inspected

This was a planned inspection based on the previous rating.

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

Follow up

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

Brentwood Care Centre is a residential care home providing personal and nursing care to up to 112 people aged 65 and over. At the time of the inspection there were 44 people living at the service. Care is provided over three floors. The Balmoral unit accommodates people with nursing needs, the Windsor unit specialises in providing care for people with dementia and the Buckingham unit accommodates people with personal care needs.

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

When we last visited the service in July 2019, we met a new registered manager who told us about the improvements they were making. There had been a high turnover of registered managers in previous years, and the provider assured us things were starting to improve and settle down. However, when we returned in September 2020, the previous registered manager had left and we were welcomed by another newly registered manager.

Although the registered manager had made positive changes since their arrival, these improvements need to be sustained to demonstrate management stability across the service. The feedback we received during our inspection combined a positive view of the new registered manager, with an anxiety that they would leave. A relative told us, “When you raise an issue with the manager you then feel you are getting somewhere and then the manager ups and leaves.” A member of staff said, “I’ve seen lots come and go [registered manager] is by far the most knowledgeable and professional.”

The registered manager had started to address the concerns we had raised at our last inspection. They had a practical, person-centred approach which was making a difference to the care people received. Feedback was particularly positive about how well and openly the registered manager was communicating with people, families and staff.

We found care was well-planned and staff minimised risks to people’s safety. The administration of medicines had improved. Risk from the spread of infection was well managed.

Previously we had concerns senior staff did not have an oversight of the clinical care people received. The registered manager had employed a new clinical lead and they both had a good understanding of the health needs of the people at the service.

There were enough staff to keep people safe. The registered manager was working well with the staff team to improve staff turnover, morale and skills.

The number of safeguarding alerts had reduced since the arrival of the new registered manager. They were working well with external professionals to investigate and resolve outstanding concerns.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The registered manager promoted a person-centred approach to managing restrictions resulting from the covid-19 pandemic. They communicated well with people and families to explain restrictions.

Senior staff carried out regular checks on the quality of care and took action which directly improved care standards.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 25 September 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider and the former registered manager to discuss their action plan. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns that the provider did not have effective systems in place to keep people safe. We also had concerns about the high turnover of registered managers within the provider’s services. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 considered how well the provider had responded to the concerns and breaches found at the previous inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brentwood Care Centre 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.

Brentwood Care Centre accommodates up to 112 people who require nursing and personal care. Care is provided over three floors. The Balmoral unit accommodates people with nursing needs, the Windsor unit specialises in providing care for people with dementia and the Buckingham unit accommodates people with personal care needs. There were 57 people using the service when we inspected.

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

The repeated changes of managers and staff turnover impacted negatively on the quality of life of the people at the service. A family member told us, “I have been coming here for a year and this is the third manager, I wonder what the underlying problems are?” People and families told us things were getting better with the recent arrival of the new manager, but we were concerned that the provider had a history of failing to sustain improvements.

Checks on the quality of the care and accommodation had not picked up all the concerns we found during our inspection. Where the provider had picked up concerns, measures were still being put in place and had not yet improved the service consistently. The manager had introduced new measures to learn lessons from mistakes, however further time was needed to ensure these made a difference to the care people received.

Lack of oversight meant people were not protected from risk of harm. Staff did not always administer medicines safely to people in line with their prescription. Measures to reduce the spread of infection were not adequate. Staff did not have the required skills to meet people’s nutritional needs, in particular risks from choking were not minimised. The provider told us they were appointing more senior staff to improve coordination and drive improvements at the service.

There were enough safely recruited staff to respond to emergencies, however staff were not always deployed effectively. This particularly affected people’s wellbeing as activity coordinators were drawn into care work. There was a reliance on agency staff. People and families told us they did not always receive good care from agency staff. Coordination and monitoring of agency staff was improving but this was still an ongoing concern.

There had been an increase in safeguarding alerts since our last inspection. The new manager had started to address this and was working well with the local authority to investigate and resolve the concerns.

The manager was supporting staff to develop their skills by improving staff attendance at training and supervision meetings. The provider had invested in enhancing dementia support at the service. Adaptations and decor reflected best practice and staff skills were being developed so they could better support people with dementia.

The manager was encouraging improvements to people’s dining experience. Staff worked with external professionals to meet people’s health and social care needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However; the policies and systems in the service did not always ensure this practice was consistent and based on people’s most up-to-date needs.

People were not always confident they would be supported by caring staff. Whilst some staff were compassionate and knew people well, people were not always supported in a respectful manner. People and families told us they became anxious when agency staff supported them or when staff were not available to meet their needs.

Staff carried out assessments of people needs and developed person centred care plans. Reviews of people’s care took place; however, care plans did not always have consistent information about people’s current needs.

There was a variety of activities on offer throughout the week, and staff had promoted positive links with the local community. However, people who were cared for in bed or who required support to leave their bedrooms did not always receive enough stimulation or encouragement to develop their interests or take part in activities and meals.

People, families and staff felt able to speak out and their complaints were responded to. There were regular meetings with senior staff where they felt they would be listened to. However, the rapid change in management meant the response they received was not always consistent and actions were not always followed up.

People received support when they required end of life care. Care plans lacked detail and were not always person-centred. We made a recommendation around best practice in this area.

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

Rating at last inspection

The last rating for this service was requires improvement (published 10 August 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to inconsistent management and oversight resulting in poor administration of medicines, management of choking risks and infection control. Please see the action we have told the provider to take at the end of this report.

We set up a meeting with the provider after the publication of the draft inspection report, to discuss any lessons learnt from the past which could help the provider sustain the current improvements and action plans.

Follow up

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

Brentwood Care Centre 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 care home accommodates 112 people in one building, over three floors in four separate units including a nursing unit on the top floor. At the time of our inspection there were 74 people living at the service some of whom were living with dementia.

There was a registered manager in post. 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 the service was rated as requires improvement with a breach of Regulation 12; safe care and treatment as medicines were not always managed safely. Despite improvements in some areas which meant the service was no longer in breach of the regulations the rating remains requires improvement.

Improvements had been made to the safe management of medicines and staff supported people to take their medicines as prescribed. However, further improvements were required to ensure people received their covert medicines in accordance with prescriber’s guidance. The provider had policies and procedures in place designed to protect people from abuse and staff had received training in how to safeguard people from the risk of abuse.

Risk assessments and management plans were in place to reduce risks to people’s health and safety but care records had not always been updated to reflect the current risks to people. Appropriate recruitment procedures were in place and on the day of inspection people’s needs were met by sufficient numbers of staff. However, mixed views were expressed by staff, people and professionals regarding staffing levels.

The environment was safely maintained and good infection control practices were adhered to. People reported satisfaction with the level of cleanliness and hygiene. Accidents and incidents were recorded and learned from with measures put in place to minimise the risk of re-occurrence.

Staff had received training and supervision to ensure their competence in their role, however annual appraisals of their practice had not been completed to support continuous learning and development.

Record keeping was not always robust, particularly on the nursing unit, which meant we could not be sure people always received effective care and support to maintain their health and wellbeing. People were supported to access healthcare professionals but improvements were required to ensure timely referrals were consistently made. People were supported to have enough to eat and drink and were offered choices, however improvements in monitoring food and fluid intake were required.

People were supported to make their own decisions and choices. The environment was suitable to meet the needs of people living with dementia.

Staff developed caring relationships with people and supported them to express their views and be involved in making daily decisions about their care and support. Independence was promoted and people’s privacy and dignity was respected.

People received personalised care that was responsive to their needs and enjoyed a range of activities, which were tailored to their interests and choices. People and their relatives had access to the complaints procedure. People were consulted about their end of life care choices and wishes.

Quality assurance mechanisms were in place to monitor and improve the safety and quality of the service. Staff felt supported by the management team and there was good morale and a strong sense of teamwork.

People, relatives and staff were included in the running of the service. Feedback was sought and points raised were acted upon to drive improvements. The registered manager worked in partnership with other agencies to ensure that the service continued to learn and improve.

During the previous inspection which focussed on the nursing unit and looked at the domains of safe and well-led we found three separate breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe management of medicines, risk management, staffing and the way in which the quality and safety of staff and the service was monitored.

Following the focussed inspection, the provider provided us with an action plan, which set out what they would do to meet the legal requirements in relation to the breaches and to improve the service. Because the breaches potentially affected all areas of the service we undertook a comprehensive inspection looking at all domains across all five units to check that the service had implemented their action plan and to confirm that they now met the legal requirements.

This inspection took place on 30th March 2017 with a follow up visit on 4th April 2017 and was unannounced. Brentwood Care Centre provides accommodation over two floors on five separate units for up to 112 people who require nursing or personal care. There were 83 people living at the service at the time of our inspection.

The service had a registered manager in post. 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 this inspection we found that the service had followed its action plan to address the breaches and those aspects of the service we had identified that required improvement which meant that the nursing unit now met the legal requirements and was no longer in breach of the regulations. However, this inspection looked not only at the nursing unit but also at the service as a whole and in so doing found a continued breach of Regulation 12 (1) (g) safe and proper management of medicines.

On two of the five units we found that people's medicines were not managed safely.

There were systems and processes in place to monitor the quality and safety of the service, however these were not always effective as we found medicine audits had failed to identify areas that required improvement to ensure people's safety. We recommend that the service re-evaluate its current system of auditing medication.

There were sufficient numbers of appropriately trained staff who had been recruited safely and were aware of their safeguarding responsibilities and knew how to protect people from risk of harm.

Staff knew people well and were aware of their preferences so were able to provide person centred care.

Training, supervision and support was made available to staff which provided a method of assessing staff competency and promoting learning and development.

Where appropriate mental capacity assessments had been completed. This ensured that any decisions taken on behalf of people were in accordance with the Mental Capacity Act (MCA), 2005.

People were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported by staff who were aware of their responsibilities under the legislation.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS ) and made appropriate applications when necessary.

People were supported to maintain their health and had access to wide range of healthcare professionals.

A choice of food and drink was available that reflected peoples nutritional needs and took into account their preferences and any health requirements.

There was a strong focus on providing good quality dementia care and new initiatives had been introduced to promote the health and wellbeing of people living with dementia.

Opportunities were made available for people to follow their interests and take part in activities and people were supported to follow their religious practices and beliefs.

People were supported to keep in contact with their family and friends and make new friendships.

There was a new manager in post who understood and met their registration requirements and demonstrated a commitment to improve quality and promote innovation within the service.

The service responded appropriately to complaints and used feedback constructively to drive improvements.

Brentwood Care Centre is a nursing home registered to provide accommodation, personal and nursing care to 112 people. On the day of our inspection 82 people were using the service, living in four separate units including a dementia unit and a nursing unit.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe management of medicines, risk management, staffing, and the way in which the quality and safety of the service was monitored. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post at the time of inspection though since our visit a new manager has been appointed. 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 time of inspection we found that risks to people were not consistently well managed. Assessments were not always up to date and did not hold sufficient detail to monitor and analyse people’s health and wellbeing to keep them safe.

The management of medicines was not consistently safe. Records were not completed accurately and there were incidents where staff had not adhered to the medicine policy and procedure regarding administration of medicines.

There were insufficient numbers of staff to keep people safe and a lack of managerial oversight which meant that the skills and competency levels of staff had not been consistently monitored and assessed.

Record keeping was not of an adequate standard and there were ineffective systems in place to monitor quality and drive improvement.

The registered manager was open and transparent and responded promptly to our requests for information. However they did not always provide us with statutory notifications in a timely fashion, nor was the information received always accurate.

The manager was well-thought of by staff and took a hands-on approach. They were able to demonstrate how they used accidents and incidents as opportunities for staff learning and development.

Safe recruitment practices were followed.

After our inspection the Provider informed us that they had appointed a new registered manager. The provider acknowledged the failings of the service identified during our inspection and prior to receiving a copy of our report were pro-active in providing us with their own action plan which identified many of the same concerns that we had found and set out how the areas requiring improvement would be addressed.

Brentwood Care Centre provides accommodation and personal care for up to 112 older people and people who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were 99 people using the service.

There was a registered manager in post at the service. 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 were safe because the management team and staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health and social needs were managed effectively with input from relevant health care professionals and people had sufficient food and drink that met their individual needs.

The adaptations and design of the premises met people’s needs and promoted their independence but improvements needed to continue to the decoration of the premises.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

People were treated with kindness and respect by staff who knew them well.

Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

The management team encouraged and supported staff to provide care that was centred on the individual.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

We considered all the evidence we had gathered under the outcomes we had inspected to answer 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?

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

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

Is the service safe?

People who used the service had risk assessments in place to enable them to be as independent as possible.

People had received Mental Capacity Assessments (MCAs) in respect of day to day decisions. This meant that where possible they were involved in decisions about their lives. Where it was deemed they could not make decisions the staff and other people acting on their behalf were involved.

We found there were enough staff on duty to support people safely and to meet their needs appropriately.

Is the service effective?

People were involved in the planning and review of their care plans and had signed to consent to this.

Menus were available in a pictorial format to aid understanding for those people who needed this type of assistance.

Staff had received appropriate training to enable them to carry out their roles effectively.

Is the service caring?

People were treated with dignity and respect by staff, who were responsive to their needs.

We observed positive interactions between staff and people who used the service. One person told us, 'I like to be up about 5am, and I do not like to go to bed until about 11pm as my joints get very painful in bed. I need to be hoisted, so am grateful that staff do not tell me when to go to bed, or get up.'

Is the service responsive?

People's care plans were written in a person centred style, and were reviewed and updated regularly.

People were assisted to enjoy a range of activities, with support when required.

Is the service well led?

The service did not have a registered manager. However, recently a new manager had been employed, in an interim position.

Quality assurance procedures were in place, however, they had not been in place long enough to prove sustainability.

People had not always been asked for their consent and therefore the provider did not always act in accordance with their wishes.

People did not always experience care, treatment and support that met their needs and protected their rights. We also found that people were not always involved in planning their care and support.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were aware of what abuse was and how to report this and the manager acted appropriately when this was highlighted.

We observed and people told us that there were not enough staff to meet people's needs and provide consistent and safe care to people. One person who used the service told us, "The night staff will start about 5am to get people up. I see them across the hall waking them up. If a person has dementia then they are not necessarily going to object to the time.'

Staff were not always supported to deliver safe and effective care to people.

Due to the complex needs of some of the people who use the service, we used a variety of methods to help us understand the experiences of people living at the home.

We saw that people's needs were assessed and delivered in line with their care plan and that people were provided with a choice of suitable and nutritious food and drink. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We found that the service did not safeguard people from abuse as the provider had failed to respond appropriately to an allegation of abuse made by a person who used the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. The home was clean and hygienic.

Appropriate checks were undertaken before staff began work within the home. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.