Bange Nursing Homes Limited t/a Bradley House Nursing Home

Bange Nursing Homes Limited t/a Bradley House Nursing Home (known as 'Bradley House' by the people who live there) is a nursing care home providing personal and nursing care to up to 34 people. The service provides support to older people, some of whom were living with dementia in one adapted building. At the time of our inspection there were 21 people using the service.

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

People and their relatives said they were safe living at Bradley House. Staff knew how to report any concerns and all incidents and accidents were recorded and reviewed to ensure actions had been taken to reduce the risk of a re-occurrence. Equipment was regularly checked and serviced.

Staff were safely recruited. There were enough staff to meet people’s needs. The number of care staff on duty would increase as more people moved into Bradley House. Staff enjoyed working at Bradley House, but felt they weren’t fully supported following an incident. The management team said they would hold a debrief following incidents in future.

A quality assurance system was in place. Any issues identified were actioned. The audits were made more robust immediately following our inspection. Relatives said communication with the home was good. A recent relatives survey had shown positive results.

People received their medicines as prescribed. A medical professional was positive about Bradley House; they made appropriate referrals and followed advice provided. The home was clean throughout and actions had been completed following a local authority infection control inspection.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 October 2019) and there were 2 breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bange Nursing Homes Limited t/a Bradley House Nursing Home on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation for best practice guidance to be followed for completing regular fire drills.

Follow up

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

Bange Nursing Homes Limited t/a Bradley House Nursing Home (known as 'Bradley House' by the people who live there) is a nursing home providing personal and nursing care to 29 older people some of whom were living with dementia at the time of the inspection. The home accommodates up to 34 people in one adapted building.

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

We found management of medicines at the home continued to be inconsistent and unsafe. Auditing systems in respect of medicines continued to be ineffective and had failed to address key concerns regarding the safe management of medicines. Documentation to support the safe use of medicines was sometimes inaccurate and incomplete.

Although we identified continued concerns around the safe management of medicines and good governance, we identified other key areas in which improvements had been embedded and sustained. We found improvements to the environment, training and recruitment practices had been made.

People were provided with assistance when required with their meals. During the inspection we identified one person’s meal diary did not always indicate if their meals had been made to the correct consistency as per the Speech and Language Therapist (SaLT) recommendations. We raised this matter with the registered manager who provided us with assurances that this person’s meals were being prepared correctly and acknowledged there was an issue with the recording keeping from staff.

Staff were recruited safely; they received regular support and training. New staff were provided with an induction which provided them with the relevant knowledge and skills for their roles. There were sufficient numbers of trained staff to support people safely.

People told us they felt safe and enjoyed life in the home. 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.

Care and support was flexible and tailored to people's needs. People were able to have some control over their preferred routines. Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risks to people’s health and safety where possible.

We observed many caring and positive interactions between staff and people throughout the inspection. Staff had formed genuine relationships with people, knew them well and were seen to be consistently caring and respectful towards people and their wishes.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home where people could move around freely as they wished.

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 8 April 2019) and there were three breaches of the regulation in respect of medicines, safe recruitment and good governance. At this inspection we found improvements had been made in certain areas. However, we have found evidence that the provider still needs to make further improvements.

Enforcement

At our last inspection we served warning notices for Regulations 12 and 17. Although improvements had been made in certain areas, we continued to find incontinences in the way people’s medicines were managed and audited. At this inspection we have served requirement notices for Regulations 12 and 17. We will also be holding a provider meeting along with the local authority to seek assurances in relation to the safe management of medicines.

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. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme.

Bradley House 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. Bradley House can provide accommodation and nursing care for up to 34 older people living with dementia. At the time of the inspection there were 29 people living at the care home.

We last inspected Bradley House on the 5 and 6 February 2018, we rated the service Requires Improvement. We found two breaches of regulations relating to the provision of safe care and treatment and good governance. 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 provider sent us their action plan detailing their planned actions to improve the service. At this inspection we found improvements had not been made in relation to the provision of safe care and treatment and good governance. This is the fifth time the service has been rated Requires Improvement.

The service had a registered manager in place as required by their Care Quality Commission (CQC) registration. 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 registered manager was also part owner of the home and was supported by a clinical nurse.

Medicines were not always managed safely. Guidance for medicines when people needed them did not contain sufficient detail to ensure they were administered consistently. The records about the stock and administration of medicines were not accurate. When audits were done they did not evidence that medicines were always administered as prescribed or could be properly accounted for.

Risks associated with the premises, such as the regulation of water temperatures to reduce the risks associated with scalding were not effectively managed. The providers approach to undertaking fire drills was inconsistent, which meant staff may not know how to use evacuation equipment in an emergency.

Staff received induction and on-going training. However, we found a number of key courses were overdue for a small number of the staff team. A detailed training plan was in place, this had been developed by the new training co-ordinator and we were provided with assurances from the registered manager staff access to supervision and annual appraisals would be improved.

Quality assurance systems were not effective as we identified issues with the management of people’s medicines and the safety of the home, which the some processes failed to recognise.

Staff were kind and caring and treated people with respect. We observed many positive and caring interactions throughout the inspection. Staff knew people's likes and dislikes, which helped them provide individualised care for people.

There were sufficient staff on duty to support people safely. One staff member had not been recruited safely in line with the requirements of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Schedule 3.

People's rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

Risk assessments were in place for people who lived at Bradley House. Risk assessments were tailored around the needs of the person, support measures were in place to mitigate risks and assessments were regularly reviewed and updated. Staff were familiar with people's risks; they received daily updates on people's health and well-being and if their circumstances had changed.

Accidents and incidents were routinely recorded and analysed. There was an accident and incident reporting policy in place and staff routinely completed accident and incident documentation. The registered manager analysed monthly accident and incidents reports and established trends that were emerging as a measure of mitigating risk.

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.

At the last inspection on 12 and 13 December 2016, the service was rated as requires improvement. We found one breach of the regulations, as improvements were needed in the recruitment of new staff. We also found improvements were needed in respect of fire safety, as we found fire drills had not been undertaken in the last 12 months to check that staff understand and are familiar with the operation of the emergency fire action plan. Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe.

Bradley House Nursing Home is registered to provide nursing and residential care for up to 34 people. People in care homes receive accommodation and nursing and/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 time of our inspection there were 28 people living in the home.

People were supported in one building over three floors. Nine people could be accommodated on the ground floor; bedrooms are all single, there is a shared bathroom, a combined lounge and dining area and a quiet lounge. There are rooms for 13 people on the first floor; these are a mixture of single and twin bedrooms with a shared bathroom and a communal lounge and dining area. There are five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager's office, the staff room, some storage areas and the laundry facilities.

The service had a registered manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The systems in place to monitor and improve the quality and safety of the service were not effective. Potential safety hazards were identified by the inspection team as we walked around the building. We brought these concerns to the management team's attention and found these had been resolved during the inspection. The safety of the premises and the quality of care provided was ineffective, as they had failed to identify a number of issues that we saw on our inspection. Failure to identify and act upon these risks to people's health and safety meant that the environment at the home was not always safe.

People were supported to access healthcare professionals when needed. Staff respected people's privacy and promoted their dignity by supporting people to be independent. People and relatives spoke highly of staff who they felt were caring and friendly.

Medication was correctly administered, stored and recorded. We looked at six people's medication administration records (MARs) and medication stocks and found that the MARs had been appropriately completed and medication stocks were accurately accounted for. The nurse we spoke with told us that they were confident managing people's medication and people received the right medication at the right times. We saw that relevant staff had received training on medication administration and there were policies and procedures in place to support staff.

Staff were safely recruited and were supported with an induction process. Criminal records checks, known as Disclosure and Barring Service (DBS) records, were carried out. We also saw that official identification, such as a passport or driving licence, and verified references from most recent employers were also kept in staff files.

Care plans were well personalised with details that supported staff to provide care in a person centred way. We observed that staff were familiar with people's chosen routines and noticed changes in their needs. Care plans were reviewed and updated regularly and gave an accurate description of the care provided.

The people we spoke with and their relatives told us they enjoyed the food and drink at the home. We saw that people were given a choice of suitable nutritious foods to meet their dietary needs and preferences. Relevant information regarding anyone who required special diets, such as diabetic or soft diets, was clearly displayed in the kitchen. However, we did observe that the meal time was more task-orientated for people who needed assistance to eat. Staff concentrated on the role of assisting people rather than creating a social atmosphere.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed and DoLS applications were completed correctly and in line with current legislation. Staff showed a good knowledge and understanding of both MCA and DoLS.

Staff that were spoken to showed good knowledge around maintaining the dignity and respect of people living within the home. During the inspection staff were observed to be kind, compassionate and respectful towards people and were seen to interact in a calm, respectful manner. People living in the home and their relatives spoke positively of staff and their care and treatment towards them.

Bradley House Nursing Home employs an activities coordinator several days a week. People living in the home spoke positively about the activities that were provided. We saw evidence of a wide range of group and individual activities, themed activities and trips out. The activities folder provided further evidence of the positive reactions from people living in the home.

We saw that there were policies and procedures in place to guide staff in relation to safeguarding adults and whistleblowing. Staff had had training on this and information about how to raise safeguarding concerns was readily available. Staff told us that they felt people living at the home were safe, as did the people living there and their relatives. They said that if they ever had any concerns they could raise them with staff and the issues would be resolved.

Staff supervisions and appraisals had been completed regularly and were clearly documented. Staff told us they felt well supported by the management team and were able to request additional support through supervisions if required.

Processes were in place to ensure people received appropriate support as they reached the end of their life. People had been asked for their wishes and the registered manager had ensured any decisions relating to the use of cardiopulmonary resuscitation were clear and correctly recorded.

The provider had a number of systems and process in place to monitor and oversee the provision of care and support. However, audits on the home's quality were not accurate or completed which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance.

At this inspection we found two new breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because health and safety issues we identified during the inspection and a lack of robust good governance systems. You can see what action we asked the provider to take at the back of the full version of this report.

This is the fourth consecutive time the service has been rated Requires Improvement.

Bradley House Nursing Home provides nursing care for up to 34 older people. At the time of our inspection there were 29 people living in the home.

People were supported in one building over four floors. In the basement area there was room for seven people to receive nursing care; all the rooms were single bedrooms, there was a shared bathroom and a communal lounge and dining area in a large conservatory that had recently been modernised. Nine people could be accommodated on the ground floor; bedrooms were all singles, there was a shared bathroom, a combined lounge and dining area and a quiet lounge. There were rooms for 13 people on the first floor; these were a mixture of single and twin bedrooms and they shared a bathroom and a communal lounge and dining area. There were five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager's office, the staff room, some storage areas and the laundry.

The service had a registered manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection took place on 15 and 16 December 2015. At that time the service was not meeting all the legal requirements. During this inspection we checked to see if improvements had been made.

The provider did not have an effective recruitment and selection procedure in place and did not carry out relevant checks when they employed staff.

Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. However, we found the home had not undertaken any fire drills for the last 12 months. We have made a recommendation that the registered provider reviews the latest fire safety guidance for nursing homes.

The home was generally clean and tidy, although we found a similar malodour at the reception area of the home; this was also noted at the previous inspection. The registered manager provided evidence that this area was regularly cleaned and the manager was looking at alternative ideas to eradicate this malodour from the home.

Staff knew how to keep people safe and how to raise any concerns if they suspected someone was at risk of harm or abuse. Staff understood the risks people could face through everyday living and how they needed to ensure their safety.

We observed staff interacting with people in a positive, respectful and friendly manner. People told us staff were kind and caring. Staff were able to describe how they would support people to retain their independence and we observed aspects of this during the first day of inspection, particularly during the lunch time meal.

Medicines were managed safely and people had their medicines when they needed them. Regular checks on the management of medicines were carried out and action taken where shortfalls were identified. Staff administering medicines had been trained to do this safely.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff were provided with regular supervision and training to support people with their care needs. People were supported to have a healthy diet and to maintain good health. The service was working within the principles of the MCA. We saw evidence of completed mental capacity assessments, best interests meetings care records. Staff had completed MCA training.

Systems were in place to manage complaints and concerns. People and their relatives had the opportunity give feedback on the service they received and the provider took steps to ensure improvements were made.

We saw that a variety of activities and entertainment had been available to people, in order to provide stimulation and motivation.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Care plans were complete and regularly reviewed. We saw any changes to care plans were reflected in handover documents to help ensure all staff were aware. Information on preferences, social history and interests were recorded. The provider told us they were in the process of implementing a new electronic care planning system that will replace the paper records.

There were a range of quality assurance audits which had identified areas for improvement. A home improvement plan demonstrated how these had been actioned.

People and staff told us they believed the home was well-led. Staff told us they felt supported by the manager and senior staff and were able to discuss any concerns openly. Records showed that staff received regular supervisions to support them in their role. Staff received training and induction prior to starting work and records showed that staff training was regularly monitored and updated.

The overall rating for this service is 'requires improvement'. During this inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Bradley House Nursing Home provides nursing care for up to 34 older people. At the time of our inspection there were 32 people living in the home. People were supported in one building over four floors. In the basement area there was room for seven people to receive nursing care; all the rooms were single bedrooms, there was a shared bathroom and a communal lounge and dining area in a large conservatory. Nine people could be accommodated on the ground floor; bedrooms were all singles, there was a shared bathroom, a combined lounge and dining area and a quiet lounge. There were rooms for 13 people on the first floor; these were a mixture of single and twin bedrooms and they shared a bathroom and a communal lounge and dining area. There were five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager’s office, the staff room, some storage areas and the laundry.

The service had a registered manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection took place on 14 April 2015. At that time the service was not meeting all the legal requirements. During this inspection we checked to see if improvements had been made.

Some corridors and communal areas were cluttered. There were no risk assessments in place for various aspects of the care home premises; for example, stair gates, steep steps, the kitchen or laundry room.

Not all of the people living at the home had a personal emergency evacuation plan in place. They might therefore be at risk in the event of a fire or other emergency situation.

We found that the registered manager had not reported all safeguarding incidents to CQC as is required by the regulations and staff had not received regular safeguarding training.

Staff training and development was not up to date and the induction process for new staff was not documented.

There was a lack of consistent and effective audit at the service. This was noted at the last inspection and constituted an ongoing breach of the regulation relating to good governance.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Most aspects of medicines management were done well at the home; however, we found that not all ‘as required’ medications had instructions for staff. We recommended that the registered manager reviews and improves current practice in line with nationally available good practice.

There were enough staff on duty to meet people’s needs and the home employed a flexible system to minimise the use of agency care staff. Care workers had time to assist the activities coordinator to provide activities for the people who used the service. There was a full time activities coordinator at the home who kept records of the activities people had taken part in as well as those that people had refused, so that care workers knew which activities individuals preferred.

The registered manager ensured all the necessary checks were done on new staff before they were employed at the home. Appropriate checks were done in relation to existing nursing staff on an annual basis.

At our last inspection there was a breach in regulation as we noted there were issues with cleanliness and some décor was seen to be in need of improvement. During the inspection, apart from some minor issues that we brought to the registered manager’s attention, the home was clean and tidy but cluttered in places. People’s relatives told us they thought the home was clean.

Staff were receiving regular supervision and were due to receive an annual appraisal at their next planned supervision session. This had been an area of concern at our last inspection but we saw evidence that this had been remedied.

The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Applications for DoLS had been made to the local authority and care workers had a good knowledge of the legislation and how it applied to the people they supported. We saw capacity assessments and best interest decision meetings were documented in people’s care files.

Feedback on the food served at the home was positive. We saw that people were supported to eat when they needed it. The cook knew people’s dietary needs and food preferences and tried to ensure people were provided with food they enjoyed.

People were supported to maintain their holistic health by access to other healthcare professionals, such as GPs, dieticians, podiatrists and mental health specialists.

People and their relatives told us that the care staff were caring. Staff at the home we spoke with could tell us people’s likes, dislikes and preferences, as well as details about their personal history. Interactions we observed between care workers and people during our inspection were warm and respectful.

At the last inspection there was a breach in regulation as people’s care plans were not person-centred and not always completed fully. At this inspection we found that people’s care plans were person-centred and complete and people and their relatives were involved in developing them. People’s bedrooms were personalised with their furniture, ornaments and photographs. Relatives told us they could visit at any time and said that they thought the building was homely and welcoming.

We saw that the service referred people to advocacy services when they needed them. The home had received positive feedback from relatives after people had received end of life care there. Care staff we spoke with were passionate about providing good quality end of life care at the home.

The service was responsive to people’s changing care needs. Risk assessments and care plans were evaluated and reviewed regularly. There was a system in place for recording various aspects of care that people received, including an innovative system for recording night care interventions.

The complaints procedure was displayed in the home and there was a policy in place for reporting, recording and responding to complaints. No complaints had been made since our last inspection, however, people and their relatives told us they would speak to the registered manager if they had any problems. Feedback from the people, their relatives and care workers about the registered manager and director was positive.

The home sought the views of people’s relatives in order to improve the service. Feedback from the last survey published in April 2015 and an action plan to address the issues raised in the survey was displayed.

Staff had regular team meetings at which good practice was discussed and the management asked for feedback and ideas for service improvement. The service had an ‘employee of the month’ scheme in order to reward and motivate staff.

We saw that the registered manager was committed to providing evidence-based practice at the home; she provided examples of how national guidance and government advice had been used to update practice at the home.

We looked at the medication records for all 30 people currently living at Bradley House

We found that improvements had been made since the last inspection.

Appropriate arrangements were in place in relation to the recording, handling, storage, disposal and safe administration of medicines. We looked at records for January 2014, the medication administration records (MAR) were in place detailing the medication, dosage and times that medication needed to be administered.

Staff were able to demonstrate a clear understanding of their roles and responsibility with regard to safeguarding people living at Bradley House. Appropriate adult safeguarding policies and procedures were in place to support staff.

We observed how people were supported and how staff interacted with people. We saw that the relationships between people living in the home and staff were warm and friendly.

The expert by experience spoke to two relatives and they told us: 'X has been here for a good few years. I find the staff very good. They treat them very, very nice.' 'They've only been here six weeks and they've settled very well.' 'I think they are all lovely staff actually'.

Medicines were not always given to people appropriately. One person was prescribed two creams only available on prescription: We found that they were being applied by members of staff who were not qualified to handle medicines.

The manager provided us with an up to date copy of a training matrix highlighting training staff had received, and where up date's were required.

Staff members the expert by experience spoke with said they enjoyed working at the nursing home. They also said they appreciated the encouragement of management and the support they received to obtain external qualifications.

We saw the manager had a matrix to monitor reviews of care had taken place and they had created a new audit system of care plans.

The warning notice was issued following major concerns identified during our inspection on 8th November 2012, when we found a lack of recording in assessments of care or nursing needs, assessments of capacity, risk assessments, medication administration and care plans. Additionally we found no evidence of care records being systematically reviewed or audited.

When we carried out the review we found there was significant improvement in record keeping, and a concerted effort by the manager to review and audit records. We found that people's personal records including medical records were accurate and fit for purpose.

We saw staff interacting with people living in the home, we observed staff chatting with people while they were having drinks in the afternoon and generally throughout the day in social areas. We saw staff talking with relatives when they visited.

We did observe one person whose needs were not being met in a timely manner

Records we looked at were not up to date to support peoples care needs or evidence consent or capacity to care or treatment. The registered manager was unable to provide evidence of suitable arrangements to monitor or assess quality of the records or care people received.

Staff we spoke to said they understood the steps they would need to take to ensure that people are safeguarded against the risk of abuse. Records provided evidence that people living in the home were being protected from harm.

One relative we spoke to told us 'My X receives excellent care and the staff are always friendly and you can tell they care for the residents.'

During our visit we spoke with a local GP who told us they 'Never any problems with following up on treatment we prescribe, we have a good relationship with seniors. The staff are very cautious about residents and will involve us with care and treatment early on.'