Long Lea Residential Home

Long Lea Residential Home is a care home providing personal care and accommodation for up to 35 adults living with dementia or mental health needs, physical disabilities and sensory loss. The care home is a 2-storey building with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 28 people receiving care.

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

There had been frequent changes in management and senior staff at Long Lea Residential Home which had impacted on the provider’s ability to maintain consistency in care standards. The service has not achieved an overall rating of good for the last 4 inspections dating back to January 2021.

The provider carried out a range of quality checks and audits. These had driven improvements in some areas and maintained standards in the key questions of effective, caring and responsive. However, systems to monitor people’s health and wellbeing required more day-to-day scrutiny. Important records were not always detailed enough to demonstrate people received the right levels of care and safe practices were followed. Training needed to become embedded in the everyday practice of staff to ensure risks were consistently mitigated.

There were enough staff on duty to support people with their care needs. Staff understood their responsibility to report any concerns of abuse or discrimination. Where potential safeguarding incidents had occurred, appropriate action had been taken. Medicines were ordered and stored safely, and people generally received medicines as prescribed. However, some improvements were required in the recording of medicines administration to ensure safe medicines practices were consistently followed.

Managers and staff liaised with other agencies and health professionals to meet people's specific needs. Staff told us changes to people's health and well-being were communicated effectively. Catering staff demonstrated a good knowledge and understanding of their responsibility to provide food and drinks that met people's nutritional needs and preferences. Changes in the layout of communal areas had improved people’s mealtime experiences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were positive about the relationships they had built with the staff and relatives told us staff demonstrated a kind and caring approach. Staff understood people’s right to be treated with dignity and respect and encouraged people to let them know how they wanted their care to be provided.

People’s care plans reflected their histories, care needs and preferences. People were supported to engage in a range of interesting things which helped keep them active and gave them opportunities to socialise with other people living at the home. People’s wishes for how they wished to be cared for in their final days had been explored and plans developed with input from their family members.

Staff told us the culture in the home had improved and the provider was working proactively to promote staff well-being. Staff felt supported and listened to and good practice was recognised.

The provider sought advice and guidance from other organisations to improve outcomes for people. They worked closely with commissioners of their service including the local authority and infection control teams, to make improvements to the service.

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 13 December 2022) and there a breach of a regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 1 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. In addition, we had received further concerns in relation to poor-quality care.

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.

The overall rating for the service has remained as Requires Improvement based on the findings of this inspection. We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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

Long Lea Residential Home is a care home providing personal care and accommodation for up to 35 adults living with dementia or mental health needs, physical disabilities and sensory loss. The care home is a 2-storey building with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 26 people receiving care.

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

Since our previous inspection there had been changes in the management team. There had been 2 new managers and the most recent was registered with us in August 2022. Since our previous inspection, significant improvements had been made. The provider had increased their oversight of the service, which had led to improvements in quality assurance processes, risk management and care planning. However, time was needed to allow the new governance systems to become embedded due to changes in staffing. Improvements were still required in the management of some environmental risks, including infection prevention control and medicine management.

There were enough staff on duty to meet people's physical needs, but people waited for support. Continued staff vacancies meant that shifts were not always staffed with care workers who had the relevant experience to provide care. The provider had identified this and stopped admissions to the home, until vacancies were filled.

People spoke positively about the staff and the care they provided. Staff felt supported by their management team.

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 20 November 2021) and there were 2 breaches of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

At our last inspection of this service, breaches of legal requirements were found.

This inspection was carried out to follow up on action we told the provider to take at the last inspection, to check they had followed their action plan and to confirm they now met legal requirements. We had also received concerns in relation to poor personal care. This report only covers our findings in relation to the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

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

We found evidence the provider has made improvements in their governance systems, but other improvements were still required. Please see the safe and well-led sections of the full report.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Long Lea Residential 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 monitor the service and will take further action if needed.

We have identified a breach of the regulations in relation to the safety of people's care.

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, the local Integrated Care Board (ICB) and the local authority (LA), to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Long Lea Residential Home is a care home providing personal care and accommodation for up to 35 adults living with dementia or mental health needs, physical disabilities and sensory loss. The care home is a two-storey building with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 26 people receiving care.

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

Since our previous inspection there had been changes in the management team. The previous registered manager had left in March 2021, another manager had been in post for three months but left in June 2021 when the current manager started in their role. The management team worked alongside other agencies to drive required improvements. However, the provider still needed to make further improvements to ensure they maintained sufficient oversight of the service. For example, risks associated with people's care were not always identified and assessed and governance systems to monitor the quality and safety of the service continued to require improvement.

People spoke positively about the staff and the care they provided. Staff felt supported by their management team. People were positive about the new manager’s leadership.

Care records were recorded both on paper and electronically and some staff had not read paper risk assessments which provided guidance for staff about how to keep people safe. Some care records were not accurate and had not been reviewed.

Incident logs were not up to date which meant the system to analyse why incidents may be occurring was not effective.

An ‘infection prevention control’ audit was carried out by CQC during the inspection. We found the provider was not always following government guidelines. Improvements had been made to infection prevention and control practices following support from the local authority (LA) and the local clinical commissioning group (CCG). However, further improvements were still required to keep people as safe as possible and minimise infection control risks associated with COVID-19.

There were enough staff on duty to meet people's physical needs, but on occasions people waited for support.

The new manager was open and explained they had worked hard to make required improvements in a short time. They understood further improvements were still required. They took some immediate action during and following our inspection visit where significant shortfalls had been identified.

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 12 February 2021) and there were two breaches of regulations.

Why we inspected

At our last inspection of this service, breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance in the home.

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 of Safe and Well-led.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Long Lea Residential 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 two breaches of the regulations in relation to the safety of people's care and the management of the service.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, the local Clinical Commissioning Group (CCG) and the local authority (LA) to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Long Lea Residential Home is a care home providing personal care and accommodation for up to 35 adults living with dementia or mental health needs, physical disabilities and sensory loss. The care home is a two-storey building with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 28 people receiving care.

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

Risks associated with people's care were not always managed well and governance systems to monitor the quality and safety of the service required improvement. The provider had failed to maintain sufficient oversight of the service, to identify that risk management was ineffective. Audits were in place, but they were not robust enough to ensure areas for improvement were identified and action taken in a timely way.

Risk of harm or injury were not always identified, assessed and well-managed. Care plans and risk assessments were not regularly reviewed or updated. Risk management plans did not contain sufficient detail to provide staff with the necessary guidance to support people safely.

An ‘infection prevention control’ audit was carried out by CQC during the inspection. We found the provider was not always following government guidelines. Improvements had been made to infection prevention and control practices following support from the local authority (LA) and the local clinical commissioning group (CCG). However, further improvements were still required to keep people as safe as possible and minimise infection control risks associated with COVID-19

There were enough staff on duty to meet people's physical needs, but staff told us there were occasions when staffing levels needed to be increased to allow them to support people in a more dignified way.

Some aspects of medicines management were not in accordance with best practice.

People spoke positively about the staff and the care they provided. Staff had supported people to maintain contact with relatives via telephone or video calls.

The registered manager was open and explained they had struggled to maintain the managerial aspects of their role because they spent significant periods of time supporting staff and being with people. They were committed to making changes to improve the service and took action straight away to address some immediate concerns we identified to them.

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. (Report published 11 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control management and reduced staffing levels. Concerns were shared with us by the local Clinical Commissioning Group (CCG) and the local authority (LA). A decision was made for us to inspect and examine those risks. 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.

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

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this inspection.

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 two breaches of the regulations in relation to the safety of people's care and the management of the service.

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, the local CCG and the LA to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Long Lea Residential Home is a care home providing personal care and accommodation for up to 35 adults living with dementia or mental health needs, physical disabilities and sensory loss. The care home is a two-storey building with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 35 people receiving care.

People’s experience of using this service

The registered manager was open and honest, and had worked in partnership with outside agencies, supported by the provider, to improve the service since our previous inspection. Checks took place to ensure good standards of care were maintained.

People felt safe using the service. Staff managed the risks to people’s health, safety and well-being and understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People received support from staff when needed. People were supported to have enough to eat and drink to maintain their well-being. They were supported with their medicines and to obtain advice from healthcare professionals when required.

Staff had training to meet people’s needs and the registered manager shared guidance with staff on how to support people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with dignity and their independence was promoted wherever possible. People were encouraged to take part in activities which interested them and which improved their wellbeing.

People and their relatives were involved in planning care in their best interests. People and their families understood how to complain if they wanted to.

Rating at last inspection and update

The last rating for this service was requires improvement and there was a breach of the regulations (report published 8 January 2019). 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 was a planned inspection based on the previous rating.

Follow up

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

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

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. The management structure of the service changed in July 2017. A new nominated individual acquired the service and employed a new registered manager in November 2017, however the service maintained its original provider registration with the CQC.

We last inspected this service in November 2017, when we rated the service as ‘Requires Improvement’ overall. Following the last inspection, we asked the provider to complete an action plan to show how they would improve the rating of all the key questions to at least good and how they would address the breach of regulations 12 HSCA 2008 (Regulated Activities) Regulations 2014. At our last inspection we found people's medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff, but were not recorded, and stock checks of medicines were not accurate. The provider’s medicine audits were not always effective.

At this inspection, we found some improvements had been made, however the changes did not reach the required standards and further improvements were still needed to assure us care was delivered effectively to meet people’s needs. We have rated the service as ‘Requires Improvement’ in the key questions of safe, effective, responsive and well-led and ‘Good’ in all other key questions. Therefore, the overall rating remains ‘Requires Improvement.’ This is the second consecutive time the service has been rated ‘Requires Improvement’ since their management restructure in July 2017.

Staff were very busy and sometimes struggled to meet people’s individual needs. Improvements were required to ensure people’s capacity was assessed in accordance with the Mental Capacity Act 2005 [MCA]. The provider’s quality monitoring system was not always effective. It was not clear if some people had received their creams as prescribed.

Staff felt supported and were trained to meet people’s needs. The registered manager checked staff’s suitability to deliver care and support during the recruitment process. Staff understood their responsibilities to protect people from the risk of abuse.

People told us staff were caring and they were encouraged to maintain important relationships. People were supported to maintain their health and to eat and drink enough to maintain a balanced diet. Staff knew people and understood their likes, dislikes and preferences for how they wanted to be cared for and supported. Staff respected people’s right to privacy and supported people to maintain their independence.

People were satisfied with the service and were positive about the leadership of the service. People decided how they were cared for and supported and staff respected their decisions. People knew how to complain and could share their views and opinions about the service they received.

We found a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Long Lea 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. Long Lea Residential Home provides personal care and accommodation for up to 35 older people.

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

From July 2017, the home was under new ownership, and a new management team was appointed. The new manager became ‘registered’ with us in November 2017.

People’s medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff and were not recorded, and stock checks of medicines were not accurate. Audits designed to check medicines practice was safe and in line with best practice had not identified some of the issues we found.

Risk assessments were in place where risk had been identified, but had not always been reviewed in line with the provider’s policy and procedure. However, staff knew about people’s risks and managed them effectively.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures.

There were enough staff to meet people’s needs effectively, and staffing levels had recently been increased following feedback from staff. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People were asked for their consent before staff supported them. Where people lacked capacity to make particular decisions, this had been assessed to ensure people were protected. Where people lacked capacity and had been deprived of their liberty to keep them safe, the provider ensured they applied to the relevant authority to ensure this was done lawfully.

Effective induction of new staff was not yet in place, and staff were not always supervised according to the provider’s policy and procedure. The provider had a plan in place to ensure this happened by the end of December 2017. The provider was moving towards a new training system, and plans were in place to ensure staff received the training they required to update their knowledge and skills.

People and relatives told us staff were respectful and treated people with dignity. We saw this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals when needed and care records showed support provided was in line with what had been recommended. People’s care records required updating to support staff to deliver personalised care and give staff information about people’s communication needs, their likes, dislikes and preferences. People were not always involved in how their care and support was delivered, but the provider had plans in place to ensure this process was completed by the end of December 2017.

Systems to ensure the service was effective and continued to improve were not yet working as they needed to. The new management team had been in place since July 2017, and had made some improvements. These had been positively received by people, relatives and staff, and the provider had an action plan in place to ensure this continued.

People, relatives and staff told us the management team were approachable and responsive to their ideas and suggestions. The home had a warm, friendly and inviting atmosphere which people appreciated and responded well to.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Long Lea Residential Home on our website at www.cqc.org.uk.

At our previous inspection in September 2016, we gave the home a rating of 'requires improvement.' We found the provider was in breach of Regulation 12(2) (g) the proper and safe management of medicines; of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive their medicines as prescribed and guidance was not always available for staff to ensure people received their medicines in a safe way. At this inspection, we found improvements had been made to ensure there was a safer, and more consistent system in place to ensure people were administered their medicines safely and as prescribed. This meant the provider was no longer in breach of the regulation.

At our previous inspection, we found the provider had not always assessed the risks to the health and safety of service users and had not done all that is reasonably practicable to mitigate any such risks. This was a breach of Regulation 12 (1) (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements had been made to ensure risks to people were identified, assessed and managed effectively to keep people safe. This meant the provider was no longer in breach of the regulation.

At our previous inspection, we found the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had some systems in place to monitor the quality of the service provided but had not ensured these were effective.

This meant opportunities to identify where action was required to implement improvement were missed. We also issued the provider with a Warning Notice in relation to governance, requiring them to take action to improve this. At this inspection, we found improvements had been made to ensure a range of audits were in place so the provider could identify areas for improvement and take action as a result. This meant the provider was no longer in breach of the regulation, and the warning notice had been met. However, some improvements were still required.

The provider sent us an action plan as required, telling us how they planned to ensure they met the legal requirements. We found these actions had been carried out by the provider.

Long Lea residential home is one of two services provided by Dwell Limited and provides accommodation and personal care for up to 35 older people; over two floors. At the time of the inspection 35 people lived at the home.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post, who is the owner / provider of this service. The registered manager splits their time between this home and their domiciliary care service.

Long Lea residential home is one of two services provided by Dwell Limited and provides accommodation and personal care for up to 35 older people; over two floors. At the time of the inspection 35 people lived at the home. Long Lea was last inspected by us in October 2015 and we found a breach in the regulation relating to the safe management of medicines. We gave the home an overall rating of ‘requires improvement.’

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post, who is the owner / provider of this service. The registered manager splits their time between this home and their domiciliary care service.

People had not always received their medicines as prescribed because staff could either not find them or stock had run out because staff had not ensured there was enough. Guidance was not available for staff to refer to in order to ensure people received ‘when required’ medicines or prescribed creams in a safe way.

People felt safe living at the home because staff were there to support them when needed. Staff were trained to know what abuse was and how to report any concerns to the registered manager.

Some risks to people’s health and welfare were assessed but actions were not always put into place to reduce the risk of harm or injury to people. Some risks were not assessed and staff did not have the information available to refer to, if needed, to know how to keep people safe.

Staff worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care. People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and see a GP, for example, if they felt unwell.

Staff had received training and felt this gave them the skills and knowledge they needed to meet people’s needs effectively. Staff promoted people’s privacy when they were supported with personal care.

People said staff were, overall, kind to them and involved them in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to do so and people told us they enjoyed the activities.

Systems were in place to assess the quality of the service provided but audits were not always effective and improvement was not implemented when needed. Risks associated with the management of medicines and risk of cross infection had not been identified by checks undertaken. Care plan reviews had not identified where improvement was needed.

We found breaches of the regulations relating to the safe management of medicines, the safe care and treatment of people and the governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

People using the service told us staff were kind and they felt well cared for. One person said, 'You couldn't wish for a better home. Everyone is so kind.'

We found that people's needs were assessed and care and treatment was planned and delivered in line with individual care plans. People looked contented and relaxed.

We watched how the staff supported the people in their care. We saw people were treated with dignity and respect. We observed that staff understood and attended patiently to their needs.

Staff told us they had regular training, which meant they could support the specific needs of people who used the service. One staff member told us, 'I enjoy working here, we have a great team and the management listen to what staff say.'

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would speak to the manager I wasn't happy about something." Another person told us, 'If we have any concerns at all we can tell them (the staff).'