Burlington Nursing Home

Burlington Nursing Home is a nursing home providing personal and nursing care to people aged 65 and over. The service supports people who may be living with dementia or need support with their physical health. The service can support up to 40 people and 32 were living there at the time of inspection.

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

Staff were not always recruited in a safe way and assurances of their character was not always sought before they started employment. This was discussed with the registered manager who took immediate steps to address the concern.

Systems were in place to monitor quality of the service and drive improvement when needed. These were not robust enough in terms of recruitment, to monitor and ensure appropriate checks were complete.

The registered manager had oversight of matters within the service and took action to address concerns should they arise. We saw evidence of staff working in partnership with external agencies to ensure people’s needs were met.

People told us they felt safe at Burlington Nursing Home. We found effective systems in place to safeguard people from the risks associated with abuse. Risk had been assessed and was managed appropriately. People’s medicines were managed safely. Staff were suitably trained to meet people’s needs.

People and their relatives spoke positively about care staff within the home. They were supported to give feedback on the care at the service. One relative said, “I can always speak to the manager or deputy if I need to. It’s the right place for my [relative], he is well looked after.”

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 15 October 2019).

Why we inspected

This inspection was prompted by concerns received in relation to the standard of care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. Whilst we did not find any evidence to confirm the concerns we received, we did find evidence that the provider needed to make improvement to their recruitment process. Please see the ‘safe’ section of this full report. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Burlington Nursing 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 have identified a breach in relation to the recruitment of staff, this is a breach of regulation 19(1) (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and in relation to good governance, regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.. 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 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. If we receive any concerning information we may inspect sooner.

Burlington Nursing Home accommodates a maximum of 40 people in one adapted building. At the time of this inspection 32 people were living at the home. Most people who lived at the service were living with dementia.

Burlington Nursing Home was located over two floors which are accessible via stairs or lifts. The home had a large communal area and people and families had access to a beautiful garden at the rear of the home.

There had been a history of the service being rated as 'Requires Improvement' and ‘Inadequate’ for three consecutive inspections. At this inspection we found that the provider had worked hard over the past six months to ensure that standards were improved to a good standard of care for people.

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

At this inspection we found significant improvements had been made to embed change and improve the management, culture, oversight and leadership at Burlington Nursing Home. However, further improvement was required to ensure people’s care plans were person-centred and reflective of their needs.

The provider had quality assurance systems in place to monitor the standard of care and drive improvement. People, relatives and staff spoke positively about the culture of the home and said it was well managed. One relative told us, “It’s changed completely. It’s homely. There’s a lot going on, they’ve worked hard.”

People felt safe and told us they enjoyed living at the service. Risks to people had been assessed and staff followed guidance to keep people safe. There were enough staff to meet people's needs. Medicines were managed safely, and staff had been trained in infection prevention and control. Lessons were learned if things went wrong and systems supported people to stay safe and reduce the risks to them, ensuring they were cared for in a person-centred way.

People spoke positively about the staff who supported them and had confidence in their skills and experience. Staff had regular supervision and an annual appraisal. People enjoyed the food and were able to choose what they had to eat and drink. People had access to a range of healthcare professionals and support.

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 and relatives told us that staff treated them with kindness and we observed friendly interactions throughout the day. People were encouraged to be involved in daily decisions about their care and support and were treated with dignity and respect.

People received personalised care that was responsive to their needs. Activities were organised according to people's preferences, interests and suggestions. People and relatives told us they felt comfortable to make a complaint and knew how to do this.

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 07 February 2019) and there were multiple breaches of 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 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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

People’s experience of using this service:

New staff had not been always been recruited safely and people could not be assured that new staff were of good character. This placed people at risk. We raised this with the registered manager who took action to address this during the inspection process. New staff were taken off the rota and replaced by agency staff while more thorough recruitment checks were completed.

Medicines were given safely to people. However, we found that staff did not always follow the advice and recommendations of an external healthcare professional which meant that one person did not always receive 'As required' medicines for pain relief when this may be needed.

Risks were not always clearly assessed for people. The action staff may need to take to safeguard people from harm or to provide person centred care was not always detailed in records. Nutritional risks were not always assessed accurately which may place people at risk of harm from malnutrition.

Electronic care plan records for people did not contain detailed, personalised information or medication assessments. There was a risk that new staff or agency staff would not know how to meet people's needs safely or in accordance with their personal wishes and preferences. By the end of the inspection process the clinical lead had begun to improve the basic information held in people's electronic records.

Since the previous inspection in July 2018, the provider had taken action to improve aspects of the service provided for people. We issued two warning notices at the previous inspection, the conditions of which had now been met. Lifting equipment was safely maintained and water quality was monitored safely. Despite this, aspects of the governance and leadership of the service were not effective in identifying some significant service shortfalls such as gaps in the recruitment processes for new staff.

An independent consultant had been commissioned by the provider to support them to make positive changes to the service. An electronic care planning system had been purchased and was being implemented at the time of this inspection. However, at the time of this inspection these improvements had not been fully embedded in daily practice and further breaches of Regulations were found. This meant that the provider did not always meet the legal requirements of their registration with the Care Quality Commission [CQC].

Despite some of the ongoing concerns identified, we observed that people were treated kindly by care staff throughout the inspection process. At the time of this inspection, people's relatives that we spoke to were positive about the experiences their relatives had at the service. Health and social care professionals told us that the provider and registered manager had been working positively with them to improve the service since the last inspection. Training and weekly support had been provided by West Sussex County Council to staff and the registered manager to help them to improve the service people received.

Rating at last inspection: Inadequate (25 October 2018).

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

Why we inspected: We inspected within six months since the last inspection based on the previous rating of 'Inadequate.'

We reviewed the providers progress against the two warning notices that had been issued by us at the last inspection. These had been issued for 'Safe care and treatment' and 'Good governance.' We found at this inspection that the provider had taken sufficient action to address the concerns raised within the warning notices and they had now met these. However, we found ongoing breaches of Regulations at this inspection. Further information is in detailed findings below.

Enforcement: At this inspection we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.

Follow up: This service remains in special measures. We will continue to closely monitor this service and inspect again within six months of this inspection date to review any progress made.

We previously inspected the service on the 29 June and 3 July 2017 at which time the service was rated as ‘Requires improvement’. There was a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was also inspected on the 4 and 5 October 2016 at which time the ‘Safe’ key question was rated as ‘Inadequate’ with an overall service rating of ‘Requires improvement.’

Following the last inspection in 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions rating to at least ‘Good.’ At this inspection we found that inadequate progress had been made and the previous breach of Regulation was repeated. We also found further breaches of Regulation at this inspection. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

Following this inspection, we received an action plan from the registered manager. This demonstrated that they had begun to address the shortfalls identified at the service. We will review this at the next inspection.

Burlington Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Burlington Nursing Home accommodates a maximum of 40 people in one adapted building. At the time of this inspection 32 people were living at the home, one of who was in hospital. Most people who lived at the service were living with dementia. 23 people received a service to support a nursing level of need, while nine people received a service to support a residential assessed level of need.

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

We found significant concerns regarding the safety of the service provided to people. Maintenance checks for lifting equipment as required in law were not completed. This placed people at serious risk of harm occurring. Environmental risks were not safely assessed or managed for people.

Medicines were not always managed safely for people and staff were not suitably trained and competencies had not been completed to demonstrate that staff were able to give medicines safely to people. The use of ‘covert’ medication was not understood by relevant staff. One person was in receipt of covert medication at the time of this inspection. Unsafe and illegal medicines practice of one nurse who ‘borrowed’ medicines from one person to give to another were seen.

Staff did not receive regular supervision or appraisals in their roles.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not fully understood by staff at the service.

Regular staff were caring and treated people with respect. One nurse said, “I enjoy it”, “lovely team” and that working at the home was “like working with a family." Although agency staff used did not always give people a caring service.

Confidentiality was not always maintained with records not stored in accordance with Data Protection legislation and policies had not been updated to reflect the changes to Data Protection law.

People’s needs were not always reviewed when their needs changed and records were seen to be out of date and not reflecting people’s current needs which placed them at risk of not receiving the care they needed when agency staff were used. People were not always offered choice of foods to meet their individual needs and preferences. We saw that regular staff interacted positively with people during meal times and took time to support people sensitively without rushing them.

People and their representatives were not always involved in the care planning and decisions about people’s care.

The complaints process was not always accessible for people or their representatives. This was an area that required improvement.

End of life care was received by people at the home and the registered manager had completed accredited end of life training. Systems regarding how staff were informed of people’s end of life and resuscitation required improvement.

The home was not well-led. Systems had not identified when there were significant risks to people’s safety.

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. We found breaches 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 this report.

Burlington Nursing Home is registered to provide nursing and residential care for up to 40 older people who may be living with dementia. At the time of our inspection 29 people were living at the home. People’s needs varied. Seven people were being cared for in bed. The majority of people residing at the home lived with dementia. 18 people required nursing care.

During our inspection the registered manager was present. 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 our previous inspection in October 2016 five breaches of regulation were identified. These related to staffing, personalised care, safeguarding, safe care and treatment and good governance. In response, the registered manager sent us an action plan that detailed the steps that would be taken to achieve compliance. The service was rated ‘Requires Improvement’ in the effective, caring, responsive and well led domains and ‘Inadequate’ in the safe domain. An overall rating of ‘Requires Improvement’ was awarded.

At this inspection we found that improvements had been made in all areas apart from record keeping. People still did not have accurate or up to date records for all their identified needs, records for monitoring fluids and positioning were not completed in full and some people’s records contained conflicting information. You can see what action we told the provider to take at the back of the full version of the report.

People said that the registered manager was approachable and that improvements in the management of the home had taken place. Since our last inspection the quality assurance processes in the home had been reviewed and an increase in service audits had taken place. We found that where improvements had been made these needed to be fully embedded to help ensure people received a consistent service. Improvements had taken place to manage risks to people’s safety but further work was needed. People’s records did not always evidence that known risks to their wellbeing were being monitored appropriately. On the second day of inspection, as a result of the feedback we gave on the first day, the registered manager had reviewed the system for monitoring people’s positioning and fluid intake. This included changing the recording format, staff handovers and the frequency of audits. This gave us assurances that potential risks to people would be managed more safely.

Since our last inspection staffing levels had been reviewed and a dependency assessment used to decide safe staffing levels. During the inspection we observed a staff presence on both floors of the home at all times. However, there were two occasions when there were no staff present in the lounge and as a result people were left without the required assistance.

At our last inspection we received mixed feedback from people about the caring service provided to people. At this inspection the majority of people said that the service was caring. Despite people commenting positively we found that staff did not always practice a caring approach. We were given assurances by the registered manager that action would be taken in response to our findings.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems were in place to support this practice. We did note that some people’s mental capacity assessments were not always decision specific or accurate. Information in accessible formats was not always available. We have made a recommendation about this in the main body of our report.

Staff said that they felt fully supported and that they received training and supervision relevant to their roles and responsibilities. Appropriate recruitment checks were undertaken before staff began work. Since our last inspection staff had been provided more training and the training programme had been expanded to offer further courses relevant to the needs of people who lived at the home. We did note that the frequency staff received formal supervision varied. We have made a recommendation about this in the main body of our report.

People expressed satisfaction with the meals provided. However, we observed that the support people received to enjoy their meal varied. We were given assurances by the registered manager that this would be addressed. Since our last inspection the registered manager had looked at ways of improving the nutritional and hydration needs of people who lived with dementia and had involved external professionals as part of this process.

People were happy with the support they received to access external healthcare professionals. Although care records were not always accurate we found that in the main their needs were being met. Staff followed safe medicine administration procedures.

People said that they felt safe living at the home. Since our last inspection staff had received safeguarding training and were able to explain the correct procedures that should be followed should they suspect abuse. Since our last inspection a safeguarding champion had been put in place and the home had signed up to West Sussex County Councils (WSCC) safeguarding champion programme.

Relatives said that they were welcome to visit their family members and people said that their views were sought on the care provided. People understood their rights to raise concerns and complaints. Formal systems for involving people were being reviewed in order to involve people further in decision making processes. People expressed satisfaction with the activities provided at the home.

Burlington Nursing Home is registered to provide accommodation and care for up to 40 older people who live with dementia. It is situated in a residential area of Bognor Regis, West Sussex. At the time of this inspection, there were 34 people living at the service. The home is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors. There is a separate seating area and communal open plan lounge with dining area.

The service 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.

We found that people were at risk of harm because risks had not always been minimised effectively through appropriate support and regular monitoring. We identified staff had used improper physical interventions for two persons, one of which had recently moved from Burlington Nursing Home. As a result of our inspection, the registered manager, identified they were unable to meet the needs of two people, which resulted in those people being served notice to leave Burlington Nursing Home. Following our inspection, the registered manager was working with the local authority to find a new home that could meet the person’s needs.

Staff knew what actions to take should they suspect abuse and received appropriate training in keeping people safe. However, staff and the registered manager lacked insight into what might constitute abuse and neglect by omission of care. Resulting in the registered manager failing to notify the local authority safeguarding team and the Commission of incidents that could constitute possible neglect and other forms abuse. In response to our findings, the registered manager reported all the safeguarding concerns to the local authority safeguarding team, identified at the time of inspection.

Whilst staff were safely recruited, there were not enough staff to meet people’s needs. The registered manager agreed with our findings at the time of inspection and following our inspection, had reassessed the needs of people’s needs, resulting in the staffing levels being increased by an additional two hours per person, per week for people who received care in bed. . The registered manager told us the additional increase would mean people who spent most of their time in bed would be better supported emotionally and physically. This also meant the service was enabled to be more flexible to meet people’s needs.

Staff had completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Applications had been made to the local authority for DoLS and some assessments had been carried out of people’s mental capacity. However, we found staff lacked understanding about the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, and obtaining consent and carrying out care and support in people's best interests. There were restrictions and interventions being used, imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice. At the time of our inspection, the registered manager agreed with our findings and had started the process of reassessing people’s needs.

Some staff practices showed a lack of respect for people and did not promote their privacy and dignity. We had to intervene on several occasions to ensure people received safe and appropriate care.

For people who were less mobile or who remained in bed, there were few opportunities to engage in activities and people were seen sitting in the lounge or their bedroom with no meaningful activity or positive interaction taking place. People who remained in their bedrooms lacked social stimulation and few opportunities to engage in activities were recorded. We have made a recommendation about improving activities and social stimulation for people who are unable to access the main activities in the home.

We found general concerns in documentation such as care planning and recording, advice from health professionals not transferred to care plans, risk assessments identified issues but lacked some control measures and care plans were not always updated following incidents. There was a lack of follow-through in recording of some issues so it was difficult to see if the care had been provided and the issue addressed. There were gaps in some people's monitoring charts and wound care records.

The registered manager and provider used a series of checks and audits to monitor and improve the quality and safety of the service. There was evidence that this system of quality assurance had delivered improvements but it had failed to identify the issues we found during this inspection.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely. Nurses had completed safe management of medicines training and had their competency assessed annually. The nurses were able to tell us about people's different medicines and why they were prescribed, together with any potential side effects.

Staff enjoyed working at the service and felt well supported in their roles. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the training, which the provider had assessed as mandatory was up to date. Staff told us that they felt supported and were in regular receipt of support and supervision.

People were provided with a variety of meals and the menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected. People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. We observed communal mealtimes where people ate together.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

The inspection team consisted of one adult social care inspector. On the day of our inspection there were 34 people living in the home, 26 of whom the manager informed us had dementia. We spoke with 15 people who lived in the home and with 10 relatives. As some people were unable to tell us about their care and support we observed staff practice and their interactions with people and listened to the views of relatives.

We observed how staff supported people and looked at documents including five care plans, training records and management reports.

We considered our inspection findings to answer questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

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

Is the service safe?

People were treated with dignity and respect by the staff. People told us they felt safe and comments included, 'It is such a nice place to be, everyone is so kind to you and you can have all your own things around you". A family member said, 'I feel my relative is safe and happy here and that is a great weight off our minds'.

There were systems in place to support the provider to learn from events such as incidents and accidents and these were reported to the statutory bodies when required. The home provided staff with guidance in relation to the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure people's freedom and rights were respected. No current applications had needed to be submitted. Where people required assistance in making some decisions about their lives we saw that meetings had been held with families and other professionals to ensure people's best interests were upheld.

Is the service caring?

We observed how members of staff cared for and treated people. We saw this was done in a patient, caring and friendly manner. People told us they were treated with kindness and respect. Comments included, 'The girls (staff) are very friendly and very relaxed and they just let you 'be'. I am never afraid and just happy to be living here'.

Is the service effective?

People's health and emotional needs were assessed and kept under regular review. Wherever possible people were involved in the compilation of their care plans. Families told us they were given opportunities to be involved in all aspects of their relative's care. Care plans detailed people's nutrition and hydrations needs and these were regularly reviewed and updated. The manager had an effective system to regularly assess and monitor the quality of care and support that people received.

People told us they had access to good healthcare support. Comments included, 'If I am feeling unwell the staff will always call the doctor for me and the nurses here are very good and very attentive.'

Is the service responsive?

We observed that staff responded promptly to people's requests. Call bells were answered straight away and requests for assistance were treated promptly and with kindness and patience. During our visit we saw that staff had concerns over the changed behaviour of one person. A doctor was called and attended the person later in the day. We saw that monthly audits were carried out to identify changes in people's needs and referrals made to health professionals as appropriate.

People's spiritual and emotional needs were recorded and addressed and there was a programme of activities and outings on offer. On the day of our visit there was a garden party in the afternoon. We saw that people greatly enjoyed this event and having their families to visit.

Is the service well led?

There were systems in place to audit the quality of service provided and to monitor the safety of the environment.

Staff told us they felt well supported by the manager and provider. They were aware of the need to protect people and ensure they received a good quality service at all times. A family member that spoke with us said, 'My relative has lived here for six years. I can't fault the care. The staff are always kind and friendly and the food is good. If I have any concerns at all I talk to the manager and it is very soon sorted out'

Everyone told us that they were happy with the care and support they received. For example a relative said, "The staff are very good, and well trained dealing with people with dementia. When problems arise with behaviour of some residents, the staff deal with it in a kind, quiet and professional manner".

People told us that they were happy with the support they received from the home to access healthcare professionals. One person told us, "They make sure I am happy and healthy. They seem to spot things before I do! They arranged for me to see the doctor and chiropodist". Another person said, "There seems excellent contact with the local GP's".

The provider had an effective system to regularly assess and monitor the quality of dementia care that people received. This included involving and informing people. One person told us, "There is a residents and carers group and niggles or suggestions can be freely aired. It's a lovely home where you really feel listened to".

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitored the quality of care that people received. We saw that the home had recently been decorated and one person that used the service told us that he helped choose the wallpaper

Staff told us that they had regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People said that they had no complaints about the service and that if they did they would speak to the staff or the manager