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Archived: Heanton Good

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Inspection carried out on 22 December 2015

During an inspection to make sure that the improvements required had been made

Heanton is nursing home registered to provide accommodation for up to 58 people who require nursing or personal care. It specialises in the care of people living with dementia. The home has two units, known as Williamson and Chichester.

In October 2014 we carried out an unannounced comprehensive inspection, where we judged the service to be overall good, but required improvement in the responsive domain. . After that inspection we received concerns in relation to risks not always being managed effectively. These included concerns there were not enough care staff to meet the needs of the people living at the home and that essential safety works had not been completed. Initially we sought assurances from the registered manager and provider. However during September 2015, we received a number of concerns about lack of staff. As a result we undertook a focused inspection to look at those concerns on 15 October 2015. We also looked to see that some essential safety work at the home had been undertaken. We found the two domains we inspected, safe and effective care required improvement. In particular, we found there was a shortage of staff to meet people’s needs. The provider was addressing this with recruitment and was supporting staff to enhance their skills through training to meet people’s needs. Essential works had been undertaken or had set timescales to be completed.

On 22 December 2015, we carried out another focused inspection. This was in response to some safeguarding information, which included two people developing pressure sores, whilst living at the home. There were also concerns about medical assistance not being sought for people in a timely way. We also received concerns from two relatives about low staffing levels and poor care being delivered. At the time of the inspection there were 50 people living at the service, although two people were in hospital.

Since our last inspection the registered manager had resigned and left. A new manager was in post who was undergoing the process to register with Care Quality Commission (CQC). 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 2014 and associated Regulations about how the service is run.

This report only covers our findings in relation to these topics. You can read the report from the last comprehensive inspection by selecting the ‘all reports’ link for Heanton on our website at

People were not always safe because there were not enough staff on duty at all times to meet the needs of people in a timely way. This was because of staff sickness, staff resigning and some newly recruited staff deciding not to follow up on employment. On the day of the inspection there were six care staff plus one nurse working on one of the units and five care staff plus one nurse on the other unit. Staff said this was unusual and they had been operating in the recent weeks with only three or four care staff and one nurse per unit. This was supported by relatives we spoke with during this inspection. One said ‘‘The staff are very good, there is just not enough of them.’’ One family reported their relative had been found still in bed in their night attire at 11.30 am in the previous few weeks and only just having their breakfast. When the relative asked why this had occurred, the staff said they were short staffed and could not get everyone up at a reasonable time. Another relative said their relative had got outside at night where a door had been left open by staff. They said their relative was ‘‘At risk of harm to themselves as there was not enough staff to support and supervise people.’’ We saw there was an incident form in relation to this event, but no signage had been put on the fire door.

The manager said the service had been wor

Inspection carried out on 15 October 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection in October 2014. After that inspection we received concerns in relation to risks not always being managed effectively, there were not enough staff to meet the needs of the people living at the home and that essential safety works had not been completed. As a result we undertook a focussed inspection to look at those concerns. This report only covers our findings in relation to these topics. You can read the report from the last comprehensive inspection by selecting the ‘all reports’ link for Heanton on our website at . This inspection took place on 15 October 2015 and was completed by two inspectors. At the time of the inspection there were 43 people living at the service.

We found there had not always been enough staff on duty to meet the needs of people in a timely way. This was because of staff sickness. The provider was addressing this issue with recruitment of further care and nursing staff. This meant they planned to have sufficient staff and have additional hours to cover sickness, holidays and training. On the day of the inspection 11 new staff were attending an induction day. Some of the current staff group had resigned or were working their notice. This included the current registered manager, deputy manager, and two care staff. The reasons for leaving were varied, but several staff members mentioned the changes which had occurred in their shift patterns recently as being a contributing factor. The provider assured us they had already recruited an experienced manager to take up the registered manager’s role.

We looked at the number of serious incidents and accidents to see if these increased when staffing levels were low. There was one date where staffing levels had been below the assessed need and the number of incidents had been high. On other days when staffing levels were lower than the assessed need, there was no evidence of an increase in incidents or accidents. This showed the risks in having decreased levels of staffing had not impacted on the safety for people, but it had impacted on the quality and timing of care and support being provided. Staff confirmed they had not always been able to offer support in a timely way when they had been short staffed.

There had been three safeguarding alerts in the earlier part of the year and one more recently; where a person had sustained a significant injury following a fall. The person did have a care plan and risk assessment which highlighted the need for using a pressure mat to alert staff the person was moving and may need support to do this safely. The pressure mat had not been in use at the time of this fall. We were assured there was sufficient equipment for the needs of people living at the service, so there was no reason why the mat should have been removed. The registered manager had also spoken with staff about ensuring timely medical intervention being sought.

The alerts in the earlier part of the year related to poor record keeping and lack of risk assessments being in place. In one incident where a person was injured as a result of using bed sides, it was found that a risk assessment had not been in place for the use of these. During this inspection, we found there were updated risk assessments in place. The care plans were in the process of being updated onto a new computer system which should streamline the records. The current care planning documentation was difficult to navigate around and although detailed, was repetitive and not always person centred. Some of the care plan information was pre-printed and was generic. Where detailed histories and important information about the person had been recorded, care staff were not always aware of the detail of this information. A senior care staff member said this would be addressed with the introduction of the new electronic care plans, as all staff would need to access these and have input into them. Training was being organised for staff so they would be confident and competent to use the new care plan system.

Information we had received about the environment being unsafe was not substantiated. One bedroom had no flooring, but had not been in use for some months and was being refurbished as part of planned works. The electrical wiring work had been completed to ensure the system was safe and met industry standards. Further work to enhance the efficiency of the electrical wiring system was planned for completion by the end of May 2016.

Inspection carried out on 10, 13 November 2014

During a routine inspection

This inspection was unannounced and took place on 10 and 13 November 2014. There were 49 people living at the service. When we last inspected on 28 July 2014 in response to some concerns raised by family whose relative lived at Heanton, there were a number of areas where improvements were needed. These were breaches in regulation and included care planning, infection control, equipment, staffing levels, records and quality assurance. Following this inspection the registered manager sent us an action plan showing how she intended to make improvements and provided a timescale for those improvements. We used this information as part of this inspection to check how well embedded any new ways of working were and whether this had impacted on the quality of care and support people were receiving. At this inspection they had addressed all the areas that needed improving.

Heanton is registered to provide nursing and personal care for up to 58 people. The home is divided into two units, Williamson unit on the ground floor and Chichester unit on the first floor. Both units provide nursing care for older people living with dementia with the Williamson unit supporting people with higher physical nursing needs.

There is 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.

Some relatives fed back that the service was not always responsive to people’s needs and we observed one incident which could have been prevented if staff had been more responsive and ensured a staff presence in the dining areas at the start of the meal time. The registered manager agreed to address the issues identified.

Since the last inspection, there had been improvements in infection control and in ensuring the environment smelt fresh and was clean. The provider had replaced much of the old flooring and some of the furnishings, which had improved the appearance and odour at the home. Staff were aware of the infection control policies and procedures and were following them to help prevent any spread of infections. The registered manager had ensured there was a ‘breakout box’, which detailed what staff needed to do in the event of an outbreak of an infectious disease.

Bathroom facilities were being upgraded. The service were in the process of completing a refurbished wet room on the ground floor and there were more plans to refurbish other bathroom areas to enable people to have more accessible washing facilities in clean and comfortable bathrooms. Wheelchairs were being cleaned and maintained along with other equipment and systems were in place to ensure this was checked.

Care was well planned and being delivered by a staff group who understood people’s needs. Staff were available in sufficient numbers and had the experience and competencies to work with people with complex needs. Our observations showed staff providing care and support in a kind and compassionate way. Staff had on going training and supervision to ensure they were working effectively. Where issues were identified with staffs’ attitude or ethos, this was picked up quickly and actions taken to address any concerns.

People were assisted to engage in a variety of activities with two full time activity coordinators. This service had been expanded to cover evenings and Saturdays. There was an activities room with a wide range of equipment to help stimulate memories and discussion.

People were supported to enjoy a relaxed mealtime. Where people needed support to eat and drink, staff provided this in a kind and respectful way.

There was a strong management team in place which staff and relatives had confidence in. Staff felt their views and opinions were listened to. Systems were in place to review the quality of care and support being delivered and to gain the views of people, their relatives and staff to help improve the service.

Inspection carried out on 28 July 2014

During a routine inspection

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

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

At the time of our inspection there were 49 people living at Heanton. The home consists of two units known as the Williamson unit on the ground floor and the Chichester unit on the first floor. Both units provide nursing care for older people with dementia with the Williamson unit supporting people with higher physical nursing needs. On the day of our inspection there were 25 people living in the Williamson unit and 24 people living in the Chichester unit.

Our inspection was carried out by two inspectors on one day which lasted ten hours.

During our inspection, we spoke with three people who lived at the home and four visitors. Most people living at Heanton were unable to comment directly on the care they received and therefore we spent time in both units in the communal areas observing people's experiences and how staff interacted with them.

We also spoke with the registered manager, two people from the provider�s higher management team and 19 staff.

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

Is the service safe?

The service was not safe. Staffing levels and skills on the Chichester unit during our inspection were insufficient to ensure people's needs were met in a timely manner. The registered manager had not ensured there were enough staff on duty with the appropriate skills and experience required at all times.

The service was not safe because of the standard of record keeping. There were gaps in some records which could affect the care or treatment people required. For example fluid charts and personal care charts had not been completed accurately. Some information was not transferred between documents, which could lead to mistakes.

The service was not safe because the home's equipment quality monitoring did not always identify areas of risk. These included wheelchairs which were unclean and with missing footplates and health monitoring equipment which had not worked when needed.

The home was clean and had processes in place to maintain a clean environment. However the service was not safe with regard to infection control procedures.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager told us they were aware of the judgement made by the supreme court in March 2014 regarding depriving people of their liberties. They had submitted applications for everybody living at the home to the DoLS team in line with Deprivation of Liberty Safeguards legislation.

Is the service effective?

With regard to people's health care needs the service was effective. Generally health and care assessment and planning was detailed and informative with risk monitoring regularly reviewed. However we saw some care plans had not been reviewed in a timely way which could put people at risk of not receiving care relevant to their needs.

Activities were effective because there were opportunities for people to be engaged in activities. We saw people engaged and enjoying activities during our visit.

Is the service caring?

The service was caring; visitors to the home told us they were happy with the care their relative received. Comments included �The staff show a caring nature towards the residents they are lovely girls� and �My mum is very content here the staff have been really friendly� and �We are really happy with the care provided by Heanton it could not be better.

We were also told by visitors they were kept informed of any changes in their relative's care and were regularly asked their opinions. Visitors told us �I am quite happy with my Mum�s care they couldn�t do any more� and �We have no concerns, my sister is always contacted if there are any changes�.

We observed staff to be friendly and polite when interacting with people and they were able to offer reassurance to people who appeared anxious or restless. We saw on the Williamson unit at mealtimes, people were assisted in a dignified and safe manner. When assisting people with their meals staff were discreet and respectful, promoting people�s privacy and dignity.

Is the service responsive?

The service was responsive to people's health care needs. Where advice was needed from external health care professionals this was sought in a timely manner.

The registered manager had been responsive to people�s needs. They had increased the provision of a designated activities person at the home to 12 hours a day for six days a week. This was because they felt it was important people had the opportunity to be engaged in social activities.

Is the service well-led?

The unit was not well led because the registered manager had been undertaking two roles at the unit and had not ensured systems were monitored to ensure people were receiving safe care.

We were told by visitors to the home they had confidence in the registered manager and were able to approach them if they had any concerns. Comments included �We can always pop in and speak with X (registered manager) at any time� and �She is always around and we can speak with her if we need to, she is brilliant�.

Staff also told us they had confidence in the registered manager and said she was very hands on and would always help if requested. Comments included "she is always here and is very supportive" and �if I have a problem I know she will listen".

Inspection carried out on 16 October 2013

During an inspection to make sure that the improvements required had been made

We completed this follow up inspection to check the service were fully compliant with outcome 13 which relates to staffing. At our previous inspection in July 2013 we found there were not always sufficient staff at key times to ensure people's needs were met. We gave the home a compliance action and received a detailed action plan showing how the registered manager intended to make improvements to enhance staffing at key times.

At this inspection we spent the majority of our time in the upstairs unit observing how care and support was being delivered and talking to people who use the service. We also spent some of the lunchtime period in the ground floor unit and spoke with staff. We checked some of the records, including two care plans, staff rotas, accident and incident reports.

We saw the home had changed the working patterns of the two activities coordinators so they provided cover from 8 am to 8pm Monday to Friday. This enabled them to provide some calming activities to people in the upstairs lounge during the busy evening period. This meant people were not left for long periods unsupervised during the evening.

We observed the period up to lunchtime on the top floor and saw there were only two staff available for a half hour period whilst staff were taking their breaks. The manager said she would change this with immediate effect to ensure only one staff member took their break.

We concluded the home were now fully compliant in the staffing outcome.

Inspection carried out on 12 June 2013

During a routine inspection

Our inspection was unannounced and lasted nine hours. It was completed by two inspectors. We spent time with people in communal areas of the home so we could make a judgement about how well people were cared for. This was because some people could not comment directly on the service. We spoke with six visitors and before our visit we contacted health and social care professionals. We also spoke with six staff members and the manager.

There was a marked improvement since our previous inspection in December 2012 when

we had highlighted shortfalls in the way the quality of the care was monitored and how infection control was managed.

During this visit, we inspected six outcome areas. Five were compliant, including infection control, which had previously been non-compliant. We saw that staff ensured that people�s consent to care was gained, and where appropriate other measures were put in place. Their health and well-being was assessed, and care was provided in a way that suited people's individual needs. The management of infection control had improved, as had the supply and quality of equipment. Quality assurance processes were more robust and effective. Staffing levels were appropriate for the majority of the day but we observed that this was not the case on one unit during the evening.

Inspection carried out on 13, 14 December 2012

During a routine inspection

We carried out this unannounced inspection over two days, with three inspectors including a pharmacist inspector. We spoke with four visiting relatives and two visiting professionals during the inspection.

We spend time on units, observing care and support being delivered. We looked in detail at six care plans, medication records, staff training information and some quality audits. We had asked the provider to send us some additional information following the inspection, to help us make our judgements.

We heard from visiting two professionals, four relatives and from eight staff working at the home, that there had been some clear improvements since the new manager had started at the home in October 2012. For example we heard that new placements for people had been fully assessed and responded quickly to an emergency situation. Care was being planned, although it lacked detail about individual�s preferred routines to be able to demonstrate person centred care.

One relative told us ��I have been very impressed with the level of professional approach from staff. I have watched them with people when I visit. They are very kind and patient.��

We saw that improvements had been made to make the environment safe and more pleasant for people.

We found that some improvements were needed to fully protect people from the risk of infection. We also found that audit processes lacked detail to be able to ensure robust infection control and safe use of equipment.

Inspection carried out on 6 July 2012

During an inspection to make sure that the improvements required had been made

Our unannounced inspection at Heanton Nursing Home took place on 6 July 2012 and took place over 2.5 hours. We last visited the home in June 2012 when we identified non-compliance under the Health and Social Act relating to the home�s environment. The service had provided us with an action plan and this inspection was to check on the improvements to the environment. We visited different areas of the home, including the back garden and the paved area at the front of the home. We spoke to staff about the changes and asked staff members to show us the improvements that had been made. Most people were not able to comment directly on the changes to their environment instead people spoke with us about topics unrelated to our inspection.

The service provided us with an action plan, which demonstrated how they would address the areas of non-compliance identified in the last inspection in June 2012. We completed a tour of the building and checked the work listed on the action plan, which we found was accurate.

Inspection carried out on 8 May 2012

During a routine inspection

Our unannounced inspection at Heanton Nursing Home took place over two days on 2 and 8 May 2012. The visit lasted in total over 15 hours and we left the home on both days in the evening. We spent the majority of our time in communal areas. On the first day of our visit, we spent the majority of our inspection on the unit on the upper floor. On the second day, two inspectors visited the home enabling an inspector to focus on one unit each.

We spoke with one person living at Heanton Nursing Home who was able to comment directly on their care. However, most people were not able to comment directly on their care so we spent time with them to help us understand what life was like at the home. This meant we spent time observing care and people�s interactions with staff to see whether they had positive experiences. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us about their experiences of care. We used SOFI both on the ground floor and upper floor of the home.

We visited 36 bedrooms to see how they were maintained and looked at how repairs were reported. On a previous inspection, we had raised concerns about the heating in some areas of the home was monitored so we looked at the current heating arrangements. We looked at a range of written records including care assessments, care plans, training records for staff, minutes of meetings, menu records and staff rotas.

We were given a list on our first day that showed 41 people were living at the home. During the inspection, we spoke with the manager, who is registered with the Care Quality Commission, a clinical lead for PSP and a manager from another home owned by the organisation. We also spoke to13 staff members about their roles and their work and three relatives. We have also been contacted by people choosing to raise concerns anonymously. We have also received further information from another relative.

We gave detailed feedback to the manager at the end of the inspection to ensure that they could begin improvements immediately. We also met with the nominated individual for PSP Health care Limited on 11 May 2012 to feedback the outcomes of the inspection.

After the inspection, we also contacted the local adult safeguarding team to advise them of the serious concerns we had regarding the non-compliance levels at the home concerning the environment. We also contacted other health care professionals who visited the home for their views on the quality of the service.

Heanton was part of a whole home safeguarding concern, which meant that commissioners, health and social professionals were reviewing and monitoring the quality of the care that was provided by the service. The day after the second day of inspection, placements were suspended by the local Council and the NHS until they were satisfied the service could meet the needs of people living there. Since the inspection, the safeguarding process has been closed.

People living at the home generally seemed relaxed with the staff who supported them, and some people showed staff signs of affection. For example, we saw a person leaning their head on a staff member�s shoulder and smiling, and other people coming up to staff and hugging them.

We saw some staff respected people�s decisions and choices. For example, one person declined being assisted and a more experienced staff member suggested to the staff person making the request that they leave the person and come back later to check again with them. However, there were times when staff practice did not support people�s dignity as staff spoke over people or did not interact with them when they were providing care.

We spoke with 14 people living on the upper floor but most people were unable to express their views on the care they received. We saw from our time in communal areas that some staff were more skilled at responding to people�s body language and therefore offered support in a manner which was acceptable to people. We saw that most staff were caring in their approach and that some recognised the importance of person centred practice. For example, staff recognising the need for some people to feel involved in providing practical help based on their past roles. We saw that people generally looked well cared for and were dressed appropriately.

A staff member told us about their new role in co-ordinating activities for the home. Their conversation showed they knew people�s backgrounds and interests, which matched information on people�s care files.

During our visit, we spent time in communal areas with people living in the home. This helped us make a judgment about whether they were safe. For example, we saw mainly good moving and handling practices, which helped keep people safe.

We saw that people who are more mobile generally live on the first floor of the building. This floor has less communal space than the ground floor and therefore restricts people�s movement. Two people told us they would like to go into the garden and another said �I can�t get out of here�. We saw people standing looking out of the windows on the first floor and commenting on the view and the gardens. A group of people were restless.We were told that people had access to the gardens with the support of staff.

The environment of the home did not support the well-being of people because it did not enable them to be independent. We saw that there was a lack of appropriate signage around the home, which meant that people were not supported to maintain their independence. For example, we met someone who was distressed as they could not find the toilet. Toilets and bathrooms did not have appropriate signs. Gardens were not adapted to promote people�s independence.

We saw that people generally seemed at ease with staff but we saw that interactions by staff were often task based. For example, we did not see care staff sitting with people and having a conversation with them or spending time with people in a meaningful way unless it was linked to a task, such as supporting people with a meal. Staff were busy throughout the two days of inspection and some shifts did not have a balanced skills mix.

Inspection carried out on 30 December 2011

During an inspection in response to concerns

This is our second inspection at Heanton nursing home in 2011. Our first inspection was planned and unannounced; it took place in October 2011.

In our first inspection, we focussed on seven standards of care and PSP Health Care Limited were required to produce an action plan as two standards of care were not compliant with the Health and Social Care Act 2008, and four standards needed further improvement. The organisation is still within the timescale to provide the Care Quality Commission (CQC) with an action plan to show how they will make improvements.

However, in December 2011 we received separate concerns from a health professional and a visitor, which meant that we carried out a further unannounced inspection on 30 December 2011. During this inspection, we looked at four standards of care. We spent eight hours at the home.

On our arrival, the manager told us they could accommodate 52 people but that on the day of our inspection she told us that 48 people were living at the home. During the inspection, we met 14 people living at the home and spoke with them but most people were unable to express their views on the care they received. We spent most of our time in communal areas to help us see how people were cared for. This included using a tool called a Short Observational Framework for Inspection (SOFI), which helped us make a judgement about the experience of people living at the home.

We also spoke with three relatives who were visiting the home and eight staff members, as well as the manager. We checked to see how warm different parts of the home were by visiting communal areas and bedrooms, and we looked at care, training and maintenance records.

We saw good practice by staff on the ground floor when they were moving people using equipment. They ensured that they did not hurry the person and explained what they were doing.

We saw staff on several occasions provide reassurance to a person. Staff involved the person with decision-making and listened to the person�s views.

We saw staff on the first floor talking with people in a way which respected their dignity. We saw staff being very inclusive in the way they included people in their conversations.

During our inspection, we looked at how people�s dignity was supported during mealtimes and to see how people were offered choice. On the ground floor unit, we did not see people being offered a choice of drink, apart from on one occasion. Mealtimes should be a pleasurable experience but we saw for some people that some practices made the meal time an institutional experience. This undermined their dignity.

The 14 people that we met looked well cared for. For example, people had clean eyes, faces and nails. Most people had clean clothes and seemed appropriately dressed, although there was one person we met who had unkempt hair but other people�s hair looked brushed and clean. We saw that people living at the home generally seemed at ease with staff.

When we first arrived a group of 13 people were taking part in a sensory experience with two activities co-ordinators. A few people were asleep but other people were participating with support from the staff. We saw that other people in other parts of the home had nothing to interact with and received little interaction from staff who were very busy. The television was left on throughout our visit but each time we visited the conservatory, there was only one person out of the six people who used the room who could see it.

We found the heating levels were inconsistent in the conservatory. None of the six people who used this room were offered a blanket and staff did not ask them if they were warm during the time we spent in the conservatory nor did they check to see if they were warm.

We found the heating levels in bedrooms were inconsistent, and seven rooms we visited felt cold when we entered and when we checked the surface temperature of the radiators they were cold. We were particularly concerned that two of these rooms were occupied.

One communal area of the home smelt musty. We checked ten bedrooms on the ground floor and found that they were odour free. However, two relatives commented that there could be an unpleasant odour on occasions when they entered the first floor unit.

Staff were very busy on the ground floor unit. Staff interaction was task based, which meant they interacted people when they moving them or when they were supporting with a meal or a drink. Some people received more interaction than others from staff.

Inspection carried out on 13 October 2011

During a routine inspection

During this unannounced inspection we spoke to three people about their experiences of living at the home. We also spoke to one visiting relative. Other people were not able to give their view due to their dementia, so we used an observational tool to see how staff interacted and provided care for people.

We looked at four plans of care in detail. We saw that care and support is planned, and that where changes to risk or care regimes had changed this had been documented. Plans gave staff good basic detail about people�s needs, but we have discussed the need for them to be more individualised and person centred to ensure that known routines and preferences are honoured.

We saw that there were good audit trails for medications. We checked the controlled drugs and saw safe systems in place. We noted that some dietary supplements and drink thickeners on one unit of the home were out of date, which was to be addressed.

We observed most care and support being done in a caring and respectful way. We also saw specific examples of carers not talking to people when for example they were moving them. They did not explain where they were taking them or why they were moving them. We saw that staff were very busy with the task of ensuring people got washed, dressed, toileted and assisted to eat their meals. We did not see carers having time to talk to people other than when performing a task.

We saw that areas of the home are in need of refurbishment. Some of the bedrooms are drab and in need of redecoration. Four of the mattresses we checked did not fit the bed frame well and one had a badly torn mattress cover that would not fully protect the mattress. We found that on entering each of the two units there was a malodorous smell of urine. One staff member told us that they had a constant problem with some people urinating on the hall carpet. Another staff member told us that some of the furniture also had a strong smell of urine and was in need of replacing. This was likely to be adding to the unacceptable smell. One visiting relative told us that it was not uncommon for the units to smell bad, and that on one unit an exactor fan had been installed in the hall way but that this was not always switched on.

We saw that two of the three bathrooms on the upstairs unit were not fit for purpose. The baths were old and in need of refurbishment. Staff told us these bathrooms were not in use, which meant that for 26 people there was only one bath they could use that met people�s needs. We saw that some bathrooms had equipment stored in them such as hoists and wheelchairs, which could be trip hazards for people and need to be removed if the bathrooms are in use.

We were told by staff that they needed more hoisting equipment, with some of their hoists currently out of service due to needing repair. We heard that this is in hand as the contractor who services them had visited the previous week and would be ordering parts for two of the standing hoists needed. We were told that there is at least one working hoist in each unit that staff can use.

We saw that there was a lack of small tables when drinks were given out, which meant that some people who were quite drowsy had to hold onto hot drinks. We were told that there was also a lack of footstools, but that when this had been raised by relatives, they were told these were trip hazards.

We saw that staffing levels were minimal, covering people�s basic care needs but not sufficient to provide people with time to assist them to make choices or have quality interactions.

We saw that the service has activity coordinators each week day so that two activities can occur each day on each unit. We observed a quiz on one unit and saw that the staff member was skilled at involving some people in this. The lounge was quite crowded and we observed at least five people asleep through the activity, who were only engaged when drinks were brought around.

Staff told us that they receive regular training in key areas of health and safety. When asked about people�s needs, those we spoke to were knowledgeable about the care of the people in the home. Staff told us and we saw records about them having regular supervision.

We saw that systems were in place to gain views of staff, people and their relatives� comments through meetings and surveys. The registered provider needs to have better systems in place for auditing the environment and ensuring the right equipment is in place.

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