Archived: Giltbrook Care Home

Giltbrook Care Home is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 40 people in one adapted building over two floors.

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

People felt safe living at the service, their risks had been identified and managed. We did find that not all risk assessments had been updated, however this was rectified straight away. Overall people felt there were enough staff to meet their needs. People were supported to take their medicines in a safe way. The service was kept clean and appropriate infection control protocols were followed.

People were supported to eat and drink in order to maintain a healthy weight and keep hydrated. People had access to healthcare and were supported by appropriately trained staff. 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 supported by caring staff who respected their privacy and dignity. People were encouraged to live as independently as possible and were able to express their views.

People were supported to take part in some activities, however at the time of the inspection these were minimal. The service did not receive many complaints but ensured that concerns received were looked into and actioned. People’s care plans were individualised, although people did not always feel directly involved in the planning or reviewing their care.

People and their relatives spoke positively about the management now in place. The registered manager had comprehensive monitoring and auditing systems in place. They were aware of their duties and worked together with other agencies to ensure people received quality care and support.

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 11 December 2018) and there was a breach 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.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Giltbrook Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation and personal and nursing care for up to 40 older people, some of whom are living with dementia. The premises are on two floors with a passenger lift for access. The service has a range of communal areas and a secluded garden. There were 14 people using the service at the time of our inspection.

This inspection was planned to follow up on our previous inspection of 31 January and 1 February 2018 when the service was placed in special measures. We had also completed a focused responsive inspection on 28 March 2018 that was completed in response to concerns with recruitment practices.

At our previous inspection on 31 January and 1 February 2018, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulations 12 and 17. These related to safe care and treatment, management of risks and governance. In addition, we completed a responsive focused inspection on 28 March 2018 and found a breach of Regulation 19; this was because evidence that all the required checks to show staff were suitable to work at the service were not in place.

This service has been in Special Measures following our inspection on 31 January and 1 February 2018. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Some improvements were still required and we found a breach of regulation 12 relating to the ordering and supply of medicines.

A registered manager was 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 system operated for the supply and ordering of people's medicines was not always effective.

Systems and process designed to identify shortfalls in the service had not always been effective as they had not enabled the registered manager to identify some medicines had been out of stock.

Medicines were stored and disposed of safely.

There were sufficient numbers of staff deployed to meet people's needs.

Staff working at the service had been subject to pre-employment checks. Pre-employment checks help the provider decide whether staff are suitable to work at the service.

People and their families felt the care was delivered safely at Giltbrook Care Homes. Staff had an understanding of how to keep people safe and how to report any concerns; this had been reinforced through staff training.

Actions had been taken to identify and manage risks to people from any health associated conditions. Actions had been taken on most risks in the environment. The registered manager took action to further risk assess some radiators during our inspection. Actions were taken from when things went wrong and accidents and incidents were analysed and steps taken to help prevent future occurrence.

Steps had been taken to help protect people from the risks associated with infections. Staff understood and followed infection prevention and control measures.

People's needs were assessed and this helped staff provide care to meet their needs. This was reinforced as staff had received training in areas relevant to people's needs; for new staff this included a period of introductory training and assessment to ensure their competence. Staff had the skills and knowledge to help provide care to people and ensure people were treated equally and were free from discrimination.

People received sufficient nutrition and hydration. People received assistance from staff with their nutrition or hydration if this was required. People at risk of weight loss were monitored and actions taken to help prevent weight loss.

People received support with their healthcare from a variety of other healthcare professionals and referral systems were used to access this support when needed. Input from relevant healthcare professionals had also been built into training sessions for staff to help them understand people's care needs.

The premises had been adapted to meet the needs of people living at Giltbrook Care Home, including for people living with dementia.

Staff checked people consented to their care and the principles of the MCA were followed. People contributed to their care plans and as such care plans reflected people’s preferences.

People and relatives told us they felt the staff were kind and caring. Staff were considerate and caring to people and enjoyed engaging in topics of interest with people. Staff responded if people became anxious and provided reassurance. People’s privacy and dignity was respected and their independence promoted.

People and relatives were involved in their care planning and staff respected people's known views and preferences.

Care was planned and provided to people when they approached the end of their lives.

People received personalised care. People were supported to maintain their relationships with their relatives and friends. People enjoyed how they spent their time and the activities provided at the service. Other activities and resources were available for people living with dementia.

Processes were in place to manage and respond to complaints.

The provider had taken steps to gather people’s views and had acted to improve the service in response to feedback from people, staff and relatives.

The provider had a clear vision for providing care that was centred on people’s individual needs.

We found one breach of Regulation 12 of the Health and Social Care Act 2008 (Registered Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Giltbrook Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. This focused inspection only looked at the area of recruitment; therefore, we did not consider the premises as this was covered within our recent comprehensive inspection. Giltbrook Care Home is registered to provide accommodation and nursing care for up to 40 people. At the time of this focused inspection, 17 people were using the service.

At this inspection, we have found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations; Good governance, and a new breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Fit and proper persons employed. We have judged that the overall rating for this service continues to be Inadequate. The provider therefore remains 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 in made within this timeframe so 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 the 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. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

There was a registered manager in post; however, they were no longer working at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of this inspection, the registered manager had not yet applied to CQC to cancel their registration. They are required to do this.

The provider needed to make improvements to ensure staff were safely recruited, and the recruitment systems, policies and procedures in place were fit for purpose and being followed by staff responsible for recruitment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

In March 2017 the provider notified us of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However the information shared with CQC about the person's death indicated potential concerns about the quality of care and the management of risk. This inspection examined those risks.

At our last inspection on 17 August 2017, we found the provider was in breach of the regulations and rated them overall as Requires Improvement. This was because the provider did not ensure that medicines were safely managed at the service, nor did they have an effective system in place to regularly assess and monitor the quality of service that people received.

Following the inspection we issued the provider with a requirement notice for the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment, and a warning notice for the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this unannounced comprehensive inspection on 31 January and 1 February 2018 to check that the provider had followed their plan to meet the legal requirements relating to safe care and good governance. At this inspection, we found that insufficient improvements had been made following our previous inspection. We identified a new breach of Regulation 12 and a continuing breach of Regulation 17.

Giltbrook Care 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. The home provides accommodation and personal and nursing care for up to 40 older people, some of whom are living with dementia. The premises are on two floors with a passenger lift for access. The service has a range of communal areas and a secluded garden. There were 19 people using the service at the time of our inspection.

A registered manager was in post. This 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.

Ineffective quality monitoring systems had failed to pick up and address the shortfalls we identified during our inspection. People were not always safe because their risk assessments and care plans did not provide enough information to ensure staff knew how to keep them safe. When accidents and incidents had occurred, lessons had not always been learnt and improvements had not always been made.

There were ongoing difficulties with the water and heating systems, resulting in water that was either too hot or too cold for people and during our inspection we found that thermostats still hadn’t been fitted to all taps and the water system had not been tested for Legionella since 2016. This put people at risk of scalding and infection.

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Not all staff had had the training they needed for their roles. There were gaps and inconsistencies in some people’s care plans. People’s privacy and dignity was not always respected. The service’s complaint procedure needed updating.

Medicines management and staff recruitment practices were safe. The premises were clean. People were mostly protected by the prevention and control of infection. Most staff had been trained in safeguarding and knew how to protect people from abuse.

People were satisfied with the food served. People had access to external healthcare professionals including GPs, dieticians, and mental health specialists. Staff had some knowledge of the Mental Capacity Act 2005 and supported people to have choice and control of their lives.

Staff were attentive to people’s needs and had a good rapport with them. People had more opportunities for stimulation than when we last inspected and were seen enjoying activities and social interactions with staff. People, relatives and staff had the opportunity to share their views on the service at meetings or through surveys.

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.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this unannounced focused inspection on 17 August 2017 to check that the provider had followed their plan and to confirm that they now met legal requirements. We found they had not and the provider was still in breach of Regulation 17. We also found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. This was because the registered persons did not ensure that medicines were safely managed at the service.

This report only covers our findings in relation to ‘Safe’ and ‘Well-Led’. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Giltbrook Care House on our website at www.cqc.org.uk

Giltbrook Care Home provides accommodation and personal and nursing care for up to 40 older people, some of whom are living with dementia. The premises are on two floors with a passenger lift for access. The service has a range of communal areas and a secluded garden. There were 24 people using the service at the time of our inspection.

A registered manager was in post. This 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.

During this inspection we found significant shortfalls in the quality of the care being provided.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. This had also been an issue at previous inspections in May 2015 and April 2016. At this inspection we found the provider had failed to identify that medicines management at the service was unsafe, care plans and risk assessments not always fit for purpose, and safe staff recruitment procedure had not always being followed.

Medicines management was unsafe in some areas due to medicines being stored at the wrong temperature, poor stock recording, missing medicines, liquid medicines and topical creams not labelled with the date of opening, gaps in MARs (medicines administration records), and medicines not given in line with the prescriber’s instructions.

Although some risk assessments were fit for purpose others were in need of improvement. For example, one person had lost a significant amount of weight and another person had had a series of falls. However inaccurate and incomplete records meant we could not be sure that risks to these people were being safely managed and addressed.

There were enough staff on duty on the day of our inspection visit to ensure people’s needs were met. Relatives said there had been a high turnover of staff which had ‘unsettled’ family members. The provider and registered manager acknowledged this and said they had had difficulty recruiting new staff including nurses but the situation was being resolved with new permanent staff starting work at the service.

Improvements were needed to the provider’s recruitment procedure to ensure the correct background checks were done before new staff started work at the service.

Staff were trained in ‘safeguarding’ (protecting people wo use care services from abuse). There had been a relatively high number of safeguarding issues at the service. The provider and registered manager were working with the local authority to address all the issues raised with a view to improving people’s safety at the service.

Following our inspection visit we attended a relatives meeting at the service called by the local authority. Some relatives said their family members were happy at the service, the care was ‘good’, and the staff ‘fantastic’. Others raised concerns about poor communication, a missed healthcare appointment, staffing issues, the laundry, and the quality of the personal care staff provided. The provider and registered manager said they were taking action to address these issues and had already made some improvements.

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 the report.

The provider is registered to provide accommodation for up to 40 older people living with or without dementia in the home over two floors. There were 30 people using the service at the time of our inspection. The home provides nursing care for older people.

At our last inspection on 20 and 21 April 2016, we asked the provider to take action to make improvements in the areas of medicines, safeguarding service users from abuse and improper treatment and good governance. We received an action plan setting out when the provider would be compliant with the regulations. At this inspection we found that the concerns in the area of medicines had been fully addressed. However, while improvements had been made, more work was required in the other two areas.

A registered manager was in post and was available throughout the inspection. 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. However a staff member did not report a potential safeguarding issue. Risks to people’s safety were not always assessed and managed.

Sufficient numbers of staff were on duty during our inspection to meet people’s needs, however, sickness levels were reported to have an effect on staffing levels especially at weekends. Staff were recruited through safe recruitment processes. Safe medicines management and infection control practices were followed.

Staff received appropriate induction, supervision and appraisal but training required improvement. People’s rights were protected under the Mental Capacity Act 2005 but documentation supporting decisions could be improved. People were supported by staff to have sufficient to eat and drink but food and fluid charts were not well completed.

External professionals were involved in people’s care as appropriate. People’s needs were not fully met by the adaptation, design and decoration of the service.

Most staff were kind and caring, however, staff did not respond in a caring way to two people in distress. People and their relatives were not fully involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and dignity and promoted their independence.

Activities required improvement. People did not always receive personalised care that was responsive to their needs.

Care plans contained sufficient information to guide staff to provide personalised care for people. Complaints were appropriately responded to.

Systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. This is the third consecutive inspection where these issues have been found. As a result the provider was not fully meeting their regulatory requirements. People and their relatives were involved or had opportunities to be involved in the development of the service.

We found one 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 this report.

Accommodation for up to 40 people is provided in the home over two floors in each building. The service is designed to meet the needs of older people and provides nursing care. There were 32 people using the service at the time of our inspection.

At the previous inspection on 18 and 19 May 2015, we asked the provider to take action to make improvements to the areas of consent, premises and equipment and good governance. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that some improvements had been made, however, more work was required in all areas.

The registered manager was no longer working at the service. A new manager had been in post for six weeks and she was available during the inspection. 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.

Appropriate actions were not always taken to respond to potential safeguarding issues and risks to people were not always managed safely. Staff were not always recruited through safe recruitment practices and safe medicines practices were not always followed. Sufficient numbers of staff were on duty to meet people’s needs and safe infection practices were followed.

Not all staff received sufficient training. People’s rights were not fully protected under the Mental Capacity Act 2005 and people’s needs were not fully met by the adaptation, design and decoration of the service. However, people received sufficient to eat and drink and external professionals were involved in people’s care as appropriate.

People were not fully involved in decisions about their care and advocacy information was not made available to people. Staff were caring and treated people with dignity and respect.

Activities required improvement. A fully comprehensive complaints process was not in place and the process was not easily available to people. Care records contained information to support staff to meet people’s individual needs.

The provider was not fully meeting their regulatory responsibilities. There were systems in place to monitor and improve the quality of the service provided, however, they were not effective. People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the manager and that they would take action.

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.

We spoke with the registered manager, care manager, a team leader, two care assistants and a health care professional visiting the home on the day of our inspection.

Throughout this inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

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

Is the service safe?

People received care in an environment that was safe. The communal areas and the bedrooms that we looked at within the home were generally clean and tidy.

A relative we spoke with told us, 'I haven't found any problems. I know they are safe with their care, and safe in the building.' Another relative said, 'My relative is definitely safe in the home.'

We saw people received their prescribed medication and this was handled and stored safely. We observed staff administer people's medication in a safe manner whilst ensuring they respected their wishes and maintained their dignity.

People were supported in their movement in a safe manner, using more than one staff member where required and using equipment where needed in a safe way.

The CQC monitors the operation of the DOLS which applies to care homes. DOLS are part of the Mental Capacity Act 2005. Correctly applied DOLS make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that care homes only deprive someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.

The manager told us there were no people who currently needed a DOLS order, but they would ensure that for anyone who did require an assessment, it would be completed and submitted to the authorising body in a timely manner.

Staffing levels were appropriate to keep people safe and to provide appropriate levels of care. One person who used the service told us, "The staff look after me well, I always feel safe here.'

Is the service effective?

We saw improvements had been made since the last inspection and work was on-going to make the home more comfortable and more user friendly for people living with dementia. We saw a dementia framework award which was won by the home in August 2013.

People were consulted on decisions relating to their care. People we spoke felt included and relatives we spoke felt their opinions and views on decisions regarding their family member were welcomed. One relative of a person who lived at the home told us, 'The care is good, the only concern I have is that we are not always informed enough about what happens in the home. We filled in a questionnaire they sent us and said that we were happy. They keep [my relative] safe and they get on well with others in the home.' The person told us the manager had agreed to meet with them to discuss their concerns.

Is the service caring?

We spoke with relatives of people who used the service and asked them if they felt their family member was safe and well cared for by the staff. One person told us, 'Every time we've gone in we have seen good care being provided. The staff are good, we always see them using two people when lifting.'

We observed staff interact with people who used the service. They were caring and attentive in their approach and did not rush people. They observed people's dignity and wishes at all times. We observed a person being transferred by hoist to a soft chair in the dining area for lunch. Two staff supported them during hoisting and talked to them to tell them what was happening and offer reassurance, whilst checking the person was happy and comfortable with what was happening.

Is the service responsive?

We saw staff respond to people's needs throughout the inspection. Staff responded promptly to people's requests for help and support. When people needed help, staff were there to assist them. A member of staff told us, 'We are trained to 'record and report' any changes or incidents that is our policy. We keep daily records of a person's care I take my role very seriously and responsibly and my colleagues share that attitude.'

The manager told us they welcomed people's views and responded to them. Questionnaires had been issued to people who used the service and their relatives. The responses received were positive.

There were sufficient staff on duty to meet people's needs. A visiting relative said, 'I can't complain, staff numbers could always be improved in any care home, but personal care is done well by all the staff.'

We saw a person's care records included a letter from a nutritionist, stating the need for the person to be given a dietary supplement due to weight loss. The person's care plan was amended to include the supplement and their weight was recorded and monitored.

Is the service well-led?

We asked people who used the service, their relatives and staff whether they felt the service was well led by the management team. A relative we spoke with told us, " I know I only need to pick up the phone and the manager will sort out any problems for me."

We saw improvements had been made since the last inspection. We saw there was now a better system of staff supervision and training in place to ensure staff had the right skills and approach to provide good care for people. Staff spoke positively about the manager. One staff member told us, 'I enjoy working here. We've got a lovely team and a good manager and team leaders to support us."

Another member of staff told us they felt listened to by managers, and staff meetings were held to allow staff to express any concerns and share information about the needs of individuals.

We spoke with two relatives of people who were using the service. We were told, 'I am very happy with the care provided here. My relative is happy and they would say if they weren't happy.'

We spoke with three people who were using the service and were told, 'The home is very clean, it has to be to meet my standards.' Another person said, 'They go around with the vacuum every day. My room is always cleaned.' During our tour of the service we found the home to be clean and tidy with no offensive odours.

We saw that staff were receiving ongoing training. Staff were not receiving appropriate supervision.

Regular checks were being completed by the manager on a daily, weekly and monthly basis. These also included checks of the care being provided by staff and the cleanliness of the home. Where an improvement was required, this had been recorded along with the action taken.

During this inspection we also spoke with one relative, three people using the service, the manager and four members of staff.

One person told us they were very happy with the help and support they received. They said, 'The staff are beautiful, they are very kind and caring. I get help when in need of it but I try to do most things myself. I like to spend a lot of time in my room.' Another person told us they were also happy and settled. They said, 'I enjoy the activities, but I would love to go out in the garden more. The staff are nice and approachable and they help me.'

During our observations we found staff were a little disorganised and task focussed at times and there was a lack of leadership during the morning shift.

We saw that some people enjoyed the activities on offer and the activities during the afternoon created discussions and laughter.

One relative we spoke with told us that staff were approachable and they were always able to discuss any issues with them. People told us they could speak with staff if they had any concerns and they would be listened to.