Archived: Evedale Care Home

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and autistic people.

Right Support:

Risks associated with people’s care and the environment were not always fully assessed and well managed. We made a recommendation about improving environmental checks. 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. Staff were recruited safely and there were sufficient staff to provide people's planned care and support.

Right Care:

Care plans and risk assessments were not always completed in a timely manner. People received personalised care from staff who knew them well and ensured their rights and dignity were promoted and protected. Staff understood their responsibilities to keep people safe and protect from harm.

Right Culture:

Quality monitoring systems and checks were in place. However, further improvement was needed to ensure issues were fully identified and reviewed to ensure action taken was effective. Staff felt supported by the registered manager who promoted an open and inclusive culture. The staff team worked in partnership with a range of professionals to achieve good outcomes for people.

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 14 December 2020) 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 regulation.

The overall rating for the service has remained requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This focused inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the key questions safe, effective, and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Follow up

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

Evedale Care Home provides nursing and residential care for up to 60 older people, including people living with dementia. At the time of our visit 28 people lived at the home. Accommodation is provided in a purpose built building across two floors.

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

Since the last inspection the provider and registered manager had worked to improve systems and recruit a permanent staff team. People experienced better care and outcomes as a result of this and a plan was in place to keep improving the service. A concern identified on this inspection means the provider remains in breach of one regulation. The registered manager took immediate action to address this to continue to manage people’s medicines safely.

Risk’s associated with people’s care had been identified, assessed and updated. Staff knew the support people needed to keep them safe. People were able to access health and social care professionals and staff followed advice they were given.

People and their relatives told us they continued to be happy with the care provided from staff at Evedale Care Home. People's needs and preferences were known by the staff who gave person centred, responsive care. Staff had developed positive relationships with people which led to people feeling safe and happy.

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 inadequate (published 4 June 2020) 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 enough improvement had been made, but the provider was still in breach of one regulation.

This service has been in Special Measures since 4 June 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Responsive and Well Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to safe care and treatment in relation to medication at this inspection.

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.

Evedale Care Home provides nursing and residential care for up to 60 older people, including people living with dementia. At the time of our visit 54 people lived at the home. This included three people in short term discharge to assessment beds (D2A) which are used to support timely discharges from hospital. Most people had complex needs. Accommodation is provided in a purpose built building across two floors.

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

There continued to be a lack of effective governance, management and provider level oversight at the service. Quality monitoring systems and checks designed to identify shortfalls, and to drive improvement had not been embedded and were ineffective. This demonstrated lessons had not been learnt since our last inspection. Despite our findings, people and relatives told us they were happy with the care provided and staff felt supported by the registered manager.

Risk’s associated with people’s care were not always identified, assessed and well-managed. Staff had been recruited safely. People’s quality of life was negatively affected by staffs limited availability. People’s medicines were not consistently managed and administered safely in line the provider’s procedure and best practice guidance.

People had access to health and social care professionals. However, the advice they gave was not always followed. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People and relatives spoke highly of the staff who cared for them and despite our findings told us they felt safe. Most staff were caring in nature but did not have the time needed to provide person centred care. Staff understood the importance of promoting people’s rights. However, some staff practices did not always reflect this.

People’s care was not always provided in line with their planned needs and preferences because staff were busy. Staff understood the needs of people who lived at the home permanently but had limited information about people staying in a D2A bed. Care records did not consistently contain accurate and detailed information. People had opportunities to engage in meaningful activities. Complaints were managed in line with the provider’s policy and procedure.

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 21 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, including risk and medicines management, person centred care, and how the service is managed at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve 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.

Special measures

The overall rating for this service is now ‘Inadequate’ and the service in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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

Evedale 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 accommodates 64 people in one adapted building across two floors. On the day of our visit 53 people lived at the home. The home is located in Coventry in the West Midlands.

We last inspected Evedale Care Home in November 2017 and gave the home an overall rating of 'Requires Improvement'. The inspection identified continued breaches of Regulation 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive adequate support with eating and drinking to maintain their health. The provider’s quality monitoring systems had not been embedded and therefore, were not effective.

We asked the provider to send us a report, to tell us how improvements were going to be made to the service. At this inspection on 18 January 2019 we checked to see if the actions taken by the provider were effective. A range of improvements had been made and sufficient action had been taken in response to the breaches of Regulations. However, previously demonstrated standards of some aspects of medicine management and administration had not been maintained.

This is the third consecutive time the home has been rated as requires improvement.

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.

People did not always receive their medicines as prescribed because some medicines had not been in stock. Improvements had been made to the level of detail and accuracy of completed daily records. However, further improvement was needed and action was planned to address this.

People felt safe living at the home. Staff were recruited safely and enough staff were available to respond to people’s requests for assistance. The use of agency staff had reduced which meant people were supported by staff they knew.

Risks to people’s safety and the environment were identified. Staff knew how to manage risks and risk management recommendations made by a health care professional were followed. The home was clean and well maintained. Staff followed good infection control practice.

Care records supported staff to provide personalised care. People and relatives, were involved in planning and reviewing people’s care. Staff were caring and kind. Staff respected people’s rights to privacy, dignity and independence and supported people to maintain important relationships and make new friendships.

Staff received the support they need to be effective in their roles through an induction, regular meetings and on-going training. People and relatives knew how to make a complaint. Complaints were managed in line with the provider’s procedure.

People and relatives shared their views about the home and feedback was used to support continuous improvement. Quality monitoring had improved but further improvement was needed to ensure checks and audits were effective.

The registered manager was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff gained people’s consent before they supported people and respected people’s decisions and choices.

During this visit we saw improvements in providing people with support to eat and drink had been made on the first floor of the home; however the improvements for people on the ground floor were only recent and had not yet fully embedded. Therefore the service remains in breach of Regulation 14 (Nutrition).

At our last inspection visit the provider was in breach of Regulation 17 (Governance); and well-led was rated as inadequate. During this visit improvements had been made, but they had not been made for a long period of time for us to be confident they would be sustained, and further improvements were still required. Therefore the service remains in breach of Regulation 17.

At our last inspection visit the provider was in breach of Regulation 18 Registration Regulations 2009 (Notifications of other incidents). During this visit we found one incident which had not been notified to us, but this had occurred before the current manager started to work at the home. They have since sent a formal notification.

Following the last inspection we have met with the provider twice to discuss on-going concerns at the home and actions taken by the provider to improve the service. We have been in regular contact with the provider’s senior management team in relation to issues which have arisen.

Evedale Care Home is a care and nursing 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.

Evedale Care Home accommodates up to 64 people in one adapted building. The ground floor of the building provides accommodation to older people and people with general nursing needs. The first floor provides accommodation to older people with dementia who have nursing needs. The home also provides short term stays of up to six weeks for people who have been discharged from hospital but who require further assessment to determine their future needs.

At the time of our visit there were 47 people who either lived at Evedale or who were on a short term stay at the home. This was because the provider had decided to stop admitting people for longer term care until they were satisfied the home was providing better quality care.

The home did not have a registered manager; however the new manager was in the process of applying to the Care Quality Commission to be registered. 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.

Since our last visit in May, the manager at the time of our inspection visit left the service, and two further managers have worked at the home. The most recent manager is applying to be registered with the CQC. They had been in post for five weeks at the time of our inspection visit. They had worked extremely hard in a short period of time to start improving the quality of care provided.

At our last visit there was a high number of agency staff working at the service to cover the staff absences resulting from staff leaving the service, sickness and planned leave. There continued to be high levels of agency workers but these had been booked over longer periods of time to provide continuity of care; and new staff were being recruited and inducted. Some staff who previously left the service had returned. There were enough staff on duty to meet people’s needs.

There have been safeguarding concerns raised since the last inspection, but the new manager had a good understanding of safeguarding policies and procedures and has supported staff in increasing their knowledge of this. Staff understood the risks related to people’s health and well-being and action had mostly been taken to reduce the likelihood of risks occurring.

Medicines were mostly managed safely. Some medicines records were not as accurate as they should be. People had the necessary equipment to support them with their care needs, and the home was clean with infection control measures being adhered to. Premises and equipment safety checks had been carried out to ensure safety, although mattresses were not always at the correct setting.

The provider had a complaints procedure, however this was not on display and there had been no formal complaints made until the later part of 2017. Where people had complained, these had been investigated.

Staff were more responsive to people’s needs on the first floor dementia unit than during our previous inspection visit. However, there continued to be a lack of activities on both floors, and the budget for providing activities for each person was minimal.

Staff were kind and caring to people and permanent staff knew people well. Agency staff were also kind to people but were not as responsive as they did not know people’s needs as well. People’s privacy and dignity was supported.

The provider’s checks on the quality of the service more accurately reflected the quality of care people received than our previous visit; and these had been completed as the provider expected.

At our last comprehensive inspection of this service on 21 June 2016, we found the provider had not met all of their legal requirements and were in breach of the regulations. This was because people did not always adequately receive support with food and fluids to maintain their health and well-being. After the inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breach. During this inspection visit we found the provider had not made the improvements required, people were not always given the support they required to eat and drink. We found there continued to be a breach of the regulation in relation to this.

Evedale Care Home provides accommodation for up to 64 older people and people with dementia who require support with their nursing and personal care. There were 58 people living at the home at the time of our inspection. The home consists of two floors, the ground floor supports people with general nursing needs and the first floor is the Dementia Unit.

The home did not have 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 and associated Regulations about how the service is run.

Since our last inspection the registered manager and deputy manager had left their employment at the service. There had also been three different regional managers appointed by the provider during this time. This meant the home had not had consistent managerial oversight. Continued changes in management had affected staff confidence and staff morale. People and relatives also told us they found this unsettling. At the time of this inspection a temporary manager from the provider’s resident experience team (RET) was overseeing the day to day running of the home whilst a new manager was recruited.

Staff felt unsupported by the provider and did not feel valued or listened to. Constant managerial changes had affected the organisation and smooth running of the home and the provider was working hard to address this.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home; however the provider acknowledged that these had not been maintained. The accuracy of some audits carried out since our last inspection visit in June 2016 could not be assured and the provider was taking robust action to ensure systems and processes were used effectively to assess the quality of the service people received.

The provider’s managing director and management team acknowledged the challenges the home had been through and that improvements were still required. They were taking positive steps to address the issues we identified and to provide support to staff to ensure stability for the home.

The provider had relied on high levels of agency (temporary) staff to support staffing numbers as several permanent staff had also left their employment at the service. This meant people did not receive consistent support from staff who they were familiar with, and who knew how people liked to receive their care. Some people and their relatives told us at times staff were not always available when people needed them.

The provider had also increased the number of staff on duty to support people’s needs; however this created pressure on permanent staff to support agency workers who were not familiar with the home and people’s needs.

At our last inspection in June 2016 the provider told us they were making improvements to the environment on the Dementia Unit to make it more ‘dementia friendly’ and additional training was being provided to staff on the unit. We saw refurbishment was taking place, however staff had not yet received the additional training to support them provide specialised dementia care.

People and their relatives told us most staff were kind and considerate, and they felt people who lived at the home were safe. Staff were caring, but did not have time to interact with people unless they were providing personal care, and people on the Dementia Unit were left for long periods with little interaction. There were delays in attending to the personal care needs of some people in the home.

Staff had a good understanding of people’s needs and most supported people with respect. Most people told us staff ensured their dignity was maintained at all times.

There were systems and processes in place to protect people from the risk of harm, however these were not consistently followed and some incidents had not been thoroughly investigated or reported to the local safeguarding team. Most staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Staff were knowledgeable about risks and how to support people safely.

People mostly received their medicines at times when they needed them. We found medicines were administered, stored and disposed of correctly, however we identified some gaps on people’s medication administration records (MARS). The provider had identified these issues and had taken positive steps to address them. Some people required their medicines “as required” (or PRN) and we saw protocols were available in people’s medicine plans. Care records showed that people’s pain levels were formally being monitored and assessed.

Some people were not involved in decisions about their care but most told us they received support in the ways they preferred. People looked well presented with clean clothes and overall people’s privacy and dignity was promoted, but sometimes this was compromised by having to wait for staff to support them to use the bathroom. People were supported to maintain relationships with people important to them and visitors were welcomed at the home

Staff did not consistently receive support from the provider to enable them to provide effective care to people. The provider acknowledged that training requirements had not been maintained, however this had been identified and improvements were underway to ensure all staff received their required training.

Staff understood the principles of the Mental Capacity Act (MCA), and most gained people’s consent before they provided personal care. People told us they were encouraged to make choices about their daily lives. There were policies and procedures in place to ensure that people who could not make decisions were protected, and we found assessments had been completed.

Most people were supported to eat and drink by staff; however on the Dementia Unit some people who required support did not consistently receive it. This had been identified at our last inspection visit in June 2016 and the provider had failed to make improvements. We saw people on the ground floor received a good choice of food and drink, and people’s individual food requirements were catered for. However some people on the Dementia Unit were not given choice with their food and drink.

Overall, people’s health needs were met. We saw appropriate referrals were made to specialist healthcare professionals where people needed support, for example with eating and drinking and skin care.

Care plans and assessments contained information that supported staff to meet people’s needs. However some lacked detail and were not ‘person centred’ in relation to how people liked to receive their care. People and their relatives were not consistently involved in the planning of care. The provider was addressing this with further training for staff and new documentation was being introduced.

The provider employed activity workers to support people with their activities, hobbies and interests. Relatives had previously expressed concerns regarding the lack of activities on the Dementia Unit and the provider was addressing this, however we still found improvements were required.

We found three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

At our last comprehensive inspection of this service on 21 October 2014, we found the provider had not met all of their legal requirements and were in breach of the regulations. This was because there were not enough staff to meet people’s care needs safely, and there continued to be an over reliance on bank and agency staff. Risks relating to people’s care had not been fully assessed and call bells were not available to people when they needed them.

After this comprehensive inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breaches. We undertook a focused inspection on the 23 April 2015 to check that they had followed their plan and found they met legal requirements.

Evedale Care Home provides accommodation for up to 64 older people and people with dementia who require support with their personal care. There were 58 people living at the home at the time of our inspection. The home consists of two floors and the first floor is the Dementia Unit.

A new manager had been working at the home since December 2015 and was applying to be registered with us. 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.

We found there was a clear divide between the two floors of the home and the care and support provided. We found improvements had been made on the ground floor since our last inspection; however we still found areas where improvements were required on the Dementia Unit. Some staff spoke of feeling happier and more valued on the ground floor. However some relatives felt there were not enough staff to support their relations on the Dementia Unit.

The manager had already identified this and was working hard to make improvements to bring both floors into alignment with each other. The provider was also investing in making improvements to the environment on the Dementia Unit to make it more ‘dementia friendly’ and additional training was being provided to staff on the unit.

People and their relatives told us most staff were kind and considerate, and they felt people who lived at the home were safe. We observed, and people told us, staff members were caring but did not have time to interact with people unless they were providing personal care and we saw some people on the Dementia Unit left for periods with little interaction.

Staff treated people with kindness. Staff had a good understanding of people’s needs and most supported people with respect, most people told us staff ensured their dignity was maintained at all times.

Most staff told us they were happier working at Evedale because the number of staff on duty to support people’s needs had increased and they felt the new manager was supportive and making improvements to the home.

Most people and relatives were happy with the care provided and staff were committed to providing a good standard of care, however we observed there were delays in attending to the personal care needs of some people on the Dementia Unit.

There were systems and processes in place to protect people from the risk of harm. Most staff understood their responsibility to safeguard people from harm but we saw one incident that should have been referred to the local safeguarding team had not been. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

Most people were involved in decisions about their care and told us they received support in the ways they preferred. People were supported to maintain relationships with people important to them and visitors were welcomed at the home

Staff received support from the provider and new manager to enable them to provide effective care to people. However training records showed only 50% of staff had received the necessary training, this was being addressed by the provider.

Staff understood the principles of the Mental Capacity Act (MCA), and most gained people’s consent before they provided personal care. People told us they were encouraged to make choices about their daily lives. There were policies and procedures in place to ensure that people who could not make decisions were protected, and we found assessments had been completed. However on the Dementia Unit some information about the decisions some people could, or could not make was not recorded consistently.

We saw people received a good choice of food and drink, and people’s individual food requirements were well catered for. Most people were supported to eat and drink by staff; however on the Dementia Unit one person who required support did not consistently receive it.

Overall, people’s health needs were met. We saw some appropriate referrals were made to specialist healthcare professionals where people needed support, for example with eating and drinking and skin care. However at times on the Dementia Unit, advice given was not consistently followed.

Care plans and assessments contained information that supported staff to meet people’s needs. However some lacked detail and were not ‘person centred’ in relation to how people liked to receive their care. People and their relatives were not consistently involved in the planning of care. The manager had identified this and the provider was addressing it with further training for staff.

The provider employed activity workers to support people with their activities, hobbies and interests. Relatives had previously expressed concerns regarding the lack of activities on the Dementia Unit and the provider was addressing this.

The provider had recruited a new area manager to support the manager and the staff. They were both open and transparent about the improvements that needed to be made in the home and the provider had already taken action to address some of the issues we highlighted.

Staff felt supported by the manager and they in turn felt the provider was supportive. We found the new manager was highly motivated to make improvements in the home.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff, surveys, checks on care staff to make sure they worked in line with policies and procedures and a programme of other checks and audits.

Arrangements were in place so that actions were taken following concerns raised, for the benefit of people who lived at the home. Systems were in place to drive continuous improvement at the home for the benefit of the people who lived there.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives 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?

We inspected staff rotas and talked with staff. We were made aware the service had been experiencing difficulties in retaining and recruiting staff because of a local hospital's recent recruitment campaign. We saw sufficient staff had been rota'd to meet the assessed needs of people living at the home. We found there was a high level of bank staff being used and the service had to use agency staff to cover some of the shifts. Staff told us they felt there was not enough staff to meet people's needs and staff were phoning in sick.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was nobody living at Evedale who had a current DoLs in place.

Is the service effective?

People all had an individual care plan which set out their care needs. These provided staff with the information they needed to support people with their care. Assessments included people's needs for equipment, skin integrity and specialist dietary requirements. We saw some inconsistencies and insufficient information in some care records which could impact on the care provided.

Is the service caring?

People were supported by staff who were kind, caring and patient. We saw staff were very busy throughout the time we were inspecting the service. They did not have time to sit and talk to people unless they were supporting them to eat. However, when staff were undertaking care tasks or talking with people, they treated people with dignity and respect.

We spoke with three relatives and two people who used the service. One person told us, 'Staff are busy but they will do things if you ask them.' A relative told us, 'We can't speak highly enough of the staff, the care is so much better here than the previous home.'

Is the service responsive?

People had access to a range of health care professionals, some of which visited the home. During our inspection we observed a GP visiting a person, and a speech and language therapist visiting another. They told us, 'They (staff) seem to be quite proactive in phoning us when things change.' We also saw a person being taken to hospital accompanied by one of the care workers. This meant the service responded to the changing health needs of people living at Evedale.

The service was less responsive to people's social needs. There was little time available for staff to sit and talk with, or undertake social activities with people. The service employed one activity co-ordinator who worked each week day. They were responsible for providing activities and social stimulation for the 55 people living at the service. One person living at the home told us, 'It's boring here.'

Is the service well-led?

The regional manager and manager told us the service had been going through a challenging period since our last visit. We saw the regional manager was supporting the manager to ensure systems designed to assure the quality of service were fully implemented. They were also supporting the manager in dealing with the challenges in recruiting and retaining staff.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, medication records and other records kept in the home, had been identified by the organisation as requiring improvement. The service was working to the company's action plan in addressing the areas of concern.

We observed staff to be kind and considerate to people living at Evedale. We saw people being treated with respect and their dignity was being maintained. Care records showed that people with high dependency needs were being well cared for.

The majority of the relatives we spoke with were pleased with the care received by people living in the home. One relative told us, 'The care is marvellous'the carers are warm towards X.'

We looked at the equipment used in the home. We saw sufficient equipment to meet the needs of people living at Evedale. Equipment was satisfactorily maintained.

We looked at staff recruitment. We noted the recruitment procedure ensured all the appropriate pre-employment checks were carried out to support the safety of people living in the home.

We looked at the complaints procedure. We saw the small number of complaints received by the service had been thoroughly investigated and action taken when necessary.

We checked whether the service had good systems in place to safeguard people from abuse. We were satisfied that staff understood how to safeguard people in their care.

We looked at nutrition. We saw people were given good support to meet their nutritional needs.

We saw people having a relaxed breakfast time, enjoying a choice of food, and a choice of whether to eat in their bedrooms or in the dining room.

We spoke with staff who told us staffing levels had improved since our last visit. We saw staff taking their time with people to help them get up and dressed. We saw people being treated with dignity and respect.

We looked at staffing levels and noted these had increased since our last visit. We saw this having a positive impact on people living at Evedale.

We saw an activities co-ordinator on duty. They were talking to people on a one to one basis. On the day we were there they had planned a group activity called 'current affairs'. This was to help people keep up to date with information read from newspapers.

We observed and talked to people in the different lounges. Due to their conditions, it was not possible to speak with people at length. We noted from facial expressions and limited conversations that people were content.

We spoke with one visitor who told us they had been pleased with the care their loved one received.

We looked at three care records and these gave good information about the care and nursing needs of each person. These had been regularly updated, and demonstrated that changes in the person's care needs had been acted upon in a timely manner.