Croxteth Park Care Home

Croxteth Park is a residential care home providing nursing and personal care to 39 people at the time of the inspection. The service is registered to support up to 42 people in one adapted building. The home is located over 1 level and there are 2 separate units.

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

There had been improvements in the home since the last inspection.

People were supported to have maximum choice and control over 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 appropriately trained and supervised to enable them to carry out their roles. People were supported to eat a balanced diet.

Care plans were person centred and reviewed regularly to ensure any changing needs were taken into account. There was a complaints policy in place, which was made available in different formats to support people’s understanding. We reviewed some recent complaints and saw they had been responded to in line with policy and procedure.

All notifications had been sent to CQC, and the registered manager understood what was expected of them under duty of candour. Staff told us they enjoyed working at the home, and they felt they could approach the registered manager to help them develop further in their roles or if they had any concerns. There was a robust governance structure in place which highlighted shortfalls in care provision and took action to address them.

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

Rating at last inspection and update

The last rating for this service was requires improvement- published 20 May 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to Effective, Responsive and Well-led.

The ratings from the previous comprehensive and focussed 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 improved to good. 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 Croxteth Park 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.

Croxteth Park is a residential care home providing nursing and personal care to 23 people at the time of the inspection. The service is registered to support up to 42 people in one adapted building. The home is located over one level, split into two units.

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

There had been improvements in the home since the last inspection. Medicines management had improved and were administered, managed and stored safely. There was some inconsistent recording with prescribed creams and a lack of guidance for staff when administering variable dose ‘as required’ medicine (PRN). The provider told us improvements with the PRNs and recording of prescribed creams would be made immediately.

Risks to people were assessed and appropriate plans were in place to keep people safe. There was some improvement in risk plans associated with people’s specific health conditions, such as diabetes and epilepsy. Plans were clearer and easier to read than previous and provided staff with more detailed guidance. However, one record still needed further information to guide staff on what actions they should take should the person become ill.

Accidents and incidents were recorded, and actions were in place to ensure people were safe. The analysis of these incidents had improved since the last inspection. It was clear the manager was using incidents to identify patterns and trends and making changes when needed to ensure people were protected from avoidable harm.

Audits were completed and effective at identifying improvements needed. Action plans were in place to improve the quality and safety of the service based on these audits.

There were enough staff to meet people's needs. Staff told us things had improved at the home and people were happier and it was a safer place to be. Staff were positive about the support they received from the new manager, and from the provider. Staff told us they felt responsive action was taken by management when they raised concerns. Staff felt the improvements that had been made had impacted positively on people living at Croxteth Park and improved the morale of the staff team.

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 7 November 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service remains requires improvement. This is the fourth consecutive time the service has been rated requires improvement.

Why we inspected

We carried out an unannounced focussed inspection of this service on 23 September 2020. Breaches of legal requirements were found relating to safe care and treatment and good governance. We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive and focussed 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 remains 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 Croxteth Park Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Croxteth Park is a residential care home providing nursing and personal care to 29 people at the time of the inspection. The service is registered to support up to 42 people in one adapted building. The home is located over one level, split into two units.

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

Audits and checks were completed by the registered manager; however, these were not always effective at identifying concerns. There was a lack of robust oversight with aspects of the service. The provider had recently implemented new governance processes to address some concerns, specifically with the management of medicines. However, these processes were fairly new and had not been embedded within the home. Concerns raised at the last inspection had not been fully addressed.

There was ineffective oversight of training for staff. Not all staff had completed appropriate inductions for their role, or completed training deemed mandatory by the provider. The provider had identified this prior to our visit and an appropriate plan was in place to address these concerns

There were concerns with the safe management of medicines. People did not always receive their medication as prescribed, and best practice guidelines were not always followed in relation to the recording of medicines.

Risks to people were assessed and appropriate plans were in place to keep people safe. However, where people had specific health conditions, such as diabetes, there were no risk assessments or care plans to support staff being able to recognise people’s symptoms and guide them with action needed to support people.

Accidents and incidents were recorded, and actions were in place to ensure people were safe. However, there were no systems in place to effectively and consistently analyse incidents to ensure learning could be implemented at the earliest opportunity to prevent reoccurrence.

People’s nutritional and hydration needs were recorded in their plans of care. Staff were aware of people’s individual needs regarding this. However, the recording of people’s food and fluid intake was inconsistent and did not always reflect their assessed needs. We made a recommendation about this.

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.

There were enough staff to meet people's needs. We received mixed feedback form staff regarding the support of management in the home. Some staff felt there was a negative ‘blame’ culture and there was little support from the provider. Most staff felt the registered manager was supportive but told us concerns raised were often overlooked and not dealt with appropriately.

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

Rating at last inspection

The last rating for this service was requires improvement (published 27 November 2019).

The service remains requires improvement. This is the third consecutive time the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 8 and 9 October 2019. 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, meeting nutritional and hydration needs 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, Effective and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains 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 Croxteth Park Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines and governance and oversight of the service.

Please see the back of this report for CQC’s regulatory response to the concerns found during inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Croxteth Park Care Home is a residential care home providing personal care to 40 people at the time of the inspection. The service is registered to support up to 42 people in one adapted building. The home is located over one level.

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

People’s medicines were not always managed safely. One person had not always received their medicine as prescribed and there were some irregularities with the count of medicines available. Staff had not had their competency to administer medicines completed within the last 12 months, as recommended in best practice guidelines.

People’s oral health needs had been assessed, however there were no plans in place detailing their support needs in relation to this. Staff told us they felt confident supporting people with oral health but had not received any training. We made a recommendation about this.

Peoples food and fluid intake had not been appropriately monitored when people were at risk of weight loss or malnutrition. We found food and fluid monitoring charts had not been completed appropriately, and in some cases weeks of recording was missing.

Care plans were not always completed to reflect the care being given to people. However, staff knew people well and people told us staff supported them in the way they preferred. Regular reviews took place, however they did not always reflect the changes in people’s needs.

Risks to people were assessed and appropriate plans were in place to keep people safe. However, there were no systems in place to effectively analyse incidents to ensure learning could be implemented to prevent reoccurrence.

Audits and checks were completed by the registered manager; however, these were not always effective at identifying concerns. There was a lack of robust oversight with aspects of the service. The registered manager implemented some new checks before the end of the inspection to improve oversight of some areas.

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.

There were enough staff to meet people's needs. We saw people had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care. Staff told us they felt there were enough staff to support people safely, but they would like more time to spend with people.

People told us they felt safe living at Croxteth Park and liked living there. However, most people told us they felt activities could be improved to avoid boredom. We saw there were activities planned most days, but people felt there could be more on offer. A new activities coordinator had recently started in post and the registered manager was working with them to develop improvements in this area.

Staff understood their role and had confidence in the manager. Staff told us they worked well together as a team, and there was good morale amongst them.

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 24 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines, nutritional monitoring and management, and the general management of the service 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Croxteth Park Care Home is registered to provide accommodation for up 42 people with personal care needs. Accommodation can be found across two separate units, each of which have separate adapted facilities. At the time of the inspection, 39 people were living at the home. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in post. A registered manager is a person who has registered with CQQ 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 previous comprehensive inspection took place in March 2016. The home was awarded an overall rating of ‘Good’.

We then conducted a focused inspection in April 2017. We received information of concern from the Office of the Coroner relating to the management of falls and the assessment of people's capacity to consent to care. The focused inspection concentrated on three of the five key questions we inspect against; safe, effective and well-led domains. We found that the registered provider was complying with all Health and Social Care Act Regulations and the rating of ‘Good’ remained.

During this inspection, we identified breaches of regulation in relation to ‘Safe Care and Treatment’ and ‘Good Governance’. We are taking a number of appropriate actions to protect people who are living at Croxteth Park Care Home.

We found that people were exposed to environmental risks and were not always receiving safe care and treatment. A cleaning cupboard which contained harmful chemicals was accessible to people who lived at the home, dangerous items such as a pair of scissors and a sling aid was found in communal areas, a hot water urn was accessible to people who had been assessed as lacking capacity and not all fire doors were effectively closing within their door frames.

We checked to see how the quality and safety of the care people received was regularly monitored and assessed. We found that systems and processes were in place; however, these were not always effective. We found that health and safety audits and checks were not always completed and the issues we identified during the inspection had not been identified.

We checked to see if the registered provider was complying with the principles of the Mental Capacity Act, 2005. Mental capacity assessments were routinely carried and the necessary deprivation of liberty safeguards (DoLS) were submitted to the local authority. However, we identified that capacity assessments were not always decision specific and people’s ‘consent’ paperwork was not always completed.

We have made a recommendation about the Mental Capacity Assessment processes and documentation.

Staff told us they were familiar with the needs of the people they supported, although records did not always contain sufficient information in relation to people’s social histories, preferences, interests and wishes.

We have made a recommendation about obtaining information to help staff provide person-centred care.

People were encouraged to engage in a range of different activities. Activities co-ordinators were in post; activities were arranged around people’s likes, interests and hobbies.

A complaints procedure was in place. People and relatives told us that they knew how to raise any concerns if they ever needed to. Complaints were responded to in accordance to organisational policy.

People’s risk was safely managed. Risk assessments contained up to date and relevant information and staff told us they were informed of any changes in people’s needs on a daily basis.

Medication processes were safely in place. Staff received medication administration training and there was an up to date medication administration policy in place.

Staff personnel files we checked had the appropriate recruitment checks in place. Personnel files, with one exception, contained application forms complete with employment and education history, appropriate references and the necessary ‘Disclosure and Barring Service’ (DBS) checks.

We found that there were sufficient numbers of staff on duty to meet people’s needs in a timely way. The registered manager explained that there had been some problems with staffing levels prior to the inspection but staffing levels had improved.

Accidents and incidents were routinely recorded and analysed and trends were established in order to mitigate further risk.

People told us they felt safe living in Croxteth Park. Staff were knowledgeable around the area of safeguarding and whistleblowing. Staff knew how to report concerns and who to report their concerns to. Staff completed safeguarding training and there was an up to sate safeguarding policy in place.

The home was clean, hygienic and odour-free. Infection control and health and safety measures were in place. Staff were familiar with health and safety policies and ensured that infection prevention measures were complied with.

Staff told us they felt supported by the management team and could seek support on a daily basis. Staff were supported with supervision, training and development opportunities.

People living at Croxteth Park were supported by external healthcare professionals. A holistic level of care and support was provided. Staff followed any guidance which needed to be followed and any guidance provided was incorporated within the care records.

People’s nutrition and hydration support needs were safely managed. People were regularly assessed and measures were in place to monitor and mitigate risk.

People were happy with the quality and standard of food provided. Seasonal menus were offered throughout the year and people had the opportunity to share their likes, dislikes and preferences.

People living at Croxteth Park told us staff were kind, caring and treated them with respect although we identified during our 'mealtime experience' observations that staff could engage and interact with people more frequently.

Confidential information was stored securely and protected in line with General Data Protection Regulation (GDPR). People’s personal information was appropriately protected and sensitive information was not unnecessarily shared with others.

Systems were in place to gather feedback of the people living at Croxteth Park. People and relatives had the opportunity to share their thoughts and suggestions in relation to the quality and safety of care provided.

The registered provider had a range of policies and procedures in place. Policies were accessible to staff and staff demonstrated their understanding of a number of policies we discussed with them during the inspection.

The registered manager was aware of the regulatory responsibilities. They had notified CQC of events and incidents that occurred in the home which enabled us to monitor the provision of care people received.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Croxteth Park Care Home is registered to provide accommodation for up to 42 people with personal care needs. The location is a single storey property which is split into two separate units. One for people living with dementia and one for people with physical care needs. Each bedroom has its own en-suite facilities.

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.

Prior to the inspection we had received information of concern from the Office of the Coroner relating to the management of falls’ risk and the assessment of people’s capacity to consent to care. This focussed inspection looked in detail at systems and practice in relation to people at risk of falls. This report is restricted to the safe, effective and well-led domains. The caring and responsive domains will be assessed as part of the next comprehensive inspection.

The initial assessment of risk in relation to falls was completed to a high standard and we saw that risk was reviewed monthly or following a significant incident. In each case, the records were clear and sufficiently detailed to alert staff to the potential risk and what action was required to reduce the frequency and impact of falls.

Risk was further reduced because the building was of a modern, single-storey design with open plan areas. This meant that staff could monitor people more easily. Each bedroom had a call-bell system so that people could call for assistance if they fell or needed support with other activities and daily tasks. Staff were vigilant in monitoring people’s movements and completed regular checks during the night to ensure people’ welfare and safety.

Where falls had occurred body maps were used to record any injuries and referrals were made in a timely manner to healthcare professionals and specialists for their advice and support around the management of people at risks of falls.

The Coroner’s report highlighted a potential issue regarding people’s capacity to consent to care and their right to refuse treatment. As part of the inspection we looked at how people’s capacity was assessed and recorded in relation to care, treatment and restrictions on their liberty. We looked in detail at the circumstances relating to one person’s alleged refusal to attend hospital for an x-ray.

The records that we saw showed that the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Capacity assessments were focused on the needs of each individual.

The records relating to the person named in the Coroner’s report were complete and clearly demonstrated that the person did not have capacity to understand the implications of any refusal to attend hospital. The registered manager and deputy manager were clear about their responsibility to act in the best-interest of people living at Croxteth Park Care Home and to seek medical attention as required.

The higher than expected volume of falls required us to look at monitoring and audit systems to ensure that they were sufficiently robust to identify patterns and trends and promote people’s safety.

We looked at paper and electronic records relating to falls and spoke with the registered manager and deputy manager. The systems that we saw were both extensive and robust. Each incident and accident was recorded in a timely manner and entered on an electronic reporting system. The system generated an immediate alert to the registered manager and populated a spreadsheet which was accessed and monitored remotely by a dedicated safety and quality team.

The registered manager was clear regarding their responsibility to monitor and report falls both internally and to the Care Quality Commission (CQC). The records that we saw indicated that all notifications to the CQC had been submitted correctly and in a timely manner.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Croxteth Park Care Home is registered to provide accommodation for up to 42 people with personal care needs. The location is a single storey property which is split into two separate units. One for people living with dementia and one for people with physical care needs. Each bedroom has its own en-suite facilities.

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 registered manager was in the process of returning to work following a period of leave and was not available on the day of the inspection.

During the course of the inspection we saw that staff provided care in a safe and compassionate manner. Each of the staff that we spoke with gave a good description of how they would respond if they suspected that one of the people living at the home was at risk of abuse or harm. People living at the home and their relatives told us that they knew how to complain if they needed to.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

Accidents and incidents were accurately recorded on a dedicated electronic system and were subject to assessment to identify patterns and triggers. Records were detailed and included reference to actions taken following accidents and incidents.

Staffing numbers were adequate to meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool. We were provided with evidence that this information was reviewed following incidents where new behaviours were observed indicating increase dependency.

People’s medication was stored and administered in accordance with good practice guidance.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for the role. New staff were trained and inducted in accordance with the principles of the care certificate.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Capacity assessments were not generic and were focused on the needs of each individual. Applications to deprive people of their liberty had been submitted appropriately.

Meals were provided by a specialist contractor and served in a well presented dining room. Issues had been identified regarding the choice of meals and portion sizes. The provider was in the processes of addressing these concerns with the contractor.

People’s privacy and dignity were respected throughout the inspection. We saw that staff were attentive to people’s need regarding personal care. People living at the home had access to their own room with en-suite facilities for the provision of personal care if required. Care was not provided routinely or according to a strict timetable. Staff were able to respond to people’s needs and provided care as it was required.

We saw staff actively involved in organising activities and motivating people to take part. The home displayed an activities board which detailed a varied programme of activities including music, movies, armchair games, hairdressing and a pamper session. We saw people engaging in chair-based exercises and discussing the visit of an entertainer.

The provider had systems in place to monitor safety and quality and to drive improvements. They completed a monthly audit which included information that was fed-back to the staff team. Areas assessed during these audits included, nutrition, medication, wound care, beds rails and hoists.

The home maintained records of notifications to the Care Quality Commission and safeguarding referrals to the local authority. Each record was detailed and recorded outcomes where appropriate.

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

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

People were encouraged to make choices and to use their independence. At the time of our visit some people who used the service were unable to make their own decisions. The manager was aware of the action to take if they had concerns or issues with regards to a person's capacity to make their own decisions. The Mental Capacity Act (2005) is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff informed us that nobody was subject to a Deprivation of Liberty Safeguards (DoLS) application or plan at the time of our inspection. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were managed.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People's care and support had been reviewed on a regular basis and their individual care plans updated. People told us they felt listened to and included in decision making.

Is the service caring?

People who lived at the home told us staff were 'good' and 'respectful'. Staff we spoke with were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity. Staff were readily available to support people when they needed support and we saw that staff showed warmth and familiarity when supporting people. People commented, 'It's a good here, we get good care and the food is lovely' and 'You only have to ask and it's done, they are very good here.'

Is the service responsive?

The service worked with other agencies and services to make sure people received their care in a joined up way. Staff made prompt referrals to GPs, district nurses and other health professionals when people required support with their health care needs. One person told us 'If I am unwell they all come running, they get the doctor in straight away, no delays.'

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done on an informal basis through one to one discussions with people and through the use of surveys. People's feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on aspects of the service and seeking the views of people who lived at the home and their relatives. The service was managed in a way that ensured people's health, safety and welfare were protected and the interests of the people who lived at the home was at the centre of how the service was run and managed.

We spoke with people who used the service, relatives and staff. Some of the comments we received included:

"The staff are often very busy but they are very good."

"The staff are very kind they'd do anything for you."

During our inspection we observed that the people who used the service appeared happy and content living at Croxteth Care Home. Throughout our observation we noted that people were treated with care and consideration. We observed that staff focussed on completing tasks for people, but always acknowledged and engaged with them.

Staff were aware of the procedures to protect vulnerable adults and knew how to report any concerns. We noted that all safeguarding referrals had been made to the relevant bodies in a timely manner. We also noted that some incidents which should have been notified to the commission had not been actioned, in a sufficiently detailed and timely manner.

'It is a lovely place.'

'I am happy here.'

'I like the place very much and the food is superb.'

'It is a good as it can be.'

During our inspection we found that there were sufficient staff working at the home and care and support was provided in a manner that met the needs of the individuals. We saw that systems were in place to monitor the quality of the service provided on a regular basis.

Overall we found that records were kept securely and were well organised and up to date.

We also looked at the overall environment of the service, including the grounds, and the maintenance of the interior. We found that these were in good order. During our visit we also reviewed records relating staff and the general management of the service. We found these to be accurate and up to date.