Archived: The Beaufort Care Home

People’s experience of using this service:

We found there continued to be a lack of effective governance, management and provider oversight. Systems and processes designed to identify shortfalls, and to drive improvement continued to be ineffective. Completed audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

Low staffing levels continued to negatively affect people’s day to day experiences. This meant people did not consistently receive good quality safe care. Despite staff understanding their responsibility to keep people safe, risk assessments did not always contain accurate information to help staff manage risk. Some risks associated with people’s safety and the environment had not been identified or assessed. Medicines were not always managed safely, for example staff did not always follow nationally recognised guidance.

Staff were recruited safely and received support though an induction and on-going programme of training.

People had access to health and social care professionals. However, the advice of health care professionals and changes they made to people’s planned care were not always recorded and 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’s right to privacy and dignity was not always considered and upheld. Some people’s personal belongings were not treated with respect and low staffing levels limited the choices people made. Staff understood the needs of people who lived at the home permanently but had limited information about people staying in a D2A bed.

Care was not always provided in line with people’s needs and preferences. Care records did not consistently contain accurate and detailed information to help staff provide personalised safe care. Some people had opportunities to engage in meaningful activities. People spoke highly of staff and despite our findings people told us they felt safe. Complaints were managed in line with the provider’s policy and procedure.

People and relatives had opportunities to feedback their views on the service they received. The most recent feedback showed overall people and relatives were satisfied with the service provided and how their home was run.

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 28 October 2018) 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Following our inspection, we notified the local authority commissioners about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2015 – Person centred care

Regulation 10 Regulated Activities Regulations 2014 – Dignity and respect

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

Enforcement: 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.

The Beaufort 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 Beaufort Care Home provides nursing and residential care to older people. The home has two floors accommodating up to 29 people in one adapted building. On the day of our visit 22 people lived at the home, most of whom had complex medical needs. The home is located in Coventry in the West Midlands.

We last inspected The Beaufort Care Home in November 2017 we identified areas for improvement in three of the five key questions we inspect against. These were safe, responsive and well-led. We gave the service an overall rating of ‘Requires Improvement’.

At this inspection we checked to see if improvements had been made in these areas and if they were effective. We found some areas had been effectively addressed, whilst others continued to require improvement. We also identified some previously evidenced standards had not been maintained. The rating remains Requires Improvement.

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.

The provider had not ensured people’s medicines were consistently managed and administered safely and in line with their procedure.

Staffing levels meant staff were not always available to respond to people’s requests for assistance in a timely way and staff practices were task focused. People told us they felt safe living at home.

Systems and procedures were in place to ensure risks associated with people’s care, the premises, equipment, and emergencies were assessed. However, these were not always effective and some staff did not follow risk management guidance.

People’s care plans were personalised and regularly reviewed. People and relatives were involved in care planning and knew how to raise concerns or complaints. Complaints were managed in line with the provider’s procedure. Other records related to people’s care were not always completed.

Staff received an induction into the organisation, and a programme of on-going training supported them to meet people's needs effectively. Staff received management support through individual and team meetings. However, staff did not feel supported by some nursing staff. People and relatives were confident staff had the skills and knowledge needed to meet their needs.

Pre-employment checks were completed before staff started working at the home. However, some checks had not be actioned in line with the provider’s procedure to ensure staff were of a suitable character to provide care and support to people who lived at the home.

The provider’s systems to check, monitor and improve the quality and safety of the service provided were not always effective. People and relatives spoke positively about the way the home was managed and the service they received.

The management team and staff understood how to protect people from abuse and their responsibilities to raise any concerns. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People received the support they needed to meet their nutritional needs and had access to health care services when needed. The management team and staff worked with other health professionals to support people to maintain their health and well-being.

People were supported to maintain relationships with people who were important to them. Family and friends were welcomed to visit the home at any time. A range of meaningful activities were available which people could choose to take part in.

The provider had not always considered people’s right to privacy. People who lived at the home were supported to maintain their independence and received their care and support from staff who they described as respectful and caring. Staff knew the people they supported well.

We found two 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 Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most people who lived at the home had complex medical conditions. The home provided permanent accommodation for people, as well as 10 temporary beds for people who had come from hospital for further nursing care before going back to their own home. At the time of our visit, 25 people were living at the home.

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

We previously inspected this service in August 2016 when we found four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in February 2017 and found the provider had taken sufficient action in response to the breaches in regulation to remove the breaches. However, there were some areas where further improvements were required.

At this inspection we found the momentum for improvement had been sustained, but there were still further improvements required to ensure people consistently received a safe and responsive service. The leadership and management of the home continued to improve, however the oversight of the provider had not always been consistent due to significant changes at a regional level. We were assured that the new structure of the regional management team would provide more focussed support to the management team at The Beaufort Care Home.

People felt safe at the home, but sometimes had to wait for staff when they requested assistance. The registered manager had recruited additional staff and was confident that consistency of care and responsiveness to requests for support would improve when all shifts were covered by their own permanent, experienced staff.

People’s risks in relation to their health and wellbeing had been assessed and plans put in place to manage any identified risks. Staff monitored people who were at risk and obtained advice and support from other health professionals to maintain and improve their health. However, records we looked at did not always evidence that specialist advice to reduce risks to people’s health was always being consistently followed. Medicines management was safe, although some minor improvements were required.

People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support from the registered manager. Staff worked within the principles of the Mental Capacity Act 2005 and involved people in decisions about their care by offering them choices. The registered manager understood their responsibilities under the MCA and applied to the supervisory body for authority to deprive people of their liberty when it was necessary for their safety.

Interactions between staff and people were warm and compassionate. Staff had a caring approach and were sympathetic and kind to people. People were offered opportunities to engage in activities and socialise. The registered manager regularly walked around the home and on occasions helped support staff on the floor. This gave them the opportunity to observe staff practice and how staff engaged with people.

Care plans were sometimes task and problem orientated rather than focussing on promoting wellbeing and independence. However, staff spoke about people in a very person centred way demonstrating they knew people’s likes and preferences.

The provider had systems and processes for reviewing the quality of the care provided. These were reviewed monthly to ensure any identified actions had been taken.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people who lived at the home had complex medical conditions. The home provided permanent accommodation for people, as well as 10 temporary beds for people who had come from hospital for further nursing care before going back to their own home. At the time of our visit, 21 people were using the service.

The home had a new registered manager. They were appointed in August 2016 and registered in January 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection on 24 August 2016 we identified four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this inspection the home was placed into special measures.

We asked the provider to improve staffing arrangements; ensure people's individual and social needs were met; improve medicine management; and improve their quality assurance systems and management support. The provider sent us an action plan and was in regular contact with the CQC informing us of the changes they had made to improve the service.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations to remove the breaches. Because of this the home is no longer in special measures. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Our previous inspection identified there were not enough staff to meet people’s needs, and the high level of agency staff meant there was little continuity of care. During this visit we found the home had significantly reduced the level of agency staff used to support people’s care, and staffing levels corresponded to the assessed dependency needs of people. People and their relatives were mostly happy with the care provided, but some felt staff did not respond to their needs as quickly as they would like.

Our previous inspection identified that people were not receiving enough personal care such as showers or baths to support their dignity. During this visit we found this had improved but some people still did not have the number of baths or showers they preferred.

Our previous inspections had identified a high turnover in management at the home. Since our last visit, the home now had a new senior management team who, whilst new to the service, were experienced managers within the company.

A manager from another of the provider’s homes had registered with the CQC to be the manager at The Beaufort. They were familiar with the quality assurance systems which were now being completed, and were seen as open and supportive by staff and people who lived there. New senior management were working with the registered manager to continue to improve the service.

Our previous inspection identified that people’s risks were not being managed safely. During this visit we found risks to people’s health and social care had been identified, and staff were aware of the risks and acted accordingly to minimise them.

Our previous two inspections highlighted concerns about the management of medicines at The Beaufort. During this visit we found the management of medicines had improved and people received the medicines they required.

Staff were kind and caring to people, but did not have time to sit and talk with them. Most interaction with people who lived at the home was whilst staff carried out personal care tasks. People told us staff respected their privacy.

The registered manager met the requirements of the Deprivation of Liberty Safeguards (DoLS). The provider had referred people to the local authority for an assessment when they thought the person’s freedom was restricted and when they had been assessed as not having capacity to consent to this. However, some aspects of the Mental Capacity Act had not been acted on.

A new activities co-ordinator was planning individual activities with people, and provided group activities for people’s enjoyment. The service aimed to improve activities for people by linking more with local community groups.

The provider had re-decorated many parts of the home which made it more homely for people to live in. The premises and equipment people used was safe and well-maintained.

Checks were carried out prior to staff starting work at The Beaufort to ensure their suitability to work with people in the home. The registered manager responded to complaints in a timely way and in line with the provider’s complaints policy and procedure.

People were provided with sufficient to eat and drink and people’s individual nutrition needs were well supported. People enjoyed the food provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support, or highly specialised nursing. 17 people lived at the home at the time of our inspection, however four were in hospital.

We inspected the home in November 2015 and found there were breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people's care and treatment needs. Staff did not always receive the appropriate support to enable them to carry out their duties competently. The provider did not continually assess, monitor and improve the quality of the service.

We issued the provider with a warning notice in relation to how they monitored and assessed the quality of the service and asked them to provide us with an action plan outlining the improvements they intended to make.

We carried out a follow up inspection at the home in May 2016 and found some improvements had been made but further improvements were still required. The provider had recruited a new manager, deputy manager and a new regional manager.

At that inspection we found there were two breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people's care and treatment needs and the proper and safe management of medicines. We also found sufficient equipment necessary to meet people's needs, was not available at all times. The provider sent us an action plan outlining how they would make improvements.

We completed a further unannounced inspection on 24 August 2016. This inspection was in response to concerns we received about how people's care was managed. There had been a recent incident in the home which had resulted in investigations from a number of organisations including local commissioning, the clinical commissioning group and police.

At this inspection, we found there had been inconsistent management and clinical leadership in the home since our last inspection in May 2016. This was because the manager and deputy manager at the time of our last inspection had recently left the service. There had also been a change in the regional manager and managing director.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new manager was in post however they had only started at the service two weeks before our visit and there had been another temporary manager supporting the home. The provider was looking to recruit a new deputy manager.

The provider and manager were responsible for completing a range of checks to ensure the quality of the service was maintained. These checks had not been completed consistently to identify when improvements were required and they were not robust. This also meant that any improvements made had not been sustained.

Some people and relatives were unhappy with the care provided, and expressed concerns about the length of time they, or their relations, had to wait to receive care. Individual staff members were committed to providing a good standard of care but we saw delays in attending to the needs of people, and call bells were not always in reach for people to request support.

Staff were kind and caring when they provided personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff and people at any other time of the day. Some relatives felt their family members did not receive the personal care required to promote their dignity and people did not consistently receive baths and showers when they wanted and needed them.

Due to the recent concerns the provider had increased the number of staff who worked at the home. However this meant the home was reliant on agency staff as several experienced care staff had left their employment at the home and people were not always provided with care by staff who knew them well.

After the May 2016 inspection we asked the provider to take action to improve the management of medicines in the home. We found the provider had not made the necessary improvements as some people did not always receive their medicines as prescribed and stock levels were not maintained.

Analysis of incidents and accidents were not always carried out to minimise the likelihood of them happening again.

Permanent staff had received training required to undertake their work but staff told us they would like further training in some areas, which the management team were arranging.

Staff told us they did not feel valued and that the provider had not kept them informed about changes within the service. Staff had started to receive sufficient support and supervision (one to one meetings) to help them work effectively but this had not been maintained due to the change in management.

The manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (permission needs to be sought when a person who does not have capacity has their liberty restricted).

The provider employed an activities co-ordinator, but some people told us they would like to be involved in more activities and spend time outside of their room and the home.

Care plans and assessments contained information that supported staff to meet people's needs; however some had not been updated when there had been a change in people's condition or when they had been seen by a healthcare professional. People and their relatives were not consistently involved in planning the care provided.

We found a number of 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 overall rating for this service is ‘Inadequate’ and the service will therefore be placed 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.

The Beaufort Care Home provides accommodation for up to 29 people who require nursing or personal care. Most of the people living at the home have complex medical conditions requiring a lot of care and support or highly specialised nursing. 19 people were living at the home at the time of our inspection.

We last inspected the home in November 2015 and found there were two breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to insufficient numbers of suitably qualified, experienced staff to meet people’s care and treatment needs and staff did not always receive the appropriate support to enable them to carry out their duties competently. The provider did not continually assess, monitor and improve the quality of the service.

We issued the provider with a warning notice in relation to how they monitored and assessed the quality of the service and asked them to provide us with an action plan outlining the improvements they intended to make. At this inspection we found some improvements had been made but further improvements were still required.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a new manager in post who was in the process of registering with us. They had started working at the home at the beginning of April 2016. The provider had also recruited a new deputy manager and there was a new area manager in post.

Some people and relatives were unhappy with the care provided, and expressed concerns about the length of time they, or their relations, had to wait to receive care. Staff were committed to providing a good standard of care but we observed there were delays in attending to the needs of people and call bells were not responded to promptly. People did not consistently receive baths and showers when they wanted them.

At our previous inspection in November 2015 the home had been reliant on agency nurses to provide nursing care in the home. At this inspection we found the provider had recruited permanent nursing staff and the use of agency staff had reduced. However, the occupancy level at the home had increased and we found there were not enough care staff to provide care and support to people at the times they needed it.

At our last inspection in November 2015 we found a breach in the regulations as quality checks had not been completed consistently to identify when improvements were required. At this inspection we found regular quality audits of the home were conducted to monitor and improve the care provided by the service. Analysis of incidents and accidents were carried out to minimise the likelihood of them happening again.

People did not always receive their medicines as prescribed and on some occasions the correct equipment to deliver medicines had not been ordered.

Improvements had been made so that permanent staff had received training required to undertake their work safely. However the provider had not kept an accurate record of staff training needs. We found staff had started to receive sufficient support and supervision to help them work effectively

The manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (permission needs to be sought when a person who does not have capacity has their liberty restricted).

Staff were kind and caring when providing personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff and people at any other time of the day. Relatives were not always confident their family member’s dignity was maintained. Some relatives felt their family members did not receive the personal care required to promote their dignity.

The provider employed an activities co-ordinator, but some families were concerned their family members were left in their rooms for long periods which could lead to social isolation.

Care plans and assessments contained information that supported staff to meet people’s needs; however some had not been updated when there had been a change in people’s condition. People and their relatives were not consistently involved in the planning of care being provided.

You can see what action we told the provider to take at the back of the full version of the report.

Two inspectors carried out this inspection on Monday 16 June 2014. We visited the service from 7.00am to 4.00pm. At the time of our visit there were 22 people living at the home. We spoke with the deputy manager, the regional manager, one visitor, three people who used the service and ten members of staff. The manager was absent from the service. We also observed the care people received to understand the experience of people who could not talk with us.

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

Equipment was safe, clean and hygienic. We saw the equipment used to support people in moving was maintained regularly and was of a required standard for safety. Staff were clear as to their responsibilities for checking the safety and suitability of equipment.

The service was not always working with a full complement of staff. Staff we spoke with told us they found it difficult when they were working with too few staff. The procedures and policies of the service were not being followed to ensure safe staffing levels were always maintained.

Staff had received training in the Deprivation of Liberty Safeguards (DoLS) and had an understanding of how the safeguards operated. There was nobody living at The Beaufort who had a current DoLS in place.

Is the service effective?

People had an assessment of their nursing and care needs prior to moving to the home. We saw care was planned and delivered in a way that ensured people's safety and welfare and incorporated people's individual needs.

Where needed, care plans had been adjusted to reflect changes in people's health and provide staff with guidance on what action to take to address people's changing needs.

Is the service caring?

People we spoke with were positive in their comments about the care provided and the staff delivering that care. A visitor told us, 'I feel the care is attentive and I feel that the patients are always dealt with very respectfully. I feel with X they are getting the details right. I have just watched a young man deal with her. Her eyes were closed but he spoke with her the whole way through the care and touched her at the end to say 'I'll be back later'.'

We observed a member of staff supporting a person to eat in their bedroom. There was lots of chat and laughter with the staff member turning the mealtime into a social activity.

Is the service responsive?

Care records we looked at confirmed people were referred to other healthcare service providers when a need was identified. For example, we saw the service was working with dieticians, speech and language therapy and physiotherapy. Professional visits were recorded in detail and advice given was added to the relevant care plans.

Is the service well led?

The service had a quality assurance system. The regional manager carried out monthly quality monitoring visits. Where issues had been identified the regional manager was supporting managers and staff to ensure they were addressed.

Plans were in place to encourage people and their relatives to complete the annual quality assurance questionnaire to identify what the service was doing well and where improvements needed to be made.

Staff we spoke with were positive about the support of the management team, but acknowledged how busy the manager was. One member of staff told us, 'When you have management that motivate staff, it energises you to be there.' Another staff member said, 'Good. I just know they are very, very busy. X (the deputy manager) has always got time for you.'

We found the service had appropriate arrangements in place for the management of medicines.

Medicines were kept securely and safely.

Staff administered medication safely and recorded the administration of medicines accurately.

There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.

Staff administering medication had assessments to check their competency. Managers were completing regular medication audits.

People we spoke with were positive about the care and support provided. One person told us, "I'm very pleased. We tried to find the best place and I think this is it."

We saw care plans were developed from a detailed assessment of people's needs prior to their admission to the home. They provided staff with information to meet people's needs safely and appropriately. Records demonstrated that there was good communication with relatives about any changes in people's health. The service facilitated discussions between relatives and visiting healthcare professionals.

We looked at people's medication and found that some improvements were needed in the recording of medications.

Staff spoke positively about their roles and told us they had access to training and support on a regular basis.

The home sought the views of people and their relatives to monitor the quality of care and service provided.

We saw that people had care plans in place which detailed their care needs. They provided staff with information so they could deliver care safely in a way people preferred. People and their relatives were involved in reviewing care plans to ensure they remained relevant to changing needs.

Relatives spoke favourably about the level of care provided by staff. One relative told us, 'I come in every day and I am left with the feeling they are good people, professional and dedicated.' Staff spoken with were knowledgeable about people's individual needs. One staff member said, 'That is what care is about, knowing the actual person, the individual.'

We saw staff engaged with other health professionals to deliver the nursing support required. One visiting professional told us staff followed medical advice provided. 'You don't worry because you know it will be carried through.'