The Wells Nursing Home

The Wells Nursing Home is a Nursing Home providing personal and nursing care for up to 40 people. The home is a large adapted building. It has 2 floors and a passenger lift. People have access to a lounge area, dining room, conservatory and garden. At the time of our inspection there were 28 people using the service.

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

People’s capacity was not always consistently assessed in line with the Mental Capacity Act 2005 and assessments were not being completed for specific decisions.

The provider audits and quality assurances took place to ensure the quality of the service was maintained. However, some risk assessments lacked detail. Quality monitoring had identified areas of the service that had improved since the last inspection.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The provider had appropriate recruitment procedures in place to ensure staff employed by the service were safe to work with vulnerable adults.

Staff followed infection prevention and control measures. Medicines were managed safely.

Staff employed had the right skill set to support people. The provider had recruited a new activity person, they undertook group activities and visited people in their rooms to spend time with them.

People and staff were positive about the registered manager. There were systems in place to communicate with people and staff. The service worked in partnership with a range of professionals.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People's privacy was respected, and their dignity and independence promoted. Staff had an awareness of individuals' needs and treated people in a warm and respectful manner.

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 May 2022). 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 in relation to good governance. The service remains requires improvement. The service has been rated requires improvement or inadequate for the last 4 consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement and Recommendation

We have identified a breach in relation to Regulation 11 (Need for consent).

Follow up

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

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

The Wells Nursing Home is a residential care home in the village of Henton a few miles from the city of Wells. The home is a large detached building. It has two floors and a passenger lift. People have access to a lounge area, dining room, conservatory and garden. They provide personal and nursing care for up to 40 older people. At the time of the inspection there were 27 people living at the home. People had mixed abilities of how much they could verbally communicate with us during the inspection.

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

The provider’s quality monitoring systems were not effective and had not identified some areas of poor quality and safety of care being provided to people. The registered manager took actions during and after the inspection to address shortfalls identified at the inspection.

We observed that staff were not always following people’s risk assessments and ensuring bedrails were used as assessed. Staff had not ensured people had access to call bells which meant people could not summon staff if they needed support. Action was taken to resolve this concern.

Care plans had been reviewed, were detailed and contained information to guide staff. However, people and their relatives had not been involved in reviewing care plans. A schedule was put in place to include people and their families as appropriate and a resident’s/relative’s meeting was held to discuss this issue.

Deployment of staff and the mix of staff skills and experience did not always ensure people’s needs were met. This resulted in some staff not being clear about the support people required. The registered manager said they would review the staff deployment to ensure staff with the right skills would work on both floors to ensure people received the support they required.

The registered manager confirmed people being cared for at the end of their lives received care in accordance with their beliefs or preferences. However, personalised care plans were not in place to record people’s end of life wishes. The registered manager took action to put these in place.

We identified that two people did not always receive appropriate continence care. The registered manager acted upon our feedback and said they would work alongside senior staff to ensure people’s continence needs would be met appropriately. They also said they would hold a staff meeting to inform staff about meeting people’s individual continence needs.

The provider had recruited a new activity person, they undertook group activities and visited people in their rooms to spend time with them.

The service was clean and free from odours. One person commented on this. They said, “On the whole it’s alright. It’s always nice and clean which is the main thing.”

Medicines were managed safely and there were suitable systems to help safeguard people from abuse.

Most staff were wearing face masks appropriately and following Covid 19 government guidance to minimise risks to people. Systems were in place to ensure equipment was safe to use and in good working order.

The registered manager told us they had not received any formal complaints. In response to concerns raised with CQC the registered manager held a resident’s and relative’s meeting and had also arranged individual meetings with relatives to discuss their concerns.

The registered manager was keen to continuously improve the service and they accepted our feedback. They began to make improvements during and after the inspection and provided CQC with details of the improvements they had implemented. They had worked alongside some of the senior care staff to share their person-centred ethos and ways of working.

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 November 2020); no breaches of regulation were found at this inspection. A previous inspection undertaken in February 2020 (published 25 April 2020) identified breach of Regulation 9 (Person Centred Care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans did not always contain personalised details and on occasions lacked key information. The provider completed an action plan after that inspection to show what they would do and by when to improve. At this inspection we found the provider had made improvements and were no longer in breach of Regulation 9.

At our last inspection we recommended that the provider consider current guidance on the content of medicine policies and procedures to ensure all staff had clear guidance and take action to update their policy accordingly. We also recommended the provider consider current guidance on employment checks in line with the UK Border Agency and take action to update their practice accordingly. At this inspection we found the provider had acted on these recommendations and made improvements.

The last rating for this service was requires improvement (published 20 November 2020). The service remains rated as requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Wells Nursing Home on our website at www.cqc.org.uk.

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 monitor the service and will take further action if needed.

We have identified a breach in relation to the governance and leadership of the service at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Wells Nursing Home is a residential care home providing personal and nursing care for up to 40 older people. At the time of the inspection there were 17 people living at the home. People had mixed ability of how much they could verbally communicate with us during the inspection. Additionally, we tried to keep people safe due to the COVID-19 pandemic by minimising interactions with them.

Each person had their own bedroom in the home and there were shared facilities. There is a garden people could access plus a lounge with a conservatory area and a dining room.

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

People and staff were all very positive about the improvements which had occurred since the last inspection. Positive, meaningful interaction was seen throughout the inspection between staff and people.

Part of this inspection we looked at infection prevention and control measures under the Safe key question. Overall, we were assured that people were being kept safe. However, whilst staff were using the correct PPE throughout the inspection. They did not fully understand the safe sequence for putting on and taking off the equipment to reduce the risk of infection spreading. We were somewhat assured that the provider was making sure infection outbreaks can be effectively prevented or managed. Staff had only received internal training in relation to infection control outbreak. Following the inspection, we contacted the local authority to provide additional support to staff.

Systems were now in place to monitor the quality and safety of care people received. Quality assurance systems made improvements when issues were identified. The management were responsive to anything raised during the inspection including making any necessary changes.

Throughout the inspection we could clearly see the culture had changed and was more positive. Interactions between staff and people were not just task based. People were smiling, laughing and singing whilst interacting with staff and were treated with respect.

Care plans had been greatly improved in identifying and providing guidance regarding risks to people. Some improvements were still required to ensure assessments were in line with best practice such as around moving and handling and catheter care.

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 25 April 2020).

After the last inspection we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action we took as a result of the inspection. The provider did send us an action plan and was regularly updating the Care Quality Commission to help us monitor whether people were kept safe.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations for Safe and Well led. We did not look at breaches in other Key Questions.

Why we inspected

This was a planned inspection based on the previous 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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 26 and 28 February and 3 March 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, recruitment, governance systems, staffing levels and notifications in line with statutory requirements.

We undertook this focused inspection to check they had followed their action plan, including their regular updates, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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. The service is no longer in special measures.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Wells Nursing Home is a residential care home providing personal and nursing care for people aged 65 and over. At the time of the inspection there were up to 26 people living at the home and two people were completing short stays. The service can support up to 40 people. People had mixed ability on how much they could tell us. We used observations to capture experiences of those with less verbal communication.

Each person had their own bedroom in the home and there were shared facilities. There was a garden people could access plus a lounge with a conservatory area and a dining room.

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

People and their relatives reported mixed feedback about the service including how safe they were. We found people were not safe at the home. Risks had not always been considered or managed effectively. Concerns continued to be found for people at risk of pressure ulcers and choking. There were not enough staff to keep people safe and meet their needs. Recruitment of new staff was not in line with current legislation. Staff had not always received enough training to keep people safe.

The management of the home had been inconsistent since the last inspection. Quality assurance systems had not identified all shortfalls found during this inspection. Lessons were not being learnt from concerns being raised at the home. We made a recommendation about this. Systems to protect people from potential abuse were not always working. Potential safeguarding was found that had not been alerted to the local authority or the Care Quality Commission.

Communication was sometimes at an issue at the home due to many staff having English as a second language. There was a high turnover of staff and high use of agency staff. There was a culture that was not always condusive to delivering good care at the home. Care plans were mixed, lacked guidance for staff and contained inconsistencies. One person did not have a complete care plan.

People were not always supported to have maximum choice and control of their lives and staff did not always demonstrate they had considered the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People’s privacy and dignity was considererd some of the time. Some people and relatives felt there was good care at the home. Most people were positive about the food offered at the home.

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 February 2019) and there were multiple breaches of regulation. The provider failed to send us an action plan in line with current regulations. 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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, managing risks, protecting people from potential abuse, recruiting new staff in line with legislation, notifying the Care Quality Commission in line with statutory requirements, ensuring people receive personalised care from suitably qualified staff and ensuring systems were in place to monitor and manage the service.

We are mindful of the impact of 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 regularly monitor the service including requesting an action plan to be submitted to keep people safe.

Follow up

We will regularly liaise 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.

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.

The Wells Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to care for up to 40 people. At the time of the inspection there were up to 31 people were living at the home. Some of the people living at the home complete short stays and then return to their own home. The home specialises in caring for older people who require nursing and personal care needs. People live across two floors in the home and on the ground floor there are communal spaces including a living room and dining room.

Although there was registered manager in place to run the home they were no longer the person responsible managing the service. 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 who was running the home.

People were not always safe living at the home even though they thought they were. Medicines were mostly managed safely and improvements had been made in the cleanliness of the home. There were systems in place to monitor health and safety and fire. However, improvements were required in relation to keeping people safe who required specialist diets, pressure care and risk assessing. Records for people were sometimes inconsistent or lacked guidance for staff.

People were protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. There were recruitment procedures in place. However, these had not always been followed when staff were recruited. Staff had not always received supervision and training to be able to meet people’s needs and wishes.

The management were striving to make improvements when shortfalls were found in their auditing systems. There was external scrutiny provided by the provider and when additional bodies found concerns this had led to improvements. However, statutory notifications were not completed in line with legislation to inform external agencies of significant events.

People and relatives continued to tell us they liked living at the home. People were being encouraged to provide feedback on the home and make suggestions to improve the service they received. Their complaints were listened to and action taken when it was required.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. However, records did not reflect the processes which had been followed to ensure it was in line with current statutory guidance.

Most people enjoyed the food they were served at the home. People told us their healthcare needs were met and staff supported them to see other health professionals. However, there were occasions other health professionals had not been contacted in a timely manner.

Improvements could be made because care plans did not always reflect people’s current needs and wishes. The service needed to ensure all parts of care plans were updated when there was a change in a person’s needs. Although some people had their end of life needs and wishes considered, this was not consistent.

People and their relatives told us, and we observed, that staff were kind and patient. People’s privacy and dignity was respected by staff. People, or their representatives, were involved in decisions about the care and support they received. The staff tried to ensure care and support was personalised to each person which ensured they could make choices about their day to day lives. People were consulted about the activities they would like to participate in. There were opportunities for cultural and religious needs to be reflected in the choices.

We have made a recommendation about the provider seeking guidance around capacity and consent.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One breach of the Care Quality Commission (Registration) Regulations 2009 was also identified.

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

This inspection took place on 16 and 17 May 2016 and was unannounced.

At the last inspection on 29 April and 1 May 2015 we found the provider to be in breach of Regulations 9 and 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s care and treatment did not always meet their current or changing needs and people could not be assured that care and treatment would be provided with the consent of the relevant person. We also found improvements were needed in how mealtimes were organised. At this latest inspection we found the necessary improvements had been made.

Staffing levels were good and people also received good support from health and social care professionals. People's medicines were managed safely. Staff had built trusting relationships with people. People were happy with the care they received. One person said “They look after me wonderfully.”

Staff understood people's needs and provided the care and support they needed. People said the home was a safe place. One person said “Safe? One hundred percent. No faults whatsoever.” There were organised activities and trips out; people were able to choose to socialise or spend time alone.

People interacted well with staff. There was a relaxed, homely atmosphere. There was laughter, chatter and friendly banter. People made choices about their day to day lives. They were part of their community and were encouraged to be as independent as they could be.

People, and those close to them, were involved in planning and reviewing their care and support. There was good communication with people's relatives. One visitor said “I’m always phoned by staff to advise of changes to” their relative’s condition. People’s friends and relations visited regularly and felt their views were listened to and acted on.

Staff recruitment was safely managed. Staff were well supported and well trained. Staff spoke highly of the care they were able to provide to people. One staff member said “We do absolutely the best we can for people. I think you have to aim for perfect but know there is always room for improvement.”

People liked and trusted the registered manager. All staff worked hard to provide the best level of care possible to people. The aims of the service were well defined and adopted by the staff team.

There were systems in place to share information and seek people's views about their care and the running of the home. There were many positive comments from people about the service overall. These included “I’m very happy here; I could not have chosen a better place.”

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service caring?

Our observations of the care provided by staff and our discussions with people who lived in the home showed the service was caring.

We observed staff treated each individual with dignity and respect. They spoke to people in a caring, polite and friendly manner. One person said 'I like it here very much. Everyone is so nice'. Another person said 'They do everything they can to make you happy'.

People who lived in the home were complimentary about the staff. One person said 'The staff are very good. They do their best to take care of us'. Another person said 'The staff are lovely and kind. I'm looked after very well thank you'.

Is the service responsive?

The service was responsive to people's preferences and choices. People told us they were asked about their likes and dislikes prior to moving to the home. We saw care plans detailed people's preferences regarding personal care routines, food, hobbies and interests.

One person said 'I've got everything here I want. If I need anything I just have to ask'. Another person said 'The food is lovely and we always get a choice'. A third person said 'It's a wonderful place here, I'm very happy'.

We observed people could decide where and how they spent their time. They were free to move around the home and the scenic gardens as they wanted. One person said 'I go for walks in the garden most days' another person with mobility difficulties said 'Staff will push me outside if it's a fine day'. People told us they could decide to have their meals in their rooms, in the dining room or on a tray in the TV lounge.

People were able to express their views at quarterly 'Residents and Relatives meetings'. Records of the meetings showed they were well attended by people and their friends or relatives. We saw a wide range of topics were covered and ideas for improving the quality of people's experiences in the home were taken on board.

An annual customer care questionnaire was sent to people and their relatives. We looked at a sample of the returned questionnaires and they predominantly showed people were 'very satisfied' with all aspects of the service.

Is the service safe?

People who lived in the home told us they felt safe and they were well treated by staff. When asked if they had ever been treated badly or witnessed anyone else being treated badly, one person said 'Not at all, they are all extremely nice and willing to help you. Matron wouldn't stand for anything like that'. Another person said 'The staff treat me very well. They are all very nice. If I didn't like anything I would tell the matron but I haven't had any problems'.

We spoke with the manager (also known as matron) and six other members of staff. They all knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns.

The manager told us they always carried out relevant employment and criminal record checks when new staff were recruited. This helped protect people from the risk of abuse.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's freedom and human rights. The manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and knew who to go to if an application was required.

There were arrangements in place to deal with foreseeable emergencies such as utility failures. People had individual evacuation plans to follow in the event of a fire. Staff received fire safety and first aid training. They knew to call the emergency services or the GP practice if they had any worries.

Environmental risk assessments were in place for fire safety, buildings and equipment. These were carried out by the home's maintenance staff or specialist external contractors as appropriate. We observed the environment throughout the home looked in good condition.

Is the service effective?

The service was effective in meeting people's care and treatment needs. People told us they were very happy with the care and treatment they received. One person said 'I'm very well. I'm happy with the care I've had up to now'. Another person said 'It's lovely here, we're well looked after'.

We observed people had call bells in their rooms to call for staff assistance whenever needed. People said they did not have to wait long for assistance. One person said 'They don't take very long to come, usually a few minutes'.

We saw care plans included a range of individual risk assessments and actions for managing these risks. These included assessment of people's risk of developing pressure ulcers, risk of malnutrition and risk of falls. The GP or a dietician was consulted if there were any concerns. The nurses who worked in the home said external advice was available whenever needed from specialist health care professionals.

Staff told us they were provided with the skills and knowledge to provide a safe and appropriate standard of care. We saw training and development records to confirm this.

People were supported to engage in social activities and interests. They went out for trips to places of interest with their family members or with support from the staff. Within the home people could participate in group activities like singing, films and reminiscence sessions. Staff regularly organised afternoon teas in the home's scenic gardens.

Individual activities such as aromatherapy and hand massage were offered to people who were being nursed in bed. The activities organiser said they spent as much one to one time as they could with people who were restricted to their rooms.

Is the service well led?

People who lived in the home and the staff we spoke with all said the manager of the home was very good.

The home was managed by a person who was registered with the Care Quality Commission as the registered manager for the service. People who lived in the home told us they could talk to the manager (also known as matron) or the other staff about any issues and they always did their best to meet their needs. A typical comment was 'I can have a chat with matron anytime, she is lovely. She always sorts things out'.

Staff told us the manager was very fair and approachable. One member of staff said 'If you have any problems or concerns you can discuss them with matron. She is very approachable and always gives good advice and support'. Another staff member said 'Matron is very fair and is good at resolving any disputes'. One of the nurses said 'The manager is in uniform for some shifts. She has her finger on the pulse and keeps a close eye on the care provided. When needed she reminds staff what is expected'.

Decisions about people's care and treatment were made by the appropriate staff at the appropriate level. There was a clear staffing structure in place with clear lines of reporting and accountability. The manager supervised the nurses and the nurses supervised the care staff. Care staff we spoke with said everyone worked well together as a team and supported each other. They were able to seek advice from the nurses and report issues directly to the manager whenever needed.

The manager told us they received excellent support from both the owner and the area support manager. The manager said 'The owner is brilliant. She visits most weeks and wants high end care provision for the residents'.

People could be confident that deaths of people who used the service were reported to the Care Quality Commission so that, where needed, action could be taken.

People said they were very well cared for and that staff were available when they needed them. They said staff were very patient and were kind to them. Comments from people included 'I would say it's first class here', 'The staff here are very kind. They do as much for me as they can' and 'It's a lovely home. We are so well looked after.'

People told us they felt safe and were well treated by staff. They said they were very happy with the home and had never had cause to complain. Staff spoken with knew how to recognise signs of abuse and how to report any concerns.

There were safe and effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work which ensured people were protected from the risk of being cared for by unsuitable staff.

Staff said they felt competent, trained and well supported to carry out their roles. Staff training and supervision had improved since our last inspection.

People could not be confident that deaths of people who used the service were reported to the Care Quality Commission so that, where needed, action could be taken.

Everyone we spoke to was complimentary about the home. One person told us "I was dreading coming here and now I wouldn't want to be anywhere else...I feel lucky to find a home a like this". Another person told us "I'm very happy here".

People told us staff asked their permission when caring for them. One relative told us how staff communicated with the person to ensure they had their consent "if (person) indicates they understand. I think staff understand because they've had more experience".

We observed care being delivered in line with people's individual care plans and staff monitored people's health. One relative told us "(person) had problems swallowing, now they have a new diet".

People told us they always got their medicines on time and we observed staff administering medicines competently and safely.

People told us staff were "caring", "good at their jobs" and "friendly". Staff did not receive regular supervision or appraisals to ensure their personal development and we could not be assured that staff had completed mandatory training in line with the home's protocol.

People told us they had "no complaints" but were aware of how to raise concerns. One person told us "I wouldn't change a thing...I can't find one thing to complain about...I can talk to matron about anything".