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Inspection carried out on 17 September 2019

During a routine inspection

About the service

Lucerne House is a residential care home providing personal and nursing care to 72 people at the time of the inspection. They provide care to younger and older adults. The service can support up to 75 people. The building has three units. During the inspection Shillingford (also known as Memory Lane) provided care to 30 people living with dementia, Ide provided predominately nursing care to 28 people and Alphinbrook care to 14 younger adults.

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

People received an outstanding, personalised, caring service. People told us they received very kind and respectful support from staff who promoted their abilities, knew them well and genuinely enjoyed their company. The whole staff group worked as a team to support people in a person-centred way. Care was planned, risk assessed and put in place with full consultation and involvement of people and their relatives where this was appropriate.

People were valued and placed at the heart of the service. Staff promoted people's privacy and dignity and enabled them to make choices and have as much control and independence as possible which helped build meaningful relationships.

Feedback about the service from people, family and linked professionals always mentioned the service in outstanding terms. People said, “The staff here have time for you. They are always relaxed and happy and have time to chat and even banter with you” and, “I can’t fault the care here. I know the care I get here, courtesy of the wonderful staff, is of the highest order.”

Relatives commented, “I feel the care my relative receives is individually suited to their needs, and they are very much treated as an individual”; “The staff keep me very well informed about my relative’s condition and what’s happening to improve things since they moved here from hospital” and, “I visit my relative daily and without fail, the atmosphere is lovely and all the staff are so friendly and welcoming”.

People received effective care and treatment from competent, knowledgeable and skilled staff who had the relevant qualifications to meet people’s needs. The provider had a good system to ensure all staff had regular training to keep them up to date with best practice. Training courses and events were relevant to the people living at the service and staff ensured they put learning into practice.

People were assured of their rights being upheld to the maximum level possible. The service applied the Mental Capacity Act 2005 (MCA) to the full. People were supported to have exceptional choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the training, management, policies and systems in the service supported this practice. Every person bar none were seen as individuals and the staff sought to identify goals and aspirations for each person, so they could live their life to the greatest extent of their ability while at Lucerne House. Every effort was then made to ensure those goals and aspirations could be realised.

The service was accredited for its care of people living with dementia. Staff were trained to understand dementia and were passionate in ensuring they continued to put this into practice. Each person’s individual life and dementia journey was important to staff and was used to inform best interests decisions. The service established relationships with and worked with local groups, including schools and tradespeople, to improve the experience and understanding of people living with dementia. As a result of this carers were also supported.

Activities were provided seven days a week by a passionate and experienced activity team. These offered a wide variety of relevant and meaningful activity both inside and outside of the service. Staff got to know people and ensured activities were enjoyed and meaningful, using past interests.

Medicines were generally managed safely. There were

Inspection carried out on 21 November 2016

During a routine inspection

This inspection took place on 21 November and 1 December 2016. Lucerne House is registered to provide accommodation for 75 people who require nursing and personal care. The service consists of three units known as; Shillingford unit, which provides care for older people living with dementia; Ide unit, which provides care for older people; and Alphinbrook unit, which provides care for younger people with physical disabilities. At the time we visited, 66 people lived at the home. We found Lucerne House to be providing an excellent service.

There was a registered manager and deputy manager employed at the home who were clearly passionate about providing a high quality, individualised service. The registered manager was on an additional temporary assignment within the company, so the deputy manager who commenced employment at the home in July 2015 temporarily manages the home when the registered manager is absent. The registered manager was present at Lucerne for the majority of the time.

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.

At the last inspection in October 2014 we found the domain of ‘responsive’ required improvement. At the time, people’s feedback was mixed about how they were supported to interact, avoid social isolation and pursue their individual interests and hobbies, and further improvement was needed in this area at that time. All of the management team had changed during 2014 and the two heads of unit were then relatively new in post. During this inspection in November 2016 we found there had been extensive improvement and we rated responsive as ‘outstanding’. People had access to and were involved in developing personalised activities that complemented their individual hobbies and interests. Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. Some people were able to improve their independence so they were able to return home to the community. This provided people with a sense of purpose and wellbeing.

People were supported by very kind, caring and compassionate staff who often went the extra mile to provide people with good, high quality care. This high standard of care enhanced people's quality of life and wellbeing. The staff as a whole, supported by the activities team, were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations. They were pro-active in ensuring care was based on people's preferences and interests, seeking out activities in the wider community and helping people live a fulfilled life, individually and in groups.

The staff were happy working in the home and felt very supported in their role. They were clear about their individual roles and responsibilities and felt valued by the registered manager, deputy manager and the wider provider, senior management team. Good leadership was demonstrated at all levels with a pro-active effort to encourage ideas from staff to further benefit the people in their care and maintain a strong, stable staff team with a shared goal. Each individual staff member was engaged in sourcing new opportunities for people and putting ideas into practice.

People were safe living at Lucerne House. There were enough staff to meet people's care needs safely and also to provide individualised support in and out of the service. There was a strong culture within the home of treating people with respect. The staff and managers were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. Staff spent time with people to get to know

Inspection carried out on 28 and 31 October 2014

During a routine inspection

The inspection took place on 28 and 31 of October 2014 and was unannounced.

Lucerne House is registered to provide accommodation for 75 people who require nursing and personal care. The service consists of three units known as Shillingford unit, which provides care for older people with dementia; Ide unit, which provides care for older people, and Alphinbrook unit, which provides care for younger people with physical disabilities. At the time we visited, 62 people lived at the home.

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

During a previous inspection on 24, 26 February and 03 March 2014, we had significant concerns about staffing levels, quality monitoring and about whether people’s care needs were being met, particularly on Ide unit. We took enforcement action against Lucerne House by serving warning notices in those areas to protect the health, safety and welfare of people using this service. On 21 May 2014, we undertook a follow up inspection to check the most urgent improvements required had been made. We found the provider had complied with the warning notices served and had made significant improvements in people's care and welfare, staffing and in monitoring the quality of the service.

At the February/March 2014 inspection, we also found other breaches of legal requirements related to the safety of the premises and equipment, safeguarding, record keeping and in how the service managed complaints. The provider sent us an action plan which explained how they planned to address the breaches of regulations we had found. At this inspection we found these actions had been completed and the provider has now met the legal requirements.

People gave us mixed feedback at the home about how well they were supported to maintain their interests and hobbies. People on Alphinbrook were very satisfied as were some people on Ide unit were satisfied. Other people on Ide unit, including those who chose to stay or were confined to their rooms reported feeling bored and lonely. On Shillingford unit, staff did not spend much time interacting with people living with dementia in a meaningful way. Further improvements were needed to prevent people becoming socially isolated through more meaningful interactions with staff.

People, relatives and staff were positive about the changes in leadership at Lucerne. One person said, “It’s very good here I am pleased with it” and a relative said, “The atmosphere is much better”. Speaking about the improvements made, one relative said, “I feel much more confident (the person) is in the best place, I would recommend it, they can look after him and they are doing it, the job now is to maintain it”.

In addition to the registered manager, there was a deputy manager and a head of each unit. All of the staff in these posts changed during 2014, and two heads of unit were recently appointed. Senior staff led by example, there was good teamwork and communication to make sure each person’s needs were met. The provider used a range of systems to monitor the quality of the service provided to people. Senior staff also undertook regular ‘spot checks’ of people’s care records and equipment, cleanliness and health and safety and by talking to people and staff. All checks were documented and showed corrective actions taken on any problem areas.

Staff knew people, understood their needs and wishes and how they liked to be supported and were kind and respectful. People were offered choices in their day to day care. Where people lacked capacity, relatives, staff and health and social care professionals were consulted and involved in decision making in their ‘best interest’.

Improvements had been made in providing end of life care; staff had done training and were more confident in managing pain relief and in supporting people’s physical and emotional needs.

People were involved in developing their care plans, which were detailed about each person’s individual needs and the support they needed from staff. Significant improvements were made in how people were supported to eat and drink. People were offered food and drink regularly and where a person declined their meal, snacks and food supplements were offered. Detailed records of people’s eating and drinking were maintained and monitored and action taken to ensure each person ate and drank enough to keep them healthy.

Inspection carried out on 21 May 2014

During an inspection looking at part of the service

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

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

Lucerne House is comprised of three units known as Shillingford unit, which provides care for people with dementia; Ide unit, which provides care for older people, and Alphinbrook unit, which provides care for younger people with physical disabilities.

At our previous inspection on 24, 26 February and 03 March 2014 we identified significant concerns about the care and welfare of people, staffing levels and quality monitoring at Lucerne House. CQC took enforcement action by serving three warning notices on the provider, which required them to make urgent improvements in these areas within four weeks. We also identified concerns about five other standards, which were less serious.

This was a follow up inspection to check the most urgent improvements required had been made. We visited the home on 21 May 2014 and found the provider had complied with the warning notices served and had and made significant improvements in people�s care and welfare, staffing and in quality monitoring. We have since received an action plan from the provider about the remaining improvements underway at Lucerne House in relation to the other five areas of non-compliance. We will carry out a further inspection later this year to check further improvements have been made and to ensure existing improvements have been sustained.

At the time of our inspection there were 59 people living at Lucerne House nursing home. Following the previous inspection, the provider agreed not to admit people to the home until improvements in care had been made. We spoke with 23 people who lived there and with seven relatives to seek feedback about the care. We spoke with 24 staff who worked at the home which included the manager and other senior staff, nurses and care workers, agency and other support staff. We also spoke with five health care professionals who regularly visited the home to seek their feedback.

Is the service safe?

As a result of the concerns identified at the previous inspection, a multiagency safeguarding process was convened to oversee the improvements. A multi-disciplinary plan was drawn up by the provider and health and social care professionals to protect people's safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role. Feedback we received from health and social care professionals confirmed our findings that care had improved across all areas of the home and risks had significantly reduced.

One person said, �I like it here and I feel 100% safe�. We found that people were well supported to have adequate nutrition and hydration and we found the health of people previously at risk of malnutrition and dehydration had improved and they had gained weight. Security in the home had also been improved to prevent visitors having unauthorised access to the home. Health and safety systems had been improved, all damaged crash mats and bed bumpers had been replaced and were being closely monitored. People on Shillingford unit who needed hoisting had individual hoist slings, which had increased their safety and reduced cross infection risks.

Is the service effective?

Since we last visited, staff on Ide unit had undertaken training on nutrition, hydration and on end of life care. Staff we spoke with demonstrated much more knowledge and confidence in caring for people�s needs. Nutritional care plans had been reviewed and updated to give staff much more information about how to support people�s nutrition and hydration needs. Health professionals also reported they received fewer phone calls for advice between their visits due to increased staff confidence in providing care. People and relatives also reported improvements. One said, �Absolutely fantastic, they are more organised� and another said, �I can see huge improvements�.

Is the service caring?

Throughout our visit, we saw that people were treated in a caring and compassionate manner and with dignity and respect. We saw that staff were engaged with in meaningful conversations with people and treated people as individuals. Comments included, �Mum is very well cared for� and �Overall my family and I are very happy with the care our mother receives�.

Is the service responsive?

Staffing levels at Lucerne House had significantly increased. A number of staff we spoke with told us how the increased staffing levels had improved people�s care. One said, �Staff are not so stressed, we can sit with people at lunch and engage with them�. One relative said, �X seems much calmer, staff can now spend more time with him, he is getting more to eat and drink regularly and I am pleased with that�.

We found that people were being regularly supported with personal care and that people who needed support to eat and drink regularly received that support. We also saw how care records had improved and provided better information for staff about how to respond to people�s individual needs. Staff were responsive when people called out and quickly went and reassured them and they also responded quickly to call bells. We observed that staff sat down next to people who needed support with their drinks and discreetly assisted them, where necessary. We saw that staff were patient and allowed people time to eat in a calm unrushed environment.

Is the service well led?

People and relatives we spoke with reported improvements in the leadership and management at the home. The manager has been in post for three months and is currently undergoing registration with the Care Quality Commission to become the registered manager at Lucerne House. One relative said, �The home feels more stable, the manager seems to be here more often, his door is always open which makes me feel happy to approach him if I felt I needed to�. Another relative said, I feel things are much better, we feel more confident in the home�.

We found the quality monitoring systems at the home had been improved and that prompt actions had been taken to reduce the risks we highlighted previously and to improve people�s health, welfare and safety.

Inspection carried out on 24, 26 February and 3 March 2014

During an inspection looking at part of the service

At the time of our inspection there were 68 people living at Lucerne House nursing home and the home employed over 100 staff. The service consisted of three units known as Shillingford unit, which provides care for people with dementia; Ide unit, which provides care for older people, and Alphinbrook unit, which provides care for younger people with physical disabilities.

At our previous inspection in August 2013, we identified five areas of non-compliance with the Care Quality Commission�s Essential Standards of Quality and Safety. These were related to people�s care and welfare, equipment, premises, staffing and managing complaints. The provider sent us an action plan outlining improvements being made to become compliant. This inspection was undertaken to check the required improvements had been made.

We visited the home over three days and spent a day on each unit. We spoke with 27 people and relatives to gain their feedback about the service. We also received feedback directly from five relatives via our website. We looked at 14 people�s care records. We spoke with 31 staff who worked at the home which included the registered manager, other senior staff, nurses and care workers, kitchen, housekeeping and maintenance staff.

Some people and relatives we spoke with were happy with the care and support they received. One person said, �When I want them, they are there.� A relative said, �The care is excellent, they look after her really well�. However, a number of people and relatives raised concerns with us about shortages of staff and about the lack of skills and experience of some staff. One person said, �The main issue here is not enough staff, they are understaffed quite a lot of the time�. A relative said, �Staff are mostly friendly and hard -working but some appear very inexperienced�. A second relative said, �They are going through a difficult time of being short staffed, particularly in the evening�. A third relative we spoke with was really concerned the person wasn�t getting enough to eat and drink.

Most of the staff we spoke with told us the home was short staffed on a regular basis. The registered manager confirmed they had reviewed staffing levels in relation to people�s needs since the last inspection and had increased staffing levels. However, we saw that frequently, the recommended staffing levels required to meet people�s needs were not being maintained due to staff absence. This meant people did not always receive the support and help they needed to maintain their health, safety and welfare.

We spoke with nine health care professionals who regularly visited the home to seek their feedback. Health professionals told us that the home contacted them appropriately for advice and support about people�s care. However, several health professionals we spoke with raised concerns with us about the lack of knowledge and experience of some staff who worked at the home and about low staffing levels. One health professional said, �It depends on which staff are on duty, some are very experienced, others less so�, another health professional said, �Some staff are struggling�.

During our inspection, we found staffing levels were not sufficient to meet people's needs. On Ide unit, we found staff were not able to meet some people�s basic care needs in a timely manner such as providing support for people who needed assistance with eating and drinking. People on Ide unit were not adequately supported to have regular meals, drinks and snacks. Also, eight care records we looked at about people�s eating and drinking were so poorly documented that we could not tell whether those people were given enough to eat and drink. We found nutrition care plans in relation had not been followed and three people had lost weight. This meant the care needs of people who were at risk of malnutrition and dehydration were not being met, which put their health, welfare and safety at risk.

We immediately raised our concerns with the provider about the lack of support for people with eating and drinking on Ide unit and gave clear feedback about the areas for improvement. The examples of poor management of care and poor practice we found on Ide unit were promptly shared under a safeguarding process. A multi-disciplinary plan was drawn up by health and social care professionals to protect people�s safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role.

We followed up equipment concerns raised at our previous inspection about damaged and soiled bed rail bumpers and crash mat equipment. We found a number of people�s bed rails bumpers and crash mats were soiled and torn. These were unsightly and undignified for those people and represented an infection control risk. We also identified ongoing security risks related to the main entrance of the home. This was because the reception desk was often unmanned during the day and because the main entrance was left open early in morning and between five and eight o� clock at night. This meant visitors and others had unrestricted access to the home, which put vulnerable people at risk.

The home had a number of quality monitoring systems in place, but some of these were not effective. This was because they were not identifying the risks we highlighted during the inspection such as about adequate nutrition and hydration for people, concerns about low staffing levels, soiled and damaged equipment and t security risks. This meant prompt actions were not being taken to reduce those risks which put the health, welfare and safety of service users and others at increased risk.

We found the home had not made the required improvements and was not compliant with any of the eight standards we inspected.

Inspection carried out on 23, 28 August 2013

During a routine inspection

At the time of our inspection there were 73 people living at Lucerne House nursing home. The service consisted of three units known as Shillingford unit, which provides care for people with dementia; Ide Unit, which provides nursing care for older people, and Alphinbrook Unit, which provides nursing care for people with physical disabilities.

We spoke with 16 people who used the service, along with 13 visitors/relatives to gain their views of the service provided. We also received information from two relatives following the inspection who raised concerns about the standard of care provided and staffing levels. We spoke with 23 members of staff including the senior management team, nursing staff, care staff, ancillary staff and agency staff.

People we met during our inspection told us that they were generally satisfied with the service they were provided with. They often spoke highly of the dedication of the staff team. Comments included, �The staff are nice to me�, �All of the staff treat us with respect and consideration�, �Staff are lovely. They couldn�t do more for me�. When asked if there were any improvements which could be made, six people told us they would like to see more staff available. Comments included, �The biggest problem is the lack of staff. This means I have to wait for attention�; �There are not always enough staff. Sometimes I can�t find staff to help me�; �I can wait for 30 minutes or more for help. The staff are always busy� and �I wish there were more staff. That�s my only negative comment�.

Not all the people we met were able to verbally tell us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

Some relatives told us they were happy with the overall care provided. One relative told us, �The staff understand X, his character and humour�. Another relative told us, �We are happy with the care although they do appear to be short staffed at times�. Other comments included; �Mum is looked after well. She gets on with the staff. They make her laugh�; �We are appreciative of care. There are incredible individuals within the staff team who go that extra mile�; �There are lots of lovely staff, however, I am not sure there are enough of them. Some people here are very ill and need a lot of attention�.

We spoke with a range of health and social care professionals including two GPs; a speech and language therapist (SALT); a care manager; continuing care nurse and a tissue viability nurse. Professionals were positive about the care provided on Shillingford and Alphinbrook saying that staff acted on and responded to their recommendations. However, concerns were raised with us about the staffing levels on Ide Unit and how this impacted on the level of care provided to some people.

During this inspection we identified five areas which required improvement. People did not always experience care, treatment and support that met their needs and protected their rights. This service provided care and support to a high number of people with complex needs and high dependency, including people with palliative care needs. We found that this was not reflected in the numbers of staff available to provide care. People were not always protected from unsafe or unsuitable equipment. There was a complaints system available, however information provided to people about the system was not accurate. Comments and complaints people made were not always responded to appropriately.

Inspection carried out on 22 May 2012

During a routine inspection

We (the Care Quality Commission) carried out an unannounced visit on 21 May 2012 and completed the visit on 22 May 2012.

When we arrived people were going about their day as they wished. Some people were relaxing in the communal areas or in their rooms. We talked with 12 people who lived at the home. Six of those people were living with dementia and were cared for in the Shillingford unit. This meant that they could not specifically tell us what it was like to live at Lucerne. We observed people were comfortable in the presence of staff and appeared relaxed and able to move about the home keeping occupied with the wide array of interests around the home.

We spent time observing care delivery in the communal areas and looked at all areas of the home. We spoke to the manager, deputy general manager, the GP who holds surgeries at the home and with 17 staff who worked at the home. People told us that it was �a wonderful home�, one person said 'I wouldn�t move to another place, staff are so nice here'. Staff were all positive such as �it�s a fantastic place and very rewarding to work here� and �everything is for the residents�. We saw two relatives enjoying a tray of tea and biscuits in one lounge with people living at the home and they were heard to say that it was �lovely, like a caf�.

We saw that the home focussed on people�s choice about how they wanted to live their lives. We saw and were told about clear examples of how knowledge of people�s previous lifestyles and preferences had been used to enhance their life at the home in a person centred way. Staff were aware of people�s likes and preferences and there was good communication between the staff and people living there. This included regular resident�s meetings, relatives meetings, a wide choice of relevant activities and topical events and a relative�s bereavement support group. In addition to group activities, the home also supported people to engage in individual activities they enjoyed, this included reading, knitting and listening to their favourite music.

People told us they felt safe in the home and were able to raise any concerns and were confident they would be dealt with. Staff we spoke to confirmed they felt well supported, were able to raise concerns within their unit or with the management. Two members of staff we spoke to told us there was a �really good atmosphere� at the home, several members of staff mentioned �good teamwork� and one staff member said 'I love working at Lucerne, everything is for the residents, people have choices�.

The staff were involved in putting forward ideas and had undertaken projects to enhance the general feel of a local community within the home. At the time of our visit, a beach side themed garden was being developed.

Staff received training and were knowledgeable about people�s needs and how to meet them and said they felt valued. The home had recently been nominated for a care award relating to their dementia services and individual staff had won recent awards within the provider group relating to care and activities.

The home had a variety of quality monitoring systems in place and regular audits and checks were carried out in all areas of the home with appropriate action taken to address any issues. There was a high standard of d�cor and cleanliness throughout the home and we saw that people looked well cared for.

We found the home was meeting the six outcome standards we looked at during our visit.

Inspection carried out on 23 September 2011

During an inspection looking at part of the service

We carried out this unannounced inspection visit to check on the service�s compliance with two warning notices that we had issued in August 2011. The notices were issued following a visit we made, on 25 July 2011, at the request of the coroner under Rule 43 of the Coroner's Rules. The coroner had asked us to look at how the risks to people who were assessed to be at risk of choking were being managed. When we did this, we found that they were not being managed sufficiently to ensure people's safety, and so we issued notices requiring the service to take prompt action to address these risks.

On this visit, we looked at the support given to five people who staff had assessed as being at high risk of choking because of swallowing difficulties they had. These difficulties were due to a range of causes. The people lived on �Shillingford� or �Ide�, the two units for older adults. We met them and, in some cases, their visiting relatives. We observed the support they received over a mealtime, looked at their care records, and spoke with staff who supported them.

Some people living at the home had various communication needs and were thus not able to give us their views directly. We observed staff interacting with people in a kindly, patient, calm and respectful way. When we asked one person what they thought of the food provided, they said they liked it and the quantity was right for them. We saw people were served good sized portions. Most people appeared to enjoy their food, and were offered �seconds� as well as more to drink.

We saw that the mealtime was managed in a skilful way, ensuring that all people were attended to and that people were not rushed by staff supporting them to eat or drink.

Two visitors we met said they knew about the risk to their relative of choking. One told us they had no concerns and considered the care to be �very good indeed�.

We found that staff knew who was at high risk of choking. They could describe the individualised support required by the people we followed up, to reduce their risk of choking when eating or drinking. We saw they provided the required support, to promote people's safety. Daily records reflected that people were given appropriate foods as indicated by advice from a Speech and Language Therapist, to avoid causing choking.

Inspection carried out on 25 July 2012

During an inspection in response to concerns

We carried out this inspection at the request of the coroner under Rule 43 of the Coroner's Rules. The coroner asked us to look at how the risks to people who are assessed as being at risk of choking were being managed. Concerns were also raised with us that safeguarding procedures were not being followed.

We carried out the inspection on Shillingford Unit where people with dementia are cared for. We identified three people who had been assessed as being at risk of choking due to swallowing problems. We read their care records, spoke with them, and/or observed their care over a mealtime period, and talked to staff about their needs.

During our visit the majority of people living here could not speak with us directly. However, we observed staff interacting with people in a kindly, discreet, calm and respectful way. We were told by one person that they enjoy the meals here and we saw people enjoyed their food. We also saw that people had choices about what to eat, including both hot and cold food choices. We saw that the mealtime in the dining room was managed in a skillful way ensuring that all people were attended to and that the experience for people was calm and relaxed. People are receiving a nutritious diet.

We found that staff knew people's needs well. However some records relating to people'sffluid and food intake were not completely accurate and therefore could not always demonstrate that people were receiving the appropriate care. We also found that some plans in place to manage people's risk of choking were not being completely followed, which meant that this risk was not being fully managed. We saw that some people were eating some foods or food and drink combinations which were associated with an increased risk of choking.

We found that people are not fully safeguarded because actions that were to be taken against a member of staff had not been actioned, and locally agreed safeguarding procedures had not been followed.

Reports under our old system of regulation (including those from before CQC was created)