Bloomfield

Bloomfield is a residential care home providing regulated activities accommodation for persons who require nursing or personal care, and treatment of disease, disorder and injury to up to 102 people. The service provides support to people living with dementia, older people and younger adults. At the time of our inspection there were 92 people using the service.

Bloomfield provides purpose built accommodation over 2 floors, both are accessible by stairs and a lift. Bedrooms have en-suite washing facilities and communal baths, showers and toilets are situated throughout the service. Lounges and dining areas are available on both floors and people have level access to a large, well-stocked garden. The registered manager’s office is located adjacent to reception.

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

At our last inspection we found the provider had failed to consistently submit statutory notifications in line with regulatory requirements. At this inspection we found statutory notifications were submitted as required. The registered manager worked with members of the management team to retain oversight of care quality and safety in the service. People and staff spoke positively about the registered manager.

Medicines were managed safely and risk assessments were in place to guide staff about how to keep people safe. Staff were aware of their responsibility to report potential safeguarding concerns. We received mixed comments about staffing levels. The registered manager told us staffing had recently been increased and they used a staffing tool to determine staffing levels, in line with people’s needs. Recruitment processes were in place to help prevent unsuitable applicants being employed in the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Why we inspected

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 and Well-led which contain those requirements.

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

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 changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Bloomfield is a nursing home. It provides accommodation, nursing and personal care for up to 102 older people, some who are living with dementia. At the time of the inspection there were 75 people living at the service.

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

People were happy and felt safe living at the service. Staffing was kept at the level deemed safe by the provider. We received positive feedback about staff and their responsiveness.

Assessments were in place to identify and reduce risks. Regularly checks on the building and environment were undertaken. Infection prevention control measures were in place to manage infection risks. Medicines were managed safely.

Notifications had not always been submitted as required. All registered services must notify the Commission about certain changes, events and incidents affecting their service or the people who use it. We use this information to monitor the service and to check how events have been managed.

Improvements were needed in the management of safeguarding concerns to ensure timely recording, reporting and learning. Systems were in place to monitor the quality of the service.

There was a positive atmosphere and culture within the service which was recognised by staff, relatives and people. People felt comfortable raising concerns. Staff received regular training and supervision.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was Good (published 13 April 2019).

Why we inspected

We received concerns in relation to the management of safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. In line with our enforcement policy, the overall rating for a service cannot be better than requires improvement if there is a breach of regulations.

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 have found evidence that the provider needs to make improvement. Please see the well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We have identified a breach in relation to notifications of other incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were supported by staff who were kind, caring and passionate. Improvements had been made around the consistency of staff. Agency staff had reduced. Staff worked well as a team. There was a friendly and inviting atmosphere at the service and a positive staff culture. Staff knew people well and had good relationships with people.

Meaningful activities were provided for people on a group and individual basis. The service was developing its engagement with the local community and had made links with local organisations to extend social and recreational opportunities. Such as gardening and a lunch club.

The environment and facilities had been considered in order to support people’s independence, experience and social opportunities. The service was bright, clean, tidy and well maintained. There was safe access to pleasant outdoor space. Visitors were welcomed.

People, staff and relatives said the service was well-led and managed. The registered manager and senior staff team had ensured improvements at the service had continued and been sustained.

Care plans were person centred and included how people preferred their care and support to be delivered. People’s individual choices and wishes were encouraged and respected. People were treated with dignity.

People enjoyed the food provided by the service. Mealtimes were relaxed and sociable. Feedback was sought from people, relatives and staff through meetings. People felt comfortable in raising any concerns or issues.

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

Rating at last inspection: Requires Improvement (June 2018).

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

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspections, by selecting the 'All reports' link for Bloomfield, on our website at www.cqc.org.uk

Bloomfield 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. Bloomfield can provide care and support for up to 102 older people, some whom are living with dementia. At the time of our inspection there were 56 people living at the service.

The service provides accommodation in purpose built premises. The service is over two floors and has four separate areas. Ash Way and Salisbury Rise provide general nursing care and Beech Walk and Mendip View which provides care and support to people living with dementia.

There was a 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.

The service had set out an action plan in order to make improvements and meet the regulations that had been identified as being in breach at the past and previous inspections. The action plan had been regularly updated and improvements made. The provider had taken action and no breaches of regulations were identified at this inspection. People, staff and relatives told us about the improvements made at the service and the positive impact the registered manager had made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Documentation and processes for people’s consent to care in line with the Mental Capacity Act 2005 had been reviewed. However, we did identify some people’s records which had not been fully completed. Audits monitored these areas and the provider’s action plan identified that this area was still being improved.

Improvements had been made in staffing levels. Staffing numbers were above the level deemed safe by the provider. We received positive feedback and conducted observations where we evidenced that people’s care and support needs were met in a timely manner. Occupancy levels at the service were currently low. The provider acknowledged that as numbers living at the service rose staffing would need to be carefully monitored and reviewed to ensure it continued to meet people’s needs. Recruitment of new staff followed the provider’s procedure and all relevant checks had been undertaken and monitored.

Systems to monitor and review the quality of care and support were effective. A range of audits were conducted to monitor different areas of the service, people’s care and experiences. For example, care records, medicines, dining experience, infection control and daily records were checked. Areas that were needed further actions or improvements were identified. Action plans were made as a result. These were monitored to ensure they were completed and actions were effective.

Notifications had been submitted to the Commission as required. Systems had been changed to ensure effective reporting and investigations of alleged abuse or concerns, incidents and accidents. Actions were taken and monitored.

Regular checks of the environment, equipment and fire safety were undertaken. The service was clean and refurbishment work was underway. Infection control policies were adhered to. Risk assessments were in place to keep people safe but enable people to be independent. Guidance was in place to direct staff in risk management.

Staff received support in their role through an induction, training and supervision. People spoke positively about the food provided at the service. People were given the support they required around food and fluids and this was regularly monitored. Medicines were administered safely to people. The service was compliant with the Deprivation of Liberty Safeguards.

People were supported by staff who were kind and caring. People’s independence was promoted. There was a range of activities available to people to choose from. Positive feedback was received about the activities provided.

Care records were person centred and detailed people’s preferences and routines. People told us that staff knew them well and respected their choices.

Staff felt valued and engaged with the service. Communication systems were effective with staff. Regular meetings occurred. People, relatives and staff were encouraged to raise any concerns or make suggestions.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Bloomfield, on our website at www.cqc.org.uk

Since July 2013 we have conducted a comprehensive inspection at the service six times. The provider has failed to fully meet all the regulations on all six occasions. Since the previous inspection in March 2017 there have also been repeated breaches of the same regulations. These relate to staffing and failing to submit statutory notifications. We have also identified additional concerns relating to recruitment checks, safeguarding adults, good governance and consent.

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

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. The accommodation is set over two floors with four separate areas. These are 'Ash Way' and 'Salisbury Rise', which provides general nursing care and treatment to people, and 'Beech Walk' and 'Mendip View' which provides care and support to people living with dementia. At the time of our inspection 69 people were living at the service.

The registered manager had recently left 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. On the day of our inspection the interim manager was on leave. During their leave the service was being run by the deputy manager with support from the senior management team.

At our previous inspection we found the service was not sufficiently staffed to meet people’s needs. Since our inspection in inspection in March 2017 we found insufficient improvements had been made.

Recruitment checks had not been consistently carried out in accordance with the provider’s recruitment checks policy.

Incidents and accidents were not consistently recorded and investigated by staff to ensure the safety and well-being of people.

At our previous inspection we found that the provider had failed to notify the Commission about certain changes, events and incidents affecting their service or the people who use it. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled . Insufficient progress had been made. The service had failed to make appropriate safeguarding and serious incident notifications to the Commission, as required.

People's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. Consent to care was not always sought in line with legislation and guidance because the principles of the MCA had not always been followed. This was particularly in relation to the use of bed rails and sensor mats. Capacity assessment and best interest meetings were not always held.

At our previous inspection people were not fully protected against the risk of unsafe or inappropriate treatment as care records were not properly maintained. The service did not consistently deliver appropriate care that met people’s needs. Improvements had been made but this area of their work requires further development.

The observed dining experience was not consistently person-centred.

People and their relatives felt that the staff were caring. Staff spoke highly of the care they provided. Despite their reservations regarding the current staffing levels all of the staff we spoke with said they would recommend the service to people.

Medicines were managed safely.

New staff undertook an induction and mandatory training programme before starting to care for people on their own. Staff were consistently supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager.

People’s nutrition and hydration needs were met. People’s nutritional needs were assessed and where risks were identified, specialist support was sought.

There is a full weekly social activity programme. Some people chose not to participate and this was respected.

People maintained contact with their family and were therefore not isolated from those people closest to them.

Staff felt well-supported by the deputy manager. The deputy manager held a regular programme of staff meetings to advise them of operational and clinical issues which required actions. This line of communication has resulted in improved recording, particularly regarding risk management.

To enable people to provide feedback on their experience of the service resident meetings were held.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations. We are currently considering the action we are taking.

As a result of the findings of the inspection in August 2016, we served two Warning Notices in relation to the management of medicines and governance. We returned to Bloomfield in November 2016 to ensure action had been taken in relation to the Warning Notice served around the management of medicines. The service had achieved compliance with that part of the regulation during that inspection.

In addition to the Warning Notices, we set requirement actions in relation to the other breaches of regulations. The provider wrote to us in September 2016 to tell us how they would achieve compliance with these requirements which we reviewed during this inspection. In addition to this, we also followed up compliance against the Warning Notice served in relation to governance.

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. The accommodation is set over two floors with four separate areas. These were ‘Ash Way’ and ‘Salisbury Rise’ which provided general nursing care and treatment to people. The ‘Beech Walk’ and ‘Mendip View’ accommodation provided care and support to people living with dementia. At the time of our inspection, 67 people were living at the service.

A registered manager was in post at the time of inspection. They had registered with the Commission in July 2016. 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.

Although we found some improvements during this inspection, the service was unable to demonstrate they had fully complied with the requirements of the Warning Notice in relation to governance. Although we found a reduction in recording errors and omissions by staff, we still found recording errors in relation to the planning of the care and treatment people required. We also found errors in the daily records that showed if people had received care in accordance with their assessed needs. This demonstrated that governance systems were not effective in identifying the recording errors.

We found evidence that people had not received care in line with their assessed needs and the provider had failed to consistently ensure enough staff were deployed to meet people’s needs. We received information from people and their relatives on how this had resulted in a negative impact on care delivery and we made observations to support this during the inspection. The service had not ensured that all legal notifications had been sent to the Care Quality Commission.

The current identified shortfalls are of particular concern as there are continued breaches of some regulations and the service is currently running at limited occupancy level. A further increase of people being accommodated may result in further negative outcomes for people receiving care and treatment at Bloomfield.

People at the service commented they felt safe. People received their medicines when they needed them and there was a system to review reported incidents and accidents. There were safe recruitment processes in operation and staff understood their obligations to safeguard people. People’s risks were assessed and the service was clean. Checks on the environment and equipment within it were completed.

The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We saw examples of how the service had involved people and their representatives in decision making processes. People said they received effective care. Appropriate referrals were made to healthcare professionals when required and we received positive feedback from GPs that attended the service. There were systems to support staff through training, supervision and appraisal.

People said that staff were caring and we made some observations to support this. However, we also made some less positive observations of interactions between people and staff. We also made observations of how poor staffing levels impacted negatively on people’s care. Staff we spoke with understood the people they supported well and people’s visitors were welcomed at the service. There were advanced care plans in place to support people at the end of their lives, however we did find an example of when this was not followed.

Care plans were person centred and showed people’s preferred routines and communication needs. People’s life histories were documented to assist staff in knowing and understanding the people they supported. There was a complaints procedure in operation and people had the opportunity to participate in activities. We received mixed feedback from people and staff about the management of the service. There were systems for the management to communicate with staff, people and their relatives. There were some effective governance systems to monitor people’s health needs and the service received support from the provider.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a continued breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of the report.

We undertook a focused inspection on 1 November 2016 to check the provider was meeting the legal requirements for one of the regulations they had breached that resulted in them being served a Warning Notice. This focused inspection was to ensure the provider had taken sufficient action that ensured people were protected against the risks associated with medicines. This report only covers our findings in relation to this areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘Bloomfield’ on our website at www.cqc.org.uk

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people.

There was a 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.

During this focused inspection on 1 November 2016, we found that sufficient action to achieve compliance with the safe and proper management of medicines had been achieved. The management at the service had introduced daily governance systems since our last inspection. This ensured that records relating to medicines were checked a minimum of twice daily for any recording errors or omissions. At shift handovers, additional documentation had been introduced between nursing staff that confirmed stock levels had been checked. All of the people who required pain relieving transdermal patches and skin creams had been individually reviewed and new documentation detailing their needs had been produced for staff.

The provider wrote to us in May 2015 to tell us how they would meet the requirements of this regulation. During this inspection we found the provider had again failed to achieve full compliance with this regulation. In addition, we found an additional three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. At the time of our inspection 84 people were living at the service.

A registered manager was in post at the time of inspection. They had registered with the Commission in July 2016. 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 managed safely. In addition to this, we found that where people had an incident or accident, insufficient action or management level reviews had been completed to minimise future risks to people. There were insufficient systems to ensure people were being lawfully deprived of their liberty. We found that Deprivation of Liberty Safeguard (DoLS) authorisations were out of date. DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. In addition to this, the provider was not always providing care in line with people’s consent and with mental capacity legislation.

The provider had not introduced robust systems since our last inspection to ensure that staff maintained accurate records of people’s care, placing people at risk of unsafe or inappropriate care and treatment. The service did not consistently deliver appropriate care that met people’s needs. There was no system that ensured people living in isolated areas of the building were regularly checked and some air mattresses were incorrectly set which may have had an adverse effect on people’s health and well-being. We found that pain management was not always effectively monitored. There were insufficient robust governance systems to ensure people’s clinical and non-clinical needs were met safely. The provider had failed to send a legal notification as required.

We received mixed feedback from people in relation to staffing levels at the service. Most staff commented that staffing numbers were sufficient, however they commented they did not feel the provider’s staffing tool was accurate. People we spoke with told us that generally there were enough staff but we did receive some negative feedback. The service was clean and checks of the environment and equipment were completed. Staff understood their obligations in relation to safeguarding adults and recruitment procedures were safe.

Staff were supported through training and the provider had an induction aligned to the Care Certificate. The service management were currently implementing regular supervision and appraisal. People were supported by staff that understood the principles of the Mental Capacity Act 2005 in relation to offering people choices. Where required, people were supported to eat and drink and the feedback we received about the food was positive. People could access healthcare professionals when needed.

People told us staff at the service were caring and we received positive feedback. People were treated with dignity and respect and we observed staff communicating with people in a caring manner. Staff understood the needs of the people they cared for and people’s preferences were recorded to help support staff in delivering person centred care. There was a range of activities people could partake in and people were enjoying activities on the day of our inspection. The provider had a complaints procedure in operation.

The service management had systems to communicate with staff and staff felt able to raise ideas and suggestions. Staff were positive about the management of the service but commented negatively about the number of management changes they had experienced. There were clinical governance meetings and systems to record people’s needs, together with a system to monitor the quality of service provided.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of the report.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 8 and 14 of the Essential Standards of Quality and Safety. During this inspection the actions the provider told us they were planning to take, had been implemented within the service.

Robust infection control procedures were in place and staff received supervision and appraisals on a regular basis.

We did not speak with people that lived in the home directly about the outcomes that we were inspecting. However we observed staff positively interacting with people that lived in the home and visiting relatives, throughout our inspection.

One member of staff we spoke with told us they were the home's infection control champion. This meant they had responsibility to ensure staff complied with the infection control procedures that were put in place. The member of staff told us they were clear about their role and enjoyed the extra responsibility. Another member of staff confirmed the recent improvements that were made were positive.

During our inspection we spoke with 18 people living in the home, 10 members of staff, the senior management team and seven relatives.

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 .

People made positive comments regarding the staff that supported them. Comments included;' I find it alright here, I am quite happy here though, staff are good to me'. 'I get up when I like, and I go to bed when the time is right. I have good food, it's fine' "staff listen to you. I am going to stay here, I love it'.

We spoke with seven family members who were visiting the home. Comments overall were positive. Comments included; 'they look 10 years younger'. 'X is always happy, clean and looks tidy. Staff are friendly and makes us feel welcome'.

We spoke with one relative who told us they felt communication was not as good as it could be. We discussed this with the registered manager who was aware of this concern and was exploring ways to improve this.

We observed examples of patient and kind care. Staff gave people choices and explained what they were doing. We spoke with six people living in the home, and a visitor. They told us staff were very respectful. People were not rushed when receiving care. They were helped with choosing appropriate clothes and deciding where they wanted to go in the home. A person told us: 'They understand as much as they need to about me as a person.'

Nursing and care staff told us they and their colleagues had received dementia training by way of e-learning. Most said they could see a difference in the quality of their work as a result.

We found there were enough staff to meet people's needs. Recruitment of staff matched losses. Shortfalls in staffing were covered from a relief bank and by existing staff offering additional hours. All but one of the staff we spoke with said there were enough staff. People who lived in the home told us call bells were answered quickly. They said staff maintained checks on people's wellbeing throughout the day.