Acorn Nursing Home

Acorn Nursing Home is a residential care home providing personal and nursing care to 34 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 30 people using the service.

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

People were at risk of harm as systems were not in place to assess, review and monitor the risks relating to peoples’ health, safety, and welfare. Medicines were not managed safely. Care records were not always person- centred and where monitoring was required this was inconsistent. There were a range of audits and quality checks in place but they were not always effective in identifying shortfalls.

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. We have made a recommendation about improving how the involvement of people and their representatives in decisions are recorded.

People and relatives told us there was enough staff to provide care and support when they needed it. They said staff were caring and they felt safe. Recruitment was managed effectively. Staff had induction, training, and supervision to be able to carry out their role safely. The service followed safe infection prevention and control measures. Systems were in place to safeguard people from abuse and poor care.

The service worked closely with other health and social care professionals. Staff felt involved in the running of the service and said the registered manager was approachable and supportive. The registered manager was responsive to inspection findings and provided assurances they would make the required changes to improve safety and quality for people living at the home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 23 June 2021). The provider had completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 13 May 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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.

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 requires improvement.

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.

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 Acorn Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection. We have made a recommendation in relation to how the service records how people and their representatives are involved in decision making.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Acorn Nursing Home is a residential care home providing personal and nursing care to 28 people, most of whom were aged 65 and over at the time of the inspection. The service can support up to 34 people.

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

People were not always safe. Risks to people were not always appropriately assessed and managed. Systems to monitor and check the service were in place but these needed to be more thorough to ensure the service consistently met the required standards.

Staff did not always follow the COVID-19 infection prevention and control government guidance. This posed a risk of staff transferring infection. We have made a recommendation that the provider reviews guidance and governance processes.

Recruitment was managed safely. The staff team were consistent and experienced and had the skills to support people safely. Medicines were managed safely. There were close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

People who used the service, relatives and staff provided consistent positive feedback about their experience. People said they felt safe and staff were caring and kind. The registered manager provided people with leadership and was approachable. They provided day to day support to people living at the home and the staff team. There was a warm and welcoming atmosphere throughout 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

The last rating for this service was Good (published 14 December 2018).

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see safe and well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider took immediate action to mitigate the risks.

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.

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

Enforcement

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

We have identified a breach in relation to good governance.

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

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.

Acorn 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 care home can accommodate up to 34 older people and older people living with dementia in one adapted building. Accommodation is provided over two floors.

At our last inspection in July 2017, we rated the service as requires improvement overall. At this inspection, we found the service had improved to an overall rating of good.

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.

Staff were recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they were well supported by the registered manager. Formal supervision and appraisals were in place where staff could discuss their ongoing development needs.

We saw people were treated with respect, kindness and compassion. People who used the service and their relatives told us staff were helpful, attentive and caring.

Care plans detailed what care and support people wanted and needed and were mostly kept up to date. Risk assessments were in place which showed actions that had been taken to mitigate any identified risks. People felt safe at the home and appropriate referrals had been made to the safeguarding team when necessary.

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

Medicines were stored and managed safely and people’s healthcare needs were being met.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was good. There were plenty of drinks and snacks available for people in between meals.

Some activities were on offer to keep people occupied either within small groups or on an individual basis. Visitors were made to feel welcome and offered refreshments by staff.

The home was spacious, clean and tidy. An ongoing programme of refurbishment was underway with some windows requiring replacement and plans to remodel the garden area.

The complaints procedure was displayed, although no complaints had been received since the last inspection. Procedures were in place to ensure any complaints received would be dealt with appropriately.

Everyone spoke highly of the registered manager and said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, actions were taken to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Acorn Nursing Home is a thirty-four bedded care home, which provides residential and nursing care. Bedroom accommodation consists of both double and single rooms situated on the ground and first floor of the building. There are communal rooms on the ground floor. There is ample car parking space at the front of the property and at the back there is an enclosed garden.

The last inspection report was published in January 2017. At that time the service was rated as requires improvement overall and was rated inadequate in the well led domain. The service was in breach of three regulations, two of these being continued breaches from the previous inspection report published in April 2016. The breaches were in relation to Regulation 10 (Dignity and respect) Regulation 17 (Good governance) and Regulation 18 (Staffing). The service remained in Special Measures because it was rated as inadequate in one of the key questions at two consecutive inspections. 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 have 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.

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

We noted the provider is registered for the regulated activity of personal care which is associated with the provision of services to people living in their own homes. We found no evidence they were delivering this kind of service and following the last inspection we asked them to submit an application to remove this regulated activity from their registration.

People told us they felt the home was a safe place. Staff knew how to report any concerns about people’s safety and welfare. The service supported some people to manage their personal money and in most cases records were kept of all transactions. However, in one case where money was being provided by a person’s relative appropriate records were not maintained. We recommended records be maintained of all transactions involving money spent on behalf of people living at the home.

There were enough staff to keep people safe although people who lived at the home and relatives told us staff always seemed very busy. The required checks were done before new staff started work and this helped to protect people from the risk of receiving care and treatment from staff unsuitable to work with vulnerable adults. Staff received the training and support they needed to carry out their duties safely and properly.

Risks to people’s safety and welfare were identified and managed. The home was clean and was being refurbished, people told us it had improved over recent months in both cleanliness and décor. The gardens were in need to attention to make them safe and suitable for people to use.

People’s medicines were managed safely.

People were supported to eat and drink and action was taken in response to unplanned weight loss. People’s special dietary needs and preferences were catered for. People’s meal time experiences had been improved due to changes in the way meal times were managed.

People were supported to have access to the full range of NHS services to maintain their health and wellbeing.

The service was working in accordance with the requirements of The Mental Capacity Act 2005 which helped to make sure people's rights were protected.

We saw staff were kind and patient and observed lots of good interactions which supported people's wellbeing. Staff knew about people’s likes and dislikes and were attentive to their needs. People and their relatives told us they were involved in making decisions about their care and treatment.

People were offered the opportunity to take part in a range of activities in the home. There were no restrictions on visiting and people could receive their visitors at times which suited them.

People told us the registered manager was approachable and they felt confident any concerns raised would be addressed.

The provider had made improvements to the way they monitored and assessed the quality and safety of the services provided. These systems and processes needed to be further embedded and tested over time to demonstrate their effectiveness in sustaining improvements. In reaching our judgements we have taken account of the history of the service. Prior to this inspection the service had been in Special Measures since April 2016. The improvements which had been made were achieved during a period of reduced occupancy and close monitoring of the service by CQC and the local authority commissioning team. The provider needs to demonstrate these improvements can be sustained over a longer period of time before we can be assured people will consistently experience good quality outcomes.

The last inspection was carried out in January and February 2016 and the report was published in April 2016. At that time we found the service was in breach of seven regulations. We found people were not adequately protected from harm and the recruitment procedures were not robust. People’s rights were not protected because the service was not working in accordance with the requirements of The Mental Capacity Act 2005 and people were not treated with dignity and respect. People’s medicines were not managed safety and records were not properly maintained. The service did not have a proper way of dealing with complaints and the governance arrangements were not effective. The service was rated as ‘Inadequate’, we served warning notices and requirement notices and the service was placed in ‘Special Measures’. We carried out this inspection to check if the required improvements had been made.

Acorn Nursing Home is a thirty-four bedded care home, which provides residential and nursing care. Bedroom accommodation consists of both double and single rooms situated on the ground and first floor of the building. There are communal rooms on the ground floor. There is ample car parking space at the front of the property and at the back there is an enclosed garden which is accessible to people living in the home.

We noted the provider is registered for the regulated activity of personal care which is associated with the provision of services to people living in their own homes. We found no evidence they were delivering this kind of service and therefore have asked them to submit an application to remove this regulated activity from their registration.

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

Staff working in the home knew how to recognise and report any concerns about people’s safety and welfare. We found improvements had been made and more safeguarding concerns were being identified and reported. This assured us there was less risk that any abuse which did take place would be undetected.

There were enough staff on duty. However, the home did not employ enough nurses to make sure there was one nurse on duty at all times without using temporary or agency staff.

No new staff had been employed since the last inspection and we were not able to check if the correct recruitment procedures were being followed.

We found improvements had been made to the way people’s medicines were managed.

We found the home was generally clean, safe and well maintained. The provider was continuing with the refurbishment programme. However, on the day we inspected the conservatory was cold and the radiators were not working all day.

Individual risks to people’s safety and welfare which were as a result of their care needs were not always managed safely. This had been a concern at the last inspection and therefore we concluded the provider remained in breach of regulation.

Although staff told us they felt supported the training records showed a significant number of staff had not received any training on safe working practices such as fire safety and moving and handling. In addition, the majority of staff had not received training on privacy and dignity which had been identified as an area of concern at the last inspection. We found this was a breach of regulation.

People were offered a variety of food and drinks and their dietary needs, likes and dislikes were catered for. People’s nutritional status was assessed and appropriate action was taken if people were having difficulty eating or had unplanned weight loss. However, we found the lunch time meal service was not well organised and people were not afforded the opportunity to enjoy the social aspects of meal times.

People were supported to have access to the full range of NHS services to maintain their health and wellbeing.

We saw staff were kind and patient and observed lots of good interactions which supported people’s wellbeing. However, we also saw examples of where a lack of attention to detail meant people’s dignity was not promoted. We concluded the provider remained in breach of this regulation. We found staff responded when people asked for help but were not always attentive to the needs of people who were, for whatever reason, unable to ask for help.

We saw people’s needs were assessed and there were care plans in place. We saw the care plans were being checked by senior managers to make sure they had all the required information and were up to date.

We found people had opportunities to take part in activities in the home and some people were supported to go out and use local amenities. However, there was a lack of organised outings which was something that had been raised in ‘resident and relative’ surveys over the past two years.

There was a complaints procedure in place but information about how to make a complaint was not displayed in the home on the day of our inspection.

People who used the service, relatives and staff were given opportunities to share their views of the service by means of surveys and meetings.

The provider had made some improvements to the systems and processes in place to assess, monitor and improve the quality and safety of the services provided. However, we found they had not done enough to make sure these systems and processes were being operated effectively to ensure people consistently experienced safe and effective care and treatment. We judged the provider remained in breach of this regulation.

We concluded the provider was still in breach of three regulations. Two of these were continued breaches from the last inspection and were Regulation 10 (Dignity and respect) and Regulation 17 (Good governance). The breach of Regulation 18 (Staffing) was new breach identified during this inspection.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Commission is considering the appropriate regulatory response to the inspection findings.

Acorn Nursing Home is a thirty-four bedded care home, which provides both residential and nursing care. The home was formerly a vicarage and it is less than one mile from Bradford City centre and close to St Luke's Hospital. The home is well served by public transport and there is adequate parking to the front of the property. Bedroom accommodation consists of both double and single rooms situated on the ground and first floor of the building.

The last inspection was carried out on 7 May 2014. At that time there were two breaches of regulations which related to the safety of the premises and the systems in place to assess and monitor the quality of the services provided. The provider sent us an action plan and assurances that the concerns about the premises had been addressed. During this inspection we checked to see if the required improvements had been made. We found the specific issues relating to the premises had been addressed. However, we found the systems for monitoring and assessing the quality and safety of the services provided had not improved. There has been a change to the regulations since the last inspection and therefore we have mapped the continued failure of the quality assurance processes to the new regulations.

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

People who used the service and relatives did not raise any concerns about safety however we found a number of issues which led us to conclude the service was not safe. We found risks to people’s safety and welfare were not always identified and managed properly. For example, we found risks to people’s safety due to unlocked storage areas and uneven floor surfaces had not been acted upon until we brought them to the attention of the registered manager. We identified problems with the way the disposal of clinical waste was being managed.

We found people’s medicines were not managed safely.

There were enough staff deployed to meet people’s needs. However, we found the required checks were not always done before new staff started work and this meant people were at risk of being cared for by staff who were unsuitable to work with vulnerable people. We found the records of staff training and support were not properly maintained and therefore could not be assured staff had received the training and support they needed to carry out their duties effectively.

The service was not working in accordance with the requirements of the Mental Capacity Act 2005 and therefore people’s rights were not always protected.

We found people were not always treated with respect, dignity and compassion. Some of the language used by staff when speaking about people who lived at the home was not appropriate or respectful.

People were offered a varied range of food and drink and special dietary needs were catered for. However, we found the meal service was rushed and chaotic and people missed the opportunity to enjoy the social aspect of meal times. When people’s dietary intake was being monitored we found the food and fluid charts were poorly completed.

We found people and their relatives were not consistently involved in making decisions about their care and treatment. Many of the care plans we looked at did not provide information about people’s individual needs and preferences.

Information about the complaints procedure was not easily accessible to people and the providers procedures for dealing with complaints were out of date.

People were given the opportunity to take part in a range of social activities in the home but for most people opportunities to go out were limited.

There were systems in place which were designed to assess, monitor and improve the quality of the services provided but they were not working properly which meant that the service did not have effective governance.

Records relating to the care and treatment provided to people and relating to the day to day management of the home were not properly maintained.

We identified eight breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

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

The service 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.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Safe -

We found there were generally sufficient staff on duty to meet people's needs throughout the day and night. When necessary the service used agency staff to cover absences. One person who used the service told us there were occasions when the home was short of staff on night duty and this meant they had to wait when they needed support from staff.

The Registered Manager told us they were in the process of implementing a twilight shift, (6pm to 10pm), because they had identified some of the people who used the service needed additional support in the evenings. One person who used the service said they did not have to wait long for staff when they used the call bell in their room. People's relatives told us they visited regularly and said there were always staff around to attend to people's needs.

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They were aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards and said they had arranged a meeting with the local DoLS team to discuss the implications for the service.

When we looked around the home we identified some risks to people's safety. For example, we found a number of windows above ground floor level did not have restrictors fitted. We have asked the provider to tell us what they are going to make sure the premises are safe and adequately maintained.

Effective -

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people's needs were met. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care records.

Caring '

The people we spoke told us the staff were 'kind, caring and friendly'. One person said 'staff work hard, are kind and look after us all'. Regular visitors to the service told us the staff were very 'patient' when dealing with people who were confused or disorientated.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Responsive '

People's needs were assessed before they moved into the home. We saw people's care records had information about people's individual needs and preferences. We found people had appropriate equipment to support them to meet their needs and/or maintain their independence.

People had access to a range of activities and were consulted about the types of activities they wanted to take part in.

Well led '

People told us they had confidence in the manager and they were approachable and listened to what they had to say. We saw the home held meetings for people who used the service and/or their representatives to give them the opportunity to share their views and make suggestions for improvements to the service.

The staff we spoke with said they enjoyed working at the home. They said they worked well as a team and felt supported by the manager.

However, we found the service did not have an effective system in place to identify, assess and manage risk. We have asked the provider to tell us what they are going to do to make sure they have an effective process in place to identity, assess and manage risks to the safety and welfare of people who use the service and others.

One person who used the service said 'I can go into my bedroom whenever I want to. I'm all right here. The staff are pleasant'. Another said 'I get up about half past eight but I can go back to bed whenever I want. I like my bedroom. It's a nice big room. We have a bingo day and the activity coordinator is very good'.

One person's relative told us they were involved in planning their relatives care. They said 'I know all the staff; they are very friendly and helpful. They understand my relative's condition and how to handle this. There's not much change of staff. It's a stable staff. I can go home relaxed because I know (my relative) is safe and well looked after'.

We found people's needs were assessed and care was planned and delivered in a way that was intended to ensure people's safety and wellbeing.

We found people were provided with a varied and nutritious diet.

We found people were cared for in clean and hygienic environment.

We found there were usually enough qualified, skilled and experienced staff to meet people's needs. However, one person who used the service said they thought they were sometimes short of staff which meant they had to wait for help.

People were protected from the risk of receiving inappropriate or unsafe care because records were managed appropriately.

We reviewed the care files of three people who used the service and found procedures were in place to ensure that consent was gained from the person or their representative in relation to the care, support and treatment provided. We saw care plans clearly identified the needs of the person and included information on how they wished their care to be delivered.

We spoke with six visitors and they told us they had no concerns at all about the standard of care their relatives received. One person said "The staff help my relative without being intrusive". Another person said "I have no doubt at all that people are well cared for, I have every confidence in the manager and staff."

We spoke with one qualified nurse and five care staff and they told us there were clear lines of communication and accountability within the home. They told us they were supported by management to carry out their roles effectively through a planned programme of supervision, appraisals and training.