Grace Lodge Nursing Home

Grace Lodge Nursing Home provides accommodation and nursing and/or personal care to up to 65 people over 2 floors. At the time of our inspection, there were 23 people using the service.

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

We found the service had made some improvements in the management of medicines since the last inspection, however they had not addressed all of the issues and further improvements were still required.

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.

The culture of the service was open and transparent. The registered manager and Director engaged with the inspection positively and were committed to making any necessary improvements.

The registered manager and staff had a clear understanding of their roles and responsibilities. The providers systems and processes were used effectively to measure and improve the quality and safety of the service. The registered manager promoted a positive culture which was person-centred, open, and inclusive which led to good outcomes for people. There was good working partnership with others to make sure people received all the care and support they needed.

People's relatives told us staff at the home were attentive to people’s needs and communicated well any changes to people’s care needs. Staff were kind, patient and respectful towards people and dignity and independence was promoted. People and relevant others were involved in decisions about the care provided. Staff members told us they enjoyed working at Grace Lodge; Lodge; they felt appreciated and well supported by the registered manager and provider.

People had care plans in place which were person centred and accompanying risk assessments which enabled staff to care for them safely.

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

Rating at last inspection and update.

The last rating for this service was Inadequate (published 17 March 2023).

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 the provider remained in breach of regulations.

This service has been in Special Measures since [17 March 2023]. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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, effective, 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 Inadequate 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 Grace Lodge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

At this inspection we found a breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to the failure to ensure medicines were managed safely.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider to understand what they will do to improve the standards of quality and safety and liaise 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.

Grace Lodge Nursing Home provides accommodation and nursing and/or personal care to up to 65 people over 2 floors. At the time of our inspection, there were 31 people using the service.

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

Medicines were not always managed safely. People did not always receive their prescribed medicines due to lack of stock. Staff did not always follow guidance from medical professionals when using specialised techniques to administer medicines. Medicines were not always stored safely or securely. Plans were not in place to guide staff when to administer ‘as required medicines’ to ensure they were only given when needed.

Risks to people’s health, safety and well-being were not always managed safely. Some risks assessments had either not been completed or lacked accurate information to determine the level of risk posed. Care plans lacked detailed information for staff to follow in order to manage people’s identified risks. Records relating to the safe evacuation of people during an emergency were out of date and lacked detailed information for staff to evacuate people safely.

Staff were observed following unhygienic practices whilst providing people with their breakfast. This was raised with the acting manager during the inspection. The home was visibly clean and hygienic. However, cleaning records required improvement to ensure all tasks completed were recorded. We have made a recommendation regarding this. The service was following current guidance in relation to visiting procedures and the use of masks.

Accidents and incidents had been recorded and information provided to show what immediate action had been taken to keep people safe. However, there was a lack of managerial oversight and detailed review or analysis to ensure lessons were learnt. We have made a recommendation regarding this.

Consent for care had not always been obtained in line with the principles of the Mental Capacity Act 2005. Where people had been assessed as having capacity to make specific decisions about their care, consent forms had been signed by staff and not the person themselves.

People told us, and observations confirmed, that they were supported by staff to have maximum choice and control of their lives and that staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service mostly supported this practice.

Staff did not always have access to accurate or detailed information about risks, needs and preferences regarding people’s food and drink intake; this included kitchen staff. People’s needs had been assessed before moving into Grace Lodge. However, care plans lacked detailed information about how to support people and important information from initial assessments had not always been transferred to people’s care plans.

Governance systems in place had failed to identify issues and drive necessary improvements to the safety and quality of the service people received. Audits and checks had not identified the issues we found during the inspection and where issues had been identified, action had not always been taken to address them.

Notifications of incidents had not always been reported to CQC as required by law.

We could not be certain the service promoted a person-centred culture; this was because records relating to people’s care and support lacked detailed information and guidance for staff to follow. Staff told us morale amongst the staff team had been low and that they had not always felt supported, especially when raising concerns to the previous manager.

The provider and acting manager were responsive to the feedback we provided both during and after our inspection. They provided some evidence of what action they intended to take to improve people’s care plans and had taken action to address some of the medicines issues we identified.

People told us they felt safe and interactions between staff and people living in the home were observed to be kind and compassionate. There were enough staff to support people and provide care in a timely manner.

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 25 September 2021).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s prescribed medicines. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

During the inspection process, we identified additional concerns that sat outside the key questions Safe and Well-led. We were therefore required to also review the key question of Effective.

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

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 good to inadequate based on the findings of this inspection.

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

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

Enforcement and recommendations

We have identified breaches in relation to risk management, medicines management, consent, notifications of incidents and governance.

We have made recommendations in relation to infection prevention and control practices and the review and analysis of accidents, incidents and safeguarding concerns.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Grace Lodge is a care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 65 people.

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

At our last inspection the provider had failed to ensure medicines were safely managed, effectively manage the risks associated with people’s care and implement robust processes to monitor and improve the safety and quality of care being provided. Improvements had been made to the service since the last inspection, and people were safe and protected from avoidable harm.

People received their medicines safely and as prescribed. Changes had been made to the home’s medicines dispensing and administration processes to ensure medicines were stored securely. Quality assurance processes around medicines administration had also improved. People had personalised risk assessments which gave staff the information needed to safely manage the risks associated with people’s care. Controlled drugs were managed appropriately; however we shared some good practice guidelines around the disposal of controlled drugs to ensure safe procedures were being followed.

People told us they felt there were enough staff at the home. One person said, "They are never far away from me." Staff were visible around the home and were readily available to support people when needed. Recruitment process were managed safely, and incident and accidents were well recorded and analysed for patterns and trends.

People were safeguarded from the risk of abuse. People told us they felt safe living at the home and relatives felt the same. One relative said, "It is ten out ten for making sure [relative] is safe and we are kept informed." Staff were aware of their responsibility to report safeguarding concerns. The provider had systems in place to manage concerns of a safeguarding nature.

Governance procedures had improved, and regular audits were being completed on records. There was no formal process for the provider to record their visits or checks at the home, however this has since been implemented.

People living at the home and their relatives gave positive feedback about the staff. One person said, "Lovely people." Another person said, "I feel very reassured my [relative] is here."

Rating at last inspection and update

The last rating for this service was requires improvement. (Published 26 September 2020)

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 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 carried out an unannounced focused inspection of this service on 8 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment and governance.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from 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 Grace Lodge on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grace Lodge Nursing Home is a residential care and nursing home in the Walton Vale area of Liverpool, providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 65 people with different health and care needs, including those living with dementia. Grace Lodge Nursing Home is laid out across two floors in one purpose-built setting. The ground floor had recently reopened to admission, following temporary closure during the COVID-19 pandemic.

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

When we inspected Grace Lodge Nursing Home to assess the safety and quality of people’s care, we took into consideration the significant pressures the COVID-19 pandemic had put on this service in particular. However, we found that some aspects of safe care, particularly medication and safety monitoring were not always robust. The underpinning of governance and recording systems to prevent or address issues had not always been effective. We therefore assessed that the provider was in breach of regulations regarding safe care and treatment and good governance.

We had previously received concerns regarding aspects of care not always being safe. Some relatives told us that monitoring of their loved one’s safety had not always been sufficient. We have included these concerns in our assessment that some aspects of safety and risk management at times needed to be more consistent. However, there were also examples of learning from events and issues to bring about improvements.

There was much gratitude from relatives for the dedication and commitment staff had shown to people living at Grace Lodge Nursing Home, particularly during the pandemic. People’s comments were positive, and most relatives felt their loved ones were safe and well care for at the service. One person told us, “The staff are excellent, I would not change them at all.”. Relatives told us, “ I can sleep at night knowing that [they are] safe” and “My family member was on end of life care and a few years later they are still here – they must be doing something right.”

People and staff told us the service was led by a well-respected, approachable and open registered manager. Staff were honest about the pressures on them due to changes in staffing and the service setup. They also praised the teamwork at the service, feeling the recent difficult times had brought them closer together. We observed kind, caring and person-centred interactions between people and staff. Although there were varying levels of details and information in people’s care plans, there were good examples of person-centred knowledge. Staff spent time with people to learn about their life.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 14 May 2019).

Why we inspected

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

This service’s last rating was requires improvement and we had previously received concerns in relation to infection control, the management of medicines and people’s nursing care needs. 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 remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and 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 Grace Lodge 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.

We have identified breaches in relation to the safe care and treatment of people, particularly medicines management, as well as the effectiveness of auditing systems and record-keeping at this inspection.

Follow up

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

Grace Lodge is a care home providing personal care for up to 65 older people. The home is purpose built and the accommodation is over two floors. At the time of the inspection there were 56 people living at the home.

People’s experience of using this service:

Before this inspection we received some complaints and negative feedback from relatives of people who wanted to share their experiences of Grace Lodge with us. We found during this inspection that some improvements were required to records and auditing systems.

Care plans were not always kept up to date and some information regarding wound care and management of wound care was confusing. Auditing was being completed, and actions were drawn up, however, there was only a small sample of audits taking place every month. We have made a recommendation concerning this. We received mixed feedback in relation to staffing levels, staff training and management support. We raised this feedback with the registered provider during our inspection, and they have rectified some of the issues we found and have a plan in place to address the rest. They have agreed to keep us updated with the progress of this.

People we spoke with and their relatives said they felt safe living at Grace Lodge. Checks and routine management were completed, and staff were recruited safely. There was a process for documenting incidents and accidents, and staff understood their role with regards to safeguarding. Risk assessments were in place, however, some risk assessments required reviewing, which we raised at the time with registered provider.

The registered manager was working within the principles of the Mental Capacity Act 2005, and associated legislation. Deprivation of Liberty requests continued to be monitored by the registered manager. People were supported with their eating and drinking needs, we sampled the food and found it tasted nice. The menu was displayed in the dining room, however, there was no consideration to presenting the menu in alternative formats to support people’s understanding. We raised this with the registered provider who said they would implement this. We saw, in the most part, referrals were being made when needed to external health care professionals. Staff were supervised regularly.

We observed kind and caring interactions between staff and people who lived at the home. People were complimentary regarding the staff. Care plans contained dignified and respectful information which supported people’s diverse needs.

Complaints were documented and responded to in line with the registered providers complaints policy. People were supported with end of life care needs, and the registered provider discussed with us how they were developing further training in this area. There was some mixed feedback with regards to the activities. Activities took place, but some people and their relatives felt this could be improved.

People and their relatives knew who the registered manager was. Staff team meetings took place, and people were asked to submit feedback regarding the home and their experience of Grace Lodge using a feedback form. Some of the actions from the last feedback had been implemented. The registered manager had reported all events that affected the service to CQC in line with regulatory requirements. The registered provider was already making changes to service provision and systems to improve.

Rating at last inspection: rated good report published January 2017.

The service is now rated ‘Requires Improvement’ overall.

Why we inspected: We brought the date of this inspection forward due to information we received of potential risk and concern.

Follow up: ongoing monitoring; We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

This was an unannounced inspection which took place on 15 and 16 December 2016.

The service was last inspected in July 2015 and at that time was found to be in breach of two of the regulations under the Health and Social Care Act 2008 (HSCA). The breach of regulations was due to concerns with the safe management of medicines and the application of the Mental Capacity Act 2005 for people who may lack capacity to consent to their care and treatment. The service had been rated as ‘Requires improvement’.

The service had 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 HSCA and associated regulations about how the service is run.

At this inspection we found the home to be meeting all of the regulatory requirements.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 [MCA] were followed, in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. We had some discussion, however, how this could be further improved by evidencing assessment around individual decisions; this would meet best practice and follow the principles of the MCA.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

We were given very positive feedback from the people we spoke with who were living at Grace Lodge. They told us they enjoyed living at the home and they were well cared for.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

There were enough staff on duty to help ensure people’s care needs were consistently met.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found recruitment to be well managed and thorough.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were effective in managing the home and were based on getting feedback from the people living there.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was on-going. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained.

Activities were organised in the home and these were appreciated by the people living at the home.

We saw written care plans were formulated and reviewed on-going. We saw that people were involved in the care planning and regular reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each individual person’s care needs and how they communicated these needs. People living at Grace Lodge told us that staff had the skills and approach needed to ensure people were receiving the right care. People were satisfied with living in the home and told us they felt the support offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed. We saw an example during the inspection was that the registered manager and staff liaised well with community services to support people.

We saw people’s dietary needs were managed with reference to individual needs. Meal times were a main feature of life in the home and we saw there was good staff support for people at this time.

People told us their privacy was respected and maintained. When we observed staff interacting with people living in the home they showed a caring nature with appropriate interventions to support people.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records. We spoke with 16 of the people who lived at the home, seven relatives and eight members of staff. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed and risks to people's safety were assessed and managed.

Accidents and incidents were being recorded appropriately and action was taken in response to these.

The provider had systems in place to monitor staff practices and to ensure risks to people's health and wellbeing were managed.

People's capacity to make decisions had been assessed and the manager was aware of their responsibility, in line with the Mental Health Act 2005, to refer to external professionals if it was felt that a person was being deprived of their liberty.

Is the service effective?

People's needs were assessed prior to them moving into the home. Care was then planned and delivered in line with people's assessed needs.

People received the care and support they required to meet their needs and maintain their health and welfare. Checks were in place to monitor and review the care that people received to make sure people received the right care and support that met their needs.

Is the service caring?

People who lived at the home told us staff were caring and respectful. People's comments included: 'The carers are very good' and 'They have patience and just do the job calmly with kindness and thoughtfulness.'

Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity. We saw that staff were respectful and warm in their interactions with people.

Is the service responsive?

The service worked well with other agencies to make sure people received the care and treatment they needed. GPs and other health professionals were referred to promptly when people required support with their health care needs.

We spoke with a visiting health professional and they gave us good feedback about the home and told us staff carried out their instructions appropriately.

We found there were few activities for people who lived at the home to take part in. There were no designated staff to support people with activities and care staff told us they were too busy supporting people with their care needs to also provide support with activities.

We found there were only two permanent qualified nurses working at the home at the time of our inspection and one of these was the Registered Manager. There were five vacant posts for qualified nurses and the vacancies were being covered by the manager, the deputy manager and a high use of agency staff. As a result we judged the provider did not have sufficient numbers of suitably qualified, skilled and experienced persons employed at the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on areas of practice such as care planning, wound management, infection control, management of falls, fire safety, staff supervision and training.

People who lived at the home and their relatives were also surveyed about the quality of the service and their feedback was acted on.

The manager ensured staff received up to date training. Staff told us they felt well supported and we saw that they were receiving regular supervision and appraisals.

We found that people's records had been reorganised making it easier to find relevant information essential to their care and welfare. Records had been regularly reviewed and were up to date.

"I can't fault them.'

'They don't rush you."

'I feel safe and contented here.'

'The staff will do anything for you.'

'We have no complaints at all.'

'There is a choice of food.'

'They communicate with us.'

' All the staff are really lovely.'

The scheduled inspection was brought forward due to concerns raised about Grace Lodge Nursing home in regards to an increase in safeguarding referrals and concerns raised about the care of people living in the home.

During our inspection we found evidence that care records for the people who used the service were not all up to date and did not contain enough information or relevant risk assessments for people to be cared for safely and effectively.

People who we spoke with told us that they felt safe and had no concerns about the care they had received from staff. We saw that appropriate safeguarding records were kept and reported on. We found that relevant employment checks were made on staff working in the home.

There was a singer performing and a number of residents were watching this and clearly enjoying the show. One resident said, 'I like it when there's a 'turn' on, we have a fair few.'

We saw carers spending time with residents in communal areas, and also chatting with those residents who had chosen to stay in their rooms. We chatted with a resident who generally, preferred to stay in her room and she told us, 'I like my own company, but they (the carers) do pop in and see me and it's nice to see their faces.'

We spoke with a number of residents as well as two visiting relatives, during our visit. We received some very positive feedback. Comments included:

'The staff here are brilliant. Nothing ever seems to be too much trouble.'

'It's lovely here, they are all very good to me.'

'I can come and go as I please. I go out a lot!'

'I don't ever mind visiting here. They are all very welcoming and you don't feel like you shouldn't be here.'

'They seem to look after people here very well. I've never seen anything to make me worried.''

We looked at a number of areas during the inspection, which included how the home promoted the care and welfare of people using the service and how they safeguarded the rights of people who were not able to consent to treatment. We found that the service was compliant in all the areas we assessed.