Woodend Care Home

Woodend Care Home is a nursing care home providing personal and nursing care to up to 79 people. The service provides support to older people, some of whom were living with dementia, over three floors in one adapted building. At the time of our inspection there were 54 people using the service.

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

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.

People felt safe living at Woodend. Risks were identified and guidance was in place to manage them. People received their medicines as prescribed. There were enough staff to meet people’s needs. Staff were safely recruited. Equipment was regularly checked and serviced in line with legal guidelines. Incidents and accidents were reviewed for any learning to reduce further occurrences. The home was clean throughout and infection control was well managed.

Staff had the training and support to carry out their roles. Staff said the management team were visible in the home and approachable if they needed to speak with them. People’s health, nutritional and hydration needs were being met. Referrals were made to medical professionals when 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.

People and relatives said the staff were kind, caring and respectful. Staff knew people’s needs and preferences. People’s cultural needs were met.

Care plans provided guidance for staff in meeting people’s needs. We were told the care and support at the end of people’s lives was good. One care plan had not synced correctly to the hand held devices used by the care assistants. This was resolved and the reasons identified to reduce the risk of it happening again. The activity team had been increased and a planned programme of activities was in place.

A quality assurance system was in place. Regular audits were completed, and any actions identified assigned to a named person with agreed timescales for completion. The provider had oversight of the service through provider audits and frequent visits to Woodend by the regional managers. Relatives said there was good communication with the staff team and any concerns they had were addressed.

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 requires improvement (published 25 September 2020).

Why we inspected

This inspection was carried out to follow up on the requires improvement rating at the last inspection.

Follow up

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

Woodend Care Home is a care home providing personal and nursing care to 52 younger and older adults and people living with dementia. The service can support up to 78 people.

The accommodation is over three floors. One floor provides dementia care with the remaining two floors providing nursing and residential care.

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

We received good feedback about the home. This reflected a positive culture change within the service since the last inspection in December 2019. A new registered manager was in place and improvements to governance systems had been effective. In order for the service to be rated good sustained improvement is required over a period of time.

Effective systems were in place to ensure that all areas of the home were safe. Infection prevention and control was well managed. Systems had improved to ensure people now received their medicines safely and issues with oral care had been resolved. Staffing levels were safe and people told us they felt safe.

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 12 March 2020) with breaches in Regulations 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

This service has been in Special Measures since March 2020. 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 carried out an unannounced comprehensive inspection of this service in December 2019. Breaches of legal requirements were found and we served two Warning Notices for Regulations 12 and 17.

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 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 Woodend Care Home on our website at www.cqc.org.uk.

Follow up

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

Woodend Care Home is a care home providing personal and nursing care to 72 younger and older adults and people living with dementia. The service can support up to 78 people.

The accommodation is over four floors. One floor provides dementia care with the remaining three floors providing nursing and residential care.

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

Medicines were not always managed safely. The unsafe management of medicines had been highlighted in the last four inspections. There were mixed responses on staffing levels although there had been an increase in staffing since the last inspection. Risks were assessed and explored. The safety of the premises was monitored. Staff were recruited safely.

The provider had audits in place to monitor and improve the service, however, the audits had not identified the repeated concerns we found with the safe management of medicines. The home had worked with the Clinical Commissioning Group and local authority to improve after the last inspection and a home improvement plan was in place, however, the safety of medicines was still at risk.

There was a lack of support with oral care and some people did not have oral care, care plans in place. We could not be assured every person in the home was receiving appropriate support with oral hygiene.

Care plans were in place but did not identify a lack of information about a serious health concern for one person. Information about the assistance people received with personal care was not always clearly recorded. We observed activities were not always completed with people during our inspection, however, there was an activity timetable and there was mixed feedback about the activities available. People were supported to remain at the home at the end of their life

People were supported to access health and social care professionals in a timely manner. An assessment of needs was completed prior to people moving into the service to ensure the home could meet the person needs. People received a varied and nutritional diet. Meal times were relaxed, and support was given to those who needed it.

People and relatives were kind and caring and we observed some kind interactions from staff to people living in the home. Staff could describe how to support people’s privacy and dignity and described how to give person-centred care.

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 24 December 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines and the leadership of the home at this inspection.

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

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

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

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

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.

This inspection took place on 25, 26 and 31 October and was unannounced. The service was last inspected on 20 and 21 September 2017 and received an overall rating of requires improvement. The previous report found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance.

During this inspection we found that the provider had met some of the previously breached regulations. Although we found that improvements had been made we found three further breaches of the Health and Social Care Act 2008 (Regulated-Activities) Regulations 2014. These breaches were around safe care and treatment, staffing levels and good governance.

The service didn't have a registered manager at the time of our last inspection. A registered manager has now been in post since January 2018. 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.

At this inspection we found that there had been improvements to the service. Recruitment procedures were now being followed correctly and all the required checks had taken place in the files that we examined. Quality monitoring reports from Trafford Council and Woodend’s monthly and six-monthly audits demonstrated that there had been improvements since the last inspection.

Despite some improvement we still had concerns about how medication was being managed. We found one person whose PRN protocol was not in place. All annual medication competencies were now completed and up to date.

People who used the service, families, visiting professionals and the majority of staff raised concerns about the level of staffing in the home and the use of agency staff. Staff were visibly under pressure, during the inspection, to keep on top of their work. The use of agency staff had reduced by half compared to the same period 12 months ago and they had just recruited seven new carers and two new nurses who were due to start next month.

Staff were aware of their responsibilities to safeguard people from abuse and risks to people's safety were assessed with guidance on how to minimise the risks. The service also had a whistleblowing policy and staff reported feeling able to report poor practice if required.

Inspection of care records showed that risks to people's health and well-being had been assessed and that plans had been put into place to manage the identified risks.

Systems were in place to monitor the safety of equipment and all other required checks were up to date, including fire safety and gas safety checks. We saw infection prevention and control policies and procedures were in place and staff we spoke with understood the importance of infection control measures. On-site laundry facilities were well resourced and well managed.

We did find hazardous substances unattended in one of the bathrooms and a window restrictor needed fitting in a top floor window. The monitoring systems had failed to pick these two issues up. The registered manager responded quickly to resolve both issues on the day of the inspection.

All the people we spoke to reported feeling safe.

People’s needs were thoroughly assessed before admission. Clear guidance was in place explaining how people’s needs would be met and this was reviewed and updated monthly. This included regular daily checks to monitor people’s personal care.

People continued to receive support with their nutrition and hydration. Advice and guidance from health professionals had been included in the support plans. People liked the food and could choose what they wanted to eat and told us that they liked the food.

The home environment required improvement. We have made a recommendation about the need for further improvements to make the home more dementia friendly.

The service continued to work within the principles of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of involving people as much as possible in their care and acted in their best interests if decisions needed to be made on their behalf.

The home was caring and we observed positive interactions between staff and residents and feedback from both residents and relatives reported that staff were caring.

People’s communication needs were routinely assessed and their views and likes and dislikes were factored into their care plans. The home removed barriers to good care and complied with the Equality & Diversity Act 2010.

People’s independence was promoted by staff on a daily basis. We have made a recommendation about promoting people’s access to independent advocacy. End of life care was good. The home had been accredited with the North West Six Steps end of life programme.

Care was person centred. People were involved in their care and their views and preferences had been recorded. Effective joint working with health and social care professionals was routine.

Activities in the home had improved. People, their families and staff had reported this improvement to us during the inspection.

People’s communication needs were routinely assessed. The service met the Accessible Information Standards.

People using the service and staff reported that things had improved since the new registered manager had been in place. Further improvement was required to ensure that safety audits are more thorough.

We inspected Woodend Care Home on 20 and 21 September 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming.

Woodend Care Home (known as 'Woodend' by the people who live and work there) can provide nursing and residential care for up to 79 older people. At the time of the inspection there were 52 people living in the home. People were supported over three floors and a basement floor had been renovated but nobody was currently living on this floor at the time of our inspection. The ground floor provided accommodation primarily for people requiring residential care. The first floor provided support to people living with dementia and the top floor provided nursing care. Each floor had a communal lounge and dining room, and a small kitchen area. The kitchen and laundry room were situated in the basement. There was a lift and stairs to all floors.

Our last inspection took place on 28 and 29 June 2016 when we rated the service as requires improvement overall. We also inspected the service on 17 and 18 November 2015. At that time we rated the service as requires improvement overall and inadequate in well-led.

At this inspection we found that although there had been improvements to some aspects of the service, we identified on-going concerns and continued breaches of the regulations. We found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance.

You can see what action we have told the provider to take at the back of the full version of this report. We are currently considering our options in relation to enforcement and will update this section once any enforcement action has concluded.

The service didn’t have a registered manager at the time of our inspection. The previous registered manager had resigned from this role in August 2017. The home was being managed by two interim registered managers from other locations connected to the provider until a new manager was recruited. 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.

At the last inspection in June 2016 we found recruitment files were not completed in line with the regulations. At this inspection we found the provider was still non-complaint in this area.

Medicines were stored safely, and staff kept accurate records of administration. However, we found one person had not received a pain relief medicine as prescribed as there had been delays in ordering the medicines. We also found 'as required' medicines (PRN) protocols were not in place for two people on the Tatton unit.

The registered provider had used a dependency tool to calculate staffing levels but we found this had not been reviewed for up to eight weeks. We observed that people's basic needs were met. People and care staff told us there were enough staff on duty.

Compliance with and staff knowledge of the Mental Capacity Act 2005 (MCA) had improved since the last inspection in June 2016. Staff sought consent from people they supported before providing care. Staff were aware of the principles of the MCA and Deprivation of Liberty Safeguards (DoLS) and how to support people effectively.

During the inspection we observed two people’s finger nails ingrained with dirt and spectacles which required cleaning. We viewed their care plans and bathing records and found the level of personal care had not always been clearly recorded.

At the last inspection in in June 2016 we found people's confidentiality was not respected as care staff discussed people's care and well-being in the presence of others living at Woodend. At this inspection we observed staff discretely discussing care tasks. However, we found newly implemented supplementary care files were not stored securely on the Arley unit.

Care assessments and plans had improved since the last inspection and were seen to be detailed and person-centred. Care plans were complete and regularly reviewed. We saw any changes to care plans were reflected in handover documents to help ensure all staff were aware. Information on preferences, social history and interests were recorded.

Systems were in place to manage complaints and concerns. People and their relatives had the opportunity to give feedback on the service they received and the provider took steps to ensure improvements were made.

At our previous inspections in November 2015 and June 2016 we found feedback from some care workers about the culture at the home was not all positive. At this inspection we were informed by some of the care workers they remained unsettled by the numerous changes in management that had occurred in recent years.

The level of supervision people received varied and was not in line with the provider’s policy of an annual appraisal and supervision every two months. The provider implemented an improvement plan and this was an area highlighted.

Staff received the initial training they needed to meet people's needs. However, we noted the provider’s compliance scores were under 60% for attendance on courses such as moving and handling, infection control, and safeguarding. The home had a clear training programme in place that they were in the process of ensuring staff were assigned to key training courses.

People were happy with the food served at Woodend. However, during our mealtime observations we found the current size of the dining rooms on the Tatton and Arley unit were not spacious enough to fit everyone in. We discussed this observation with the area manager who informed us there is a plan of refurbishment for the home, but no date has yet been set for this

Two nurse at the home had received advanced training in end of life care and people had their future wishes recorded in their care plans.

People had access to activities; however we received mixed feedback with regards to the activities provided to people on the Tatton and Arley units. People were not always protected from social isolation. The range of activities available was not always appropriate or stimulating for people. We have made a recommendation in ensuring activities are fully reviewed by the provider.

Audits on the home's quality were not always completed in line with the provider’s policy, which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service. We noted the home had an improved plan for the Tatton unit, and shortly after the inspection we received the provider’s improvement plan for the entire home.

Woodend Care Home (known as ‘Woodend’ by the people who live and work there) can provide nursing and residential care for up to 79 older people. When we started the inspection 41 people were living in the home and there were admissions during the two days we were there. People were supported over three floors and a basement floor was being renovated at the time of our inspection. The ground floor provided accommodation primarily for people requiring residential care. The first floor provided support to people living with dementia and the top floor provided nursing care. Each floor had a communal lounge and dining room, and a small kitchen area. The kitchen and laundry room were situated in the basement. There was a lift and stairs to all floors.

Our last inspection took place on 17 and 18 November 2015. At that time we rated the service as requires improvement overall and inadequate in well-led. As the previous inspection in January 2015 had rated the service as inadequate overall, we placed the service into ‘Special Measures’ because it was inadequate for two consecutive inspections in one of the domains.

At this inspection we found there had been improvements which were sufficient for the service to be rated as requires improvement overall with no inadequate domains. This meant the service could come out of special measures.

The service had a registered manager who had been in post since January 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.

Recruitment files we inspected were not complete. Not all files for recently recruited employees contained records of the interviews they had, completed health questionnaires or evidence of a full employment record.

We noted improvements in medicines management from the last inspection in November 2015 and some examples of good practice in dementia care in relation to medicines. However, we saw an out of date medicine being administered, a care worker administering medicines which involved touching people and not washing their hands afterwards and found an unlocked medicine trolley in a communal area.

People told us there were not enough staff. Care workers said there were enough staff if all those rostered came to work. The registered manager had used a dependency tool to calculate staffing levels but was not sure if the information it was based upon was accurate. We observed that people’s basic needs were met on fully staffed floors and care workers struggled on those that were not.

Compliance with and staff knowledge of the Mental Capacity Act 2005 had improved since the last inspection November 2015, however, we identified three people who were being deprived of their liberty without authorisation from the local authority.

People’s confidentiality was not respected as care staff discussed people’s care and well-being in the presence of others living at Woodend. Care files were also not stored securely.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Care assessments and plans had improved since the last inspection and were seen to be detailed and person-centred. However, we identified two people who at times displayed behaviours that may challenge others that did not have care plans to help guide staff when supporting them.

The registered manager had followed the home’s policies and procedures when responding to complaints, however, people’s relatives told us they did not feel complaints they had voiced were acted upon.

Feedback from care workers about the culture at the home was not all positive. Some care workers remained unsettled by the numerous changes in management that had occurred in recent years and others were not complimentary about the current registered manager’s leadership style.

Care workers had supervision with senior staff. The registered manager was reviewing the supervision and appraisal system to ensure care workers received an annual appraisal and supervision every two months. Staff received the training they needed to meet people’s needs.

Most people were happy with the food served at Woodend. We saw the home had changed how foods were offered to people living with dementia to try and encourage them to eat more.

We saw that people had access to a range of healthcare professionals in order to support their holistic health. Feedback from visiting healthcare professionals about the home was positive.

The involvement of people and their relatives in care planning had improved since our last inspection. Care workers knew people well as individuals and we saw warm and friendly interactions between people and care workers.

Some senior care staff at the home were receiving advanced training in end of life care and people had their future wishes recorded in their care plans.

Activities at the home were much improved since our last inspection in November 2015. A second activities coordinator had been employed and feedback from people and their relatives was positive.

Feedback from the local authority and Clinical Commissioning Group about improvements made to the home since our last inspection was positive. They had lifted the embargo on new admissions to the home in May 2016.

A good system of safety and quality auditing was now in place at Woodend. We saw the provider’s recovery team had supported the registered manager to improve the service with regular meetings and detailed reviews of the home.

The registered manager had started holding regular meetings with people and their relatives to generate feedback about the home.

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-

Is the service safe?

CQC has a statutory duty to monitor the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw there were policies and procedures in place and training had been provided for staff in relation to the Mental Capacity Act and DoLS Codes of Practice.

We spoke with senior staff who showed an awareness of the process and were able to identify when an application might be required. There had been no applications made to deprive people living in the home of their liberty.

Where beds were fitted with safety rails protective bumpers were used. These were used to minimise the risk of entrapment and keep people safe.

There were contracts in place to demonstrate equipment was regularly maintained and serviced to minimise risks to people who lived at the home.

The recruitment practices were thorough and the required safety checks such as; a check with the Disclosure and Barring Services (DBS) was made before new staff started work.

The staff we spoke with were aware of safeguarding procedures and their responsibilities to report poor practice. However we saw evidence to demonstrate procedures were not being followed.

Care plans contained risk assessments in relation to people's moving and handing requirements. Some of the care plans we looked at had not been updated to reflect the changing needs of the person. For example, one person's risk assessment stated they required the assistance of two staff for transfers. We observed one member of staff transfer the person from a wheelchair to an armchair. We discussed this with senior staff who confirmed the person should be transferred with the assistance of two staff. Using inappropriate moving and handling techniques has the potential to place people at risk of harm.

Is the service effective?

Staff told us care plans were in place for each person. There was limited evidence that people had been involved in planning their care. Although care plans had been reviewed on a regular basis some of the information was outdated and gave incorrect information and some sections had not been signed or dated. This made it impossible for staff to know if the information contained was current and therefore followed.

Visitors we spoke with told us visiting times were flexible and they were welcomed by staff. We were told they were able to visit their relative in private.

Is the service caring?

We had received concerns that people were being woken early in the morning. We arrived at the home at 06:00 and walked around the building. We saw two people were up and dressed and the majority of people were asleep in their bedrooms. We spoke with the people who were up and they confirmed they preferred to get up early.

We spent time over the lunch service observing interactions between staff and the people they supported. People were offered a choice of meal and drinks. Staff were observed assisting people to eat. Staff were calm and patient explained what the meal was and encouraged the person to eat at their own pace.

We spoke with five people who lived at the home who told us staff were caring. Comments included: 'They (staff) provide everything I need.' 'They are all very considerate.' 'They are lovely.'

Staff took time to talk with people when assisting them with their care needs. The people we spoke with told us: 'It is nice here and they (staff) are very kind.' 'I am quite happy.' 'I have everything I need.' 'I am very comfortable.' 'I think they do look after us they are very good.'

We spent time observing interactions between staff and the people they cared for. We saw there was some really good practice, staff approached people with respect and worked at the person's own pace.

Is the service responsive?

There were a number of forums in place to gain people's views and opinions about the care and support they received. The manager told us a questionnaire was sent to relatives on an annual basis but the most recently completed surveys could not be found on the day of our inspection. This meant it was difficult for us to establish if the manager considered peoples comments or opinions by making changes.

The people we spoke with told us if they had any concerns they would speak to their relatives or one of the nurses.

We looked at a sample of people's care plans and saw although they had been signed as reviewed on a regular basis, where there had been changes to a person's support needs, some care plans had not been amended to record the changes.

Is the service well led?

There was a newly recruited manager in post who was registered with the Care Quality Commission (CQC). The quality manager was also visiting the home to offer support to the manager. The quality manager visited the home on a monthly basis to conduct audits and provide additional management oversight to the home.

Staff told us they were well supported and had access to training, supervision and annual appraisals. In addition the staff we spoke with told us the unit manager or registered manager were available to discuss any concerns or issues.

Staff meetings were taking place and there was a handover at the start of each shift. This was to ensure staff were aware of the most up to date information about the people they cared for. In addition there was a daily heads of department meeting where equipment and repairs were discussed and information about appointments and staffing handed over.

There was a system of audits in place that included; infection control, medication and mattresses. Although there were systems in place to support the delivery of good care we identified shortfalls in the care being provided which meant the systems in place were not properly implemented or acted upon.

Staff supervision was provided by unit managers and there was a daily heads of department meeting. The clinical lead was responsible for monitoring staff performance and quality of care.

A record of accidents and incidents was kept. We found there was conflicting information in accident reports. For example, one person had a fall resulting in bruising and a skin tear but the managers' investigation summary stated there had been no injury.

This meant it was difficult for us to establish whether the accident had been investigated or what systems had been put in place to minimise the risks of future accidents.

We looked at a sample of people's care plans. We saw that they were detailed and gave enough information about the persons care needs and preferences.

We looked at how staff managed medicines. We saw that medication was dispensed in 'blister packs' and stored in lockable trolleys in locked rooms. We saw that regular audits of the medication systems were taking place.

We looked at the equipment provided and how this was maintained. We looked at maintenance records and saw records of safety checks.

We looked at the staffing levels to make sure there were enough staff on duty to care for people who lived at the home. Records showed staffing levels were consistent.

We spoke with people who lived at the home and their visitors. Comments included: 'They are very good to X.' 'The staff are always welcoming.' 'X is very happy here.' 'They keep us up to date with everything.' 'They really do care.'

We spoke with people who used the service who confirmed that they were given choices and were spoken to with respect. One person said 'All the staff speak to me respectfully'. Another person told us 'Everything is fine, we are well looked after'.

We asked staff to tell us about how they would obtain consent from people who used the service. One staff member told us 'I always ask permission before I do anything, I explain what I am doing and why'.

We looked at six care files. All followed a standard format. We saw the files had comprehensive information which showed how people would be cared for and supported in the home.

Staff were able to tell us about the signs and symptoms of abuse and the procedures they would take if they suspected someone was being abused.

We found medicines were not always given to people appropriately.

Some of the bedrooms and bathroom rooms we looked in were seen to be cluttered. We saw two wheelchairs being stored in a bathroom, we asked the manager about this who told us storage of equipment was being addressed.

We spoke with people who used the service who were complementary about the manager. Comments received were 'Things are getting better since the new manager took over. I have no concerns ', 'Everything is fine, we are well looked after', and 'The staff are good with me I like where I am living'.

We looked around the home and checked 68 people who used the service's bedrooms. We noted that 1 floor had 3 members of staff on duty. They told that they were all agency staff. These staff were unable to tell us how many people who used the service were located on this floor. This is important in the event of a fire and evacuation. Staff did not know the names of people who used the service and had to keep referring to a list'.

We spoke with people who used the service. 1 person told us that they were concerned about the 'staffing levels' and that 'standards had dropped over the last few months' and 'was not as good as it had been'. They raised concerns over the lack of staff at the weekend. One person told us they were 'happy'.

We saw in 1 person care file that a kosher diet had been specifically requested for religious reasons. Evidence was seen in the care files that dietary instructions related to only omitting specific meat. Staff told us that family had agreed with this diet plan, however there was no evidence of this documented in the care file.