Cleveleys Nursing Home

Cleveleys Nursing Home is registered to provide care for up to 32 older people, people living with dementia or physical disabilities. The home is situated close to Cleveleys town centre. There are bedrooms on all 3 floors, and there is a choice of communal lounges and seating areas. There were 24 people living at Cleveleys Nursing Home when we inspected.

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

Records and systems were not in place or robust enough to demonstrate risk was effectively managed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; as the policies and systems in the service did not support this practice.

Some audits were not consistently applied and did not either identify concerns or drive improvement. Some information was not up to date or correct. We have made recommendations about recruitment, staff deployment and the use of person - centred language.

Observations showed people were happy and relaxed in the company of staff. Feedback about staff, manager and provider was positive. Medicines were stored and administered safely. People were supported safely, and the provider had contingency plans in place in case of emergencies. The home was clean and hygienic, and staff were seen to wear appropriate personal protective equipment (PPE).

The manager and provider were positively engaged in the inspection process and clearly understood their regulatory responsibilities. The manager and staff had been responsive in working with health professionals to improve people’s quality of life.

The service had systems to protect people from the risk of abuse and improper treatment. The service met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences.

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 07 May 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended current guidance on the proper and safe management of medicines be followed and communication related to medicines management be improved. At this inspection we found improvements had been made. At our last inspection we recommended the provider ensure schedule 3 information is shown as required, as part of their recruitment process.

The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection, and in part due to concerns received about the management of risk, staffing and good governance. A decision was made for us to inspect and examine those risks.

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

We have found evidence the provider needs to make improvements. Please see the Safe, Effective, Caring and Well-led sections of this full report.

The provider has mitigated the risks and some improvements have been made.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, consent and good governance 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 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.

Cleveleys Nursing Home is registered to provide care for up to 32 older people, people living with dementia or physical disabilities. The home is situated close to Cleveleys town centre. There are bedrooms on all three floors, and there is a choice of communal lounges and seating areas. There were 24 people living at Cleveleys Nursing Home when we inspected.

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

Best practice for the safe management of medicines was not consistently followed. Some documentation was not consistently completed. Some documentation did not have clinical oversight or evidence of clinical oversight. These were similar concerns identified at the previous inspection. Current practice on recruitment was not consistently followed. We have made a recommendation about this.

People told us they felt safe, and staff were effectively deployed so people received support when they needed it. Staff knew the help and support people required and risk assessments were carried out to minimise the risk of avoidable harm. People were supported in be involved in decisions about their care. Staff were seen to wear appropriate personal protective equipment, and visitors were welcomed into the home.

People, relatives, and staff told us there was a positive culture at Cleveleys Nursing Home. The provider worked with healthcare professionals to meet people’s needs and promote their independence. The provider and registered manager co-operated with the inspection and took swift action to reduce risks and improve the service.

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 09 February 2022). The service remains rated requires improvement. For services rated requires improvement on one or more occasions, we will take proportionate action to help encourage prompt improvement.

At our last inspection we recommended that the provider considered current guidance on the safe management of medicines and the introduction of effective communication systems to promote accurate and complete records. At this inspection we found similar concerns.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 Cleveleys Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk and the ongoing concerns around good governance.

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

Follow up

We will request an action plan 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.

Cleveleys Nursing Home is registered to provide care for up to 32 older people, people living with dementia or physical disabilities. The home is situated close to Cleveleys town centre. There are bedrooms on all three floors, and there is a choice of communal lounges and seating areas. There were 15 people living at Cleveleys Nursing Home when we inspected.

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

Best practice for the administration of medicines was not consistently followed. We have made a recommendation about the management of some medicines. The management team had auditing systems to maintain ongoing oversight of the service. However, concerns had not been escalated to the registered manager when best practice on the management of medicines had not been consistently followed. We have made a recommendation about communication systems.

The provider had made improvements to recruitment procedures to help ensure suitable staff were employed to work with people who may be vulnerable. Risks to people were assessed and documented. Systems were in place to support people visiting the home safely.

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 were provided with a choice of meals and snacks and were supported by staff to eat and drink if this was needed. Staff knew the help people needed to remain safe and had received suitable training for their role. Staff received inductions which were tailored to meet their experience and developmental needs.

The provider and registered manager had worked with the local authority and CQC to drive improvements in the home. They worked in partnership with health professionals to ensure people had access to medical support when required. The provider and registered manager had created a supportive environment were staff morale was high. Staff said they felt able to challenge poor practice and believed their concerns would be acted on.

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 September 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At our last inspection we recommended the provider made improvements within employment records to show gaps in employment histories had been explored. At this inspection we found the same concern remained in one recruitment pack we viewed. The provider took steps during the inspection to ensure the staff members employment history was complete.

This service has been in Special Measures since 10 March 2021. 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 on 21, 22 July and 02 August 2021. 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 safe care and treatment, consent and good 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, Effective 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 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 Cleveleys Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have made a recommendations about the safe management of medicines and communication systems aimed to promote accurate and complete records.

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, which will help inform when we next inspect.

Cleveleys Nursing Home is registered to provide care for up to 32 older people, people living with dementia or physical disabilities. The home is situated close to Cleveleys town centre. There are bedrooms on all floors. There is a choice of communal lounges and seating areas, although people were self-isolating in their rooms, due to the COVID–19 pandemic when we visited. There were 17 people living at Cleveleys Nursing Home when we inspected.

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

The service was not safe. Risks to people's health, safety and wellbeing were not consistently assessed or planned for. We reviewed seven care files and found inconsistencies or missing information in all of them. We found concerns with the cleanliness and maintenance of the environment. We observed staff not following good practice guidance around infection prevention and control including the use of Personal Protective Equipment (PPE). We found that staff had not received training in all areas required to support peoples assessed needs. We found recruitment records were not always complete and we have made a recommendation around this.

The service was not always effective. Not all staff had completed the necessary training to keep people safe. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not well-led. At this inspection we found failures in the provider's quality and assurance systems. Records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. This could have compromised the quality and safety of the service provided.

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

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

Rating at last inspection and update:

The last rating for this service was inadequate (10 March 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made, and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to quality assurance, risk management and people's safety. As a result, we carried out a focused inspection to review the key questions of safe, effective 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.

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.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this report.

Following the inspection, the provider took immediate action to start addressing shortfalls we identified.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cleveleys 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At our last inspection we identified breaches around risk management, infection prevention and control, staffing levels, staff training and leadership and oversight. We took urgent enforcement action and imposed conditions on the providers registration. During this inspection we have identified continued breaches in relation to safe care and treatment, good governance and staffing. Additionally, we have found a breach in relation to consent. 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 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 remains 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.

Cleveleys Nursing Home is registered to provide care for up to 32 older people, people living with dementia or physical disabilities. The home is situated close to Cleveleys town centre. There are bedrooms on all floors. There is a choice of communal lounges and seating areas, although people were self-isolating in their rooms, due to the COVID–19 pandemic when we visited. There were 20 people lived at Cleveleys Nursing Home when we inspected

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

People and their relatives told us they felt they were cared for safely by the staff team. However, this did not reflect our findings in relation to infection control and cleanliness, staffing and training, record keeping and governance.

Areas of the home were not clean and hygienic on the inspection, which increased the risk of infection outbreaks. The management team had not assessed risks to minimise the likelihood and spread of infection and in relation to COVID-19. The infection prevention and control policy gave inaccurate information which increased risks to people. Staff practice in infection control was not of a safe standard for reducing and managing the risk of infection outbreaks. After the inspection, the provider arranged a deep clean of the home, routine cleaning was increased, and infection control practice improved.

We saw the management team had not completed actions highlighted during gas and electric utilities and lift checks. The provider arranged for these checks to be completed soon after the inspection, and any actions needed were taken.

Record keeping was unsatisfactory. We saw on the inspection staff did not always assess, review and update care records and help people to manage avoidable risks. They had not always completed care plans to assist staff in providing the right care for each person. The provider told us the manager made sure people all had care plans after the inspection.

The home was not well-led, and governance was ineffective. The provider and manager did not have a system for auditing and monitoring the service to check on the quality and to make sure staff were providing good care. Where the manager completed audits, they were basic, infrequent and did not identify issues of concern. The management team did not fully understand and act on legal obligations, including conditions of CQC registration and those of other organisations. They were not aware of national and local guidance available to keep people safe and improve their well-being.

Although, Cleveleys Nursing Home is required to have a nurse on duty 24 hours a day, on the inspection the inspectors found significant periods where there was not a nurse on duty. After the inspection the manager made sure all shifts had a nurse on duty. Staff recruitment procedures were sufficient, although the manager had not provided adequate and recognised induction to assist new staff with the skills needed to give people good care. They had not overseen important training was provided to staff and this affected care practice.

Staff spoken with demonstrated an understanding about how to safeguard people from the risk of abuse. Staff supported people with their medicines safely and were reorganising the medicines room to improve medicine processes when we inspected.

We received positive feedback from people supported and their relatives about the home. They told us they felt the manager and staff team involved and informed them about their care and any changes in 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 last report (published 25 July 2018).

Why we inspected

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

We have found evidence that the provider needs to make improvements. 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.

The provider began to take action shortly after the inspection to mitigate the risks identified. This has made the home safer than it was on inspection. The provider arranged a deep clean of the home, improved infection control, arranged checks on utilities and equipment and completed the risk assessments and care plans we had identified. Staff training for infection control has been completed. However, other issues identified on the inspection still need action.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cleveleys 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to care practice, infection control, staffing, governance, record keeping and monitoring the home at this inspection.

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.

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 time-frame. 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.

This is a care home that provides nursing for 32 older people. The home comprises of three floors with lift access. Rooms have en-suite facilities and there are a number of bathrooms and toilets on each floor. The first floor has separate dining and lounge areas. Car parking facilities with disabled access to the building is available. At the time of the inspection visit there were 30 people who lived at the home.

Cleveleys Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 May 2017 we rated the service as Requires Improvement. This was because breaches of legal requirements were found. These related to incidents that affect the health, safety and welfare of people who lived at the home. Furthermore, the provider failed to ensure care planning and risk assessments were accurately recorded and personalised to ensure people did not receive inappropriate or unsafe care. In addition, medication procedures were poor and people were at risk of unsafe medication procedures that may affect their health. Also, the management team failed to properly assess the quality assurance of the service provided.

We further made recommendations for the provider to improve people’s safety and welfare. These concerned improving care and domestic staffing levels. In addition to improve infection control procedures and put processes in place to maintain the building and keep the home clean.

During this inspection, we found the provider had made improvements to ensure they met legal requirements. However further improvements were required and we made recommendations to ensure the safety of people was maintained.

At this inspection visit we found the management team had improved medication procedures. However, there were still gaps in their recording systems that were needed to ensure people received their medication safely.

We have made a recommendation about safe medicine procedures

At this inspection visit we found care plans and risk assessments required further development to ensure the right care and support was provided for people to keep them safe.

We have made a recommendation the provider seeks guidance to ensure people’s care plans and risk assessments were accurate and up to date.

Furthermore, we found they had improved their quality monitoring systems of the home in terms of more audits and seeking the views of people who lived at Cleveleys Nursing Home. Improvements were still required in terms of audits being carried out in a timely manner. The management team ensured us they were in the process of introducing systems to gain better service oversight.

We found, the building required further updating in terms of decoration and refurbishment. This would enable people to live in comfortable, pleasant surroundings. A relative we spoke with said, “The presentation of the home is below standard. It needs lots of redecorating.”

The registered manager made improvements to assessing staffing levels in relation to domestic staff being deployed. In addition, sufficient care staff were now on duty and infection control processes met people’s needs. Staff we spoke confirmed extra staff had been deployed and more time was spent with people who lived at the home.

We spoke with people who lived at Cleveleys Nursing Home, comments were positive in relation to care and support provided by the staff team. One person said, “I couldn’t live in a better place. The staff here make up for not having my family close.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Staff had been appropriately recruited, trained and supported. They had skills, knowledge and experience required to support people with their nursing care and social needs.

People had been 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.

We found meal times had become a more relaxed enjoyable experience for everyone. This was confirmed by our observations, staff we spoke with and what people who lived at the home said. One person said, “The food is really very nice.” People were positive in their comments about the quality and quantity of meals and snacks available to them.

The service had information with regards to support from an external advocate should this be required by people they supported.

People who lived at Cleveleys Nursing Home told us staff who supported them treated them with respect, patience and dignity. One person said, “I like to be called [name] and they all know and respect that.”

There was a complaints procedure which was made available to people on their admission to the home and their relatives. We found any complaints were acted upon promptly and in a timely manner.

The registered manager and staff provided a range of activities and employed an activity co ordinator. One person who lived at Cleveleys Nursing Home said, “A lot better now and the nurses take me out on my own often which is what I like.”

The registered manager used a variety of methods to assess and monitor the quality of the service. These included, staff and resident meetings. In addition, relative surveys were collected to seek their views about the service provided.

This is a care home that provides nursing for 32 people. The home comprises of three floors with lift access. Rooms have en-suite facilities and there are a number of bathrooms and toilets on each floor. The first floor has separate dining and lounge areas. Car parking facilities with disabled access to the building is available. At the time of the inspection visit there were 29 people who lived at the home.

During this inspection visit we found administration of safe handling of medicines was poor. The management team had not managed people’s medicines with a consistently safe approach. For example medicines records did not consistently provide a clear, auditable record of the treatment people had received.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment.

Care records were not consistently kept up to date. For example a referral was identified of a person requiring an appointment with a dietician. We asked the nurse if this was carried out as no documentation could be found to confirm this. The nurse informed us this had not been carried out.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment.

Since the inspection we have been informed that the person has now had input from the dietician. The person had responded to the action plan in place and their weight was now stable.

The provider failed to ensure quality assurance was up-to-date and fully assessed people’s experiences of living at Cleveleys Nursing Home. Audits failed to pick up concerns we found.

This was a breach of Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

During this inspection, people who lived at the home told us they felt safe whilst at the home. However, the reduction of domestic staff and lack of upkeep of the building may put people’s safety and health at risk. For example we found waste bins not emptied until late in the day. Also, a soap dispenser was empty and not refilled from the morning when we checked late afternoon. Other areas of the building we found windows not cleaned outside and general up keep of the building was in need of updating.

We have made a recommendation the provider seeks guidance about safe domestic staffing levels.

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify the different types of abuse and had received training in safeguarding adults. We confirmed this by talking with staff and looking at training records.

Risk assessments were in place to minimise the potential risk of harm to people during the delivery of their care.

The registered manager understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. The registered manager discussed the applications which had been authorised and the restrictions in place to make sure people were safe.

We received mixed responses in relation to food provided and the way lunch was served. Comments included, “Oh yes there is always plenty of food and drink around if you want it.” Also, “There’s no choice.” Another person who lived at the home said, “The food is good but it is not a good atmosphere.”

The registered manager had a range of training to assist staff development, skills and understanding. Staff told us access to training courses was good. The registered manager had completed a training programme for staff to follow to make sure they were well trained and equipped to support people.

During the day we observed many examples of staff maintaining people’s privacy and dignity. People who lived at the home told us staff were caring. Examples of this included staff knocked on bedroom doors before entering, also called people by their preferred term of address. One relative wrote in a survey returned, ‘I did like the way they (staff) treated [relative] in terms of respecting her privacy.’

During the inspection visit there were activities taking place such as board games and reminiscence music. However comments were mixed from people who lived at the home about activities. For example comments included, “I like the entertainers when they come.” However other comments included, “I watch television and read the newspaper. I’m bored from the minute I get up to the minute I go to bed.”

People told us they had been informed about how to raise concerns if they had a complaint. The registered manager provided opportunities for them to feed back about the quality of their care and any suggestions they may have.

Staff told us the manager was approachable and supportive in their roles. They held regular meetings to obtain staff comments, suggestions and concerns about the ongoing improvement of the home.

You can see what action we told the provider to take at the back of the full version of the report.

During our visit we looked at care records, staff training schedules and undertook a tour of the building. We observed meal times and spoke with people staying at the home. We did this to confirm people were well supported and competent staff were providing the support people needed. We observed care practices and saw people were treated with respect and dignity. Comments from people were positive and included, 'Mum was in here and I wouldn't hesitate in staying here myself the staff are wonderful.'

The people we spoke with said they were receiving safe and appropriate care which was meeting their needs. One resident we spoke with said, 'The staff are very good. They always have time to spend and chat.' Also a relative spoken with said, 'We went to a few homes but this was the best by far.'

During the inspection process we contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We also spoke with the local environmental health agency. They told us at their last visit they had no issues with the service. They rated the kitchen area 5 star excellent.

Residents we spoke with told us they were treated respectfully by staff and felt safe and secure, comments included, "They all seem dedicated at what they do. The staff are polite and kind people." Also, "Its nice to feel safe with so many staff around to help."

We spoke with staff members about individual care needs of residents. They had a good understanding of what support and care was required for each resident we discussed. Families we spoke with confirmed staff always keep them informed of any changes in their relatives care. One said, "This is the best nursing home we looked at and it has proved to be that. They always let us know if mums health changes or something happens."

We spoke with Lancashire council contracts monitoring department and they had no concerns or issues with the service.