Archived: Mill Lodge Residential Care Home

Mill Lodge Residential Care Home provides personal care and support for up to 16 people aged 65 and over, some of whom are living with dementia. The service does not provide nursing care. Mill Lodge Residential Care Home is a residential care home situated on the outskirts of Great Harwood, Lancashire. There were 14 people living in the home at the time of the inspection.

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

People told us they felt safe and were happy with the service they received. They said staff were kind and they were treated well. Staff understood how to protect people from abuse and recruitment processes ensured new staff were suitable. We discussed improving the processes around the use of agency staff. There were enough staff to meet people's needs and to ensure their safety; additional staff were being recruited. People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments enabled people to retain their independence. Infection control was well managed, and the home was clean and free from hazards. Improvements were being made inside and outside the home; there was a plan to support this.

Management and staff had developed friendly, caring and respectful relationships with people and their families. People were treated as individuals which helped protect their dignity. People's equality and diversity was respected and care was tailored to their needs, routines and preferences. Staff knew people well. Safe visiting processes were in place to ensure people could see their visitors and could maintain relationships that were important to them. People spoken with, did not have any complaints about the service but were confident they could raise any issues.

People were happy with the way the service was managed and staff told us they enjoyed working at the home. The systems to assess and monitor the quality of the service and the practice of staff, had improved. Appropriate action was taken when shortfalls were noted. The management of records relating to people's care and to the management of the home had improved. People’s views and opinions of the service were sought and 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 requires improvement (published 21 May 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced focused inspection of this service on 29 and 30 April 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 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 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 Mill Lodge Residential 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Mill Lodge Residential Care Home provides personal care and support for up to 16 people aged 65 and over, some of whom are living with dementia. The service does not provide nursing care. Mill Lodge Residential Care Home is a residential care home situated on the outskirts of Great Harwood, Lancashire. There were 14 people living in the home at the time of the inspection.

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

We found the systems to monitor the quality of the service were not effective. We found shortfalls around medicines management, care planning, infection control, the environment, recruitment and record keeping that had not been identified. We were also concerned that staff had not reported obvious shortfalls such as gaps in the medicine records, environmental shortfalls and the absence of window restrictors and the registered manager had not addressed actions from the last inspection. The registered manager was aware of the shortfalls in service delivery and was able to discuss improvements going forward.

Records relating to people’s care and to the management of the home were not always accessible, accurate or organised. We found the records relating to the servicing and maintenance of equipment and systems were not well organised and some servicing was overdue. Care records provided staff with guidance about people's diverse needs but did not always fully reflect the care and support people were receiving; the registered manager was addressing this. The risks to people's health, safety and wellbeing were assessed and clear guidance was provided for staff. Accidents and incidents were recorded, and the information was analysed to determine whether appropriate actions had been taken.

The home needed redecoration and refurbishment; this was noted at the last inspection. We found improvement work had commenced; the registered manager was able to describe the work needed but there was still no formal plan to support this. People living in the home were happy with the improvements so far, whilst others described the environment as ‘shabby’ and ‘outdated’.

Employment checks were carried out on new staff before they were employed. We discussed how the process could be improved. Prior to the inspection, concerns were raised about the numbers of staff available at the weekend which could impact on people’s supervision and choices. The registered manager assured us this would be reviewed, using an appropriate assessment tool, and acted on. Relatives and people living in the home made positive comments about the care and support provided by staff.

People's medicines were managed and stored safely, and records were clear. However, improvements were needed in relation to recording the application of creams. We were assured the registered manager and staff were making sure infection outbreaks could be effectively prevented or managed. However, we were concerned that advice issued at the last inspection regarding safe disposal of PPE and health risk assessments had not been followed. Following the inspection, the registered manager advised this had been addressed.

The registered manager and staff were clear about when to report incidents and safeguarding concerns to other agencies. Relatives said staff were knowledgeable about their family members and they were kept up to date and involved in decisions. They had no concerns about the safety of their family members, and we observed good interactions between staff and people. One person said, “They are very good; very patient.”

People looked settled and we observed them being treated with care and respect; they were engaged in various activities and discussions with staff. People and staff told us communication was good. Relatives confirmed they had been kept up to date and involved in any changes and decisions. They made positive comments about the care and support provided by staff particularly during the pandemic. Restrictions on visiting had recently been eased and this was being managed safely. People's views and opinions were sought through day to day discussions and surveys. People were regularly consulted about the standards of the meals; we noted positive feedback. The registered manager told us customer satisfaction surveys would be sent to relatives and professionals. We discussed the importance of giving staff the opportunity to share their views and to ensure they were kept up to date and made aware of their individual responsibilities and contributions to service delivery.

Management and staff worked in partnership with external agencies and had good links with a variety of professionals to enable effective coordinated care for people. We received positive feedback from a healthcare professional.

The registered manager understood their responsibility to be open and honest when something went wrong. People told us the management team were approachable and visible in the service. The registered manager and staff worked in partnership with a range of professionals to ensure people received the care and support they needed. Staff told us they received regular training and were supported.

Rating at last inspection

The last rating for this service was good (published 25 November 2019).

We also carried out an unrated targeted inspection to look at the infection prevention and control measures in place (published in February 2021). We discussed areas for improvement including displaying appropriate signage, introducing checks on visitors health before they entered the home and ensuring staff in high risk groups and those not receiving vaccination were subject to a risk assessment. We signposted the registered manager to local agencies for assistance with this.

Why we inspected

We received concerns in relation to staffing, conduct of staff and care practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led. 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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mill Lodge Residential Care 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 and 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.

During this inspection, we have identified breaches in relation to Regulation 17 – record keeping and quality monitoring systems and Regulation 15 – premises and equipment. We also made recommendations about the management of external medicines and staffing.

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

We found the following examples of good practice.

Personal protective equipment (PPE) stations and hand sanitiser were available throughout the home. There were enough stocks of PPE and management and staff were using this correctly. Staff were able to don and doff their PPE safely and had received training in the use of PPE, infection control and hand hygiene. The correct use of PPE was regularly monitored. We discussed displaying prominent signage to remind staff, visitors and people about the use of PPE, the importance of washing hands and the regular use of hand sanitisers; the registered manager agreed to address this.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included regular testing of staff and people living in the home and testing of visitors to the home, when restrictions allowed. We noted there were no health checks on essential visitors before entering the home; the registered manager agreed to address this. We discussed ensuring staff in high risk groups and those not receiving vaccination were subject to a risk assessment; we signposted the registered manager to local agencies for assistance with this.

There were enough staff available to provide people with safe and effective care and support and to provide continuity of support should there be a staff shortage. The registered manager told us staff were valued and appreciated for their hard work and commitment.

There was a good standard of cleanliness in the home. Enhanced cleaning schedules, additional housekeeping staff and adequate ventilation were in place. We suggested using pedal bins in the home and particularly for safe disposal of PPE. The atmosphere of the home was calm, and we observed good interactions between staff and people living in the home.

Visiting was subject to government restrictions and a national lockdown was in force. In line with visiting guidance, all visits had been restricted and were only allowed in exceptional circumstances. Policies reflected this and were being further reviewed. People were supported to maintain contact with their relatives in different ways including the use of social media, window visits and telephone calls; this assisted in promoting people's emotional wellbeing. Guidance was followed to ensure people were safely admitted to the home during the pandemic.

The provider’s infection prevention and control policies and procedures were up to date and audits had been carried out on a regular basis. The provider also had a business contingency plan and had developed guidance and risk assessments in relation to the current pandemic.

Mill Lodge Residential Care Home provides personal care and support for up to 16 people aged 65 and over, some of whom are living with dementia. The service does not provide nursing care. At the time of the inspection there were 12 people living in the home.

Mill Lodge Residential Care Home is a residential care home situated on the outskirts of Great Harwood, Lancashire. The accommodation includes a small lounge and a dining room with a conservatory. There is one double bedroom and 14 single bedrooms over two floors. A passenger lift provides access to the first floor.

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

There was a friendly atmosphere in the home and staff clearly cared about people. People told us they felt safe and were treated well; they said staff were kind and caring. Staff understood how to safeguard people from abuse and knew how to report any concerns about poor practice. There were enough numbers of staff to meet people's needs and ensure their safety. Staff told us they were happy working at the service. Recruitment checks were carried out before new staff started to work in the home; improvements were being made to this process. People received their medicines when they needed them from staff who had been trained and had their competency checked.

Risk assessments were carried out to enable people to maintain their independence and receive care with minimum risk to themselves or others. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were protected from the risks associated with the spread of infection.

Arrangements were in place for staff to receive induction and ongoing training. Staff were supported with regular supervisions and were given the support they needed to ensure they could deliver care effectively. People enjoyed the meals and were supported to eat a nutritionally balanced diet; they had access to various healthcare professionals, when needed. People were happy with their bedrooms and with the communal areas. However, most areas of the home needed redecoration and refurbishment; the registered manager was aware improvements were needed. However, there was no development plan to support this. We made a recommendation that a development plan was recorded to support planned improvements in the home.

Staff treated people with kindness and respect and spent time getting to know them and their specific needs and wishes. We observed warm, friendly and caring interactions between staff and people. Staff knew about people's routines and preferences and, where possible, had been consulted about their needs.

People's care and support needs were assessed prior to them living in the home. Some people, or their representatives, were consulted about, and involved in the care plans. The information in the care plans had improved and described people’s health, care and support needs and included preferences and daily routines. From our discussions and from looking at records, we found people had enjoyed a number of activities however, others said they were bored. People were supported to maintain contact with friends and family. People knew how to raise a complaint or concern if they needed to and had access to a complaint’s procedure.

The registered manager provided good leadership and support and sought people’s views about the quality of care provided. The feedback was used to make improvements to the service. The systems to monitor quality and the management of records had improved. The quality of the service was effectively monitored, and appropriate action was taken to improve the service when needed. Lessons had been learned and shared with staff when things went wrong.

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 22 November 2018).

At the last inspection, we found a continued breach of the regulations in respect of management of medicines and a lack of effective monitoring systems. We also found a breach of the regulation in respect of records management. 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

This was a planned inspection based on the previous rating.

Follow up

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

Mill Lodge Residential Care Home is located in the town of Great Harwood, near Blackburn. There are facilities on two floors, which could be accessed by a passenger lift. There was a small seating area and car parking to the front of the house.

Mill Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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. The care home accommodates 16 older people, some of whom were living with dementia. At the time of the inspection, there were 11 people living in the home. Nursing care is not provided by the service.

The service was managed by a registered manager who is also one of the service providers. A registered manager is a person who has registered with 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 carried out on 2 and 5 February 2018, we found breaches of the regulations in respect of medicines management, risk management and a lack of effective monitoring systems. We also found the service had failed to notify CQC about serious incidents and deaths in the service. The provider was served with a penalty notice (fine) for failing to send us notifications in relation to notifiable incidents and events in the home.

At the last inspection, the overall rating for the service was 'Inadequate' and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. At that time, we asked the provider to complete an action plan to show what they would do to improve the service and by when.

Following the last inspection, regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection prevention control team and local commissioners of services had worked with the management team and staff to support them with improvements. The provider had voluntarily suspended admissions to the home until the commissioners were satisfied that significant improvements had been made. A recent agreement was in place to allow a restricted number of admissions to the home. An action plan was available to support further improvements and was regularly updated by the provider and shared with local commissioners and CQC.

At this inspection, we found the rating had improved to ‘Requires Improvement’.

We found the registered manager and staff had made a number of needed improvements since our last inspection. However, some of these improvements had been introduced over a short period of time and further work was needed to embed these processes into the day to day practice at the home. In addition, our findings demonstrated there was a continued breach of the regulations in respect of management of medicines and a lack of effective monitoring systems. We also found an breach of the regulation in respect of records management. You can see what action we asked the provider to take at the back of the full version of the report.

New quality assurance and auditing processes had been introduced to help the registered manager to effectively identify and respond to matters needing attention. We saw evidence of regular monitoring that had identified shortfalls in the service and appropriate action had been taken to address the shortfalls. However, the audit tools had not identified the shortfalls found during the inspection in relation to medicines management and records management. People's opinions on the quality of care provided were sought.

The management of people’s medicines had improved. The clinical commissioning group medicines optimisation team had supported the staff and they were making good progress to address the shortfalls found. However, we found there were still some shortfalls in medicine management practices in the home and further improvements were needed. People received their medicines when they needed them and staff administering medicines had received training and supervision to do this safely.

There had been improvements made to the systems, processes and records in a short space of time; this meant that some of the records, such as risk assessments and auditing tools, were duplicated and difficult to locate. The registered manager was aware this needed action to reduce the risk of people not receiving the care they needed. We found a number of policies and procedures were not up to date with regards to current legislation and did not provide management or staff with safe and up to date guidance. We found people’s care records and staff members’ personal information were stored securely in locked cabinets and were only accessible to authorised staff.

Risk assessments had been developed to minimise the potential risk of harm to people. They had been reviewed in line with people's changing needs. The registered manager and staff had accessed training, support and advice to help them develop their systems in this area and had taken steps to improve their awareness with the reporting and recording of incidents and accidents.

Safeguarding adults' procedures were in place and staff had received additional training. Staff understood how to protect people from abuse and how to report any concerns. Staff awareness of their duty and responsibility around safeguarding had improved to ensure appropriate reporting of concerns to the local authority and CQC. People told us they felt safe in the home and that staff were caring. People appeared comfortable in the company of staff and it was clear they had developed positive trusting relationships with them.

People were supported to have 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. Since the last inspection, staff had received additional training to help them understand the requirements of the Mental Capacity Act 2005 (MCA). People's consent to various aspects of their care was considered. The registered manager was aware the recording of information about any restrictions placed on people needed to be improved.

Records relating to people's care and support had improved although, at the time of our visit, there was some duplication of records which could cause confusion. Staff knew people very well and the information in the care plans included information about their needs and preferences. The registered manager was aware further improvements were needed to ensure the care records fully reflected the care and interventions that were being provided. People's care and support had been kept under review and, where possible, people and their relatives were involved in decisions and reviews about their care. Relevant health and social care professionals provided advice and support when people's needs changed.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. However, improvements were required to the recruitment and selection procedures to ensure a robust and fair process was followed. Following the inspection, we were told action was being taken to improve this area. Arrangements were in place to make sure staff were supported, trained and competent. People considered there were enough staff to support them when they needed any help. Staff told us they enjoyed their work and spoke positively about the support and guidance they received from the registered manager.

The environment was clean and adaptations and decorations had been adapted to suit the needs of people living at the home. The service had been supported by the local authority infection prevention and control team and improvements were being made in line with recommendations made. Equipment was stored safely and regular safety checks were carried out on all systems and equipment. Improvements had been made to the home but there was no development plan to support this.

People told us they enjoyed the meals and their dietary needs and preferences were discussed and met. People were offered a choice of meal and food and drinks were offered throughout the day. People were encouraged to participate in activities of their choice. We observed staff spending time chatting to people, listening and singing to music and watching movies.

People and staff were happy with the service provided and considered the service was managed well. People did not have any complaints but knew how to raise their concerns. People felt they had been involved in decisions and were happy with the care and support they received; they made positive comments about the staff and the registered manager and about their willingness to help them.

Mill Lodge Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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. The care home accommodates 16 people. At the time of the inspection, there were 11 people who received support with personal care as nursing care is not provided at this home.

The service was managed by a registered manager who is also one of the service providers. 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 October 2016, the service was rated ‘Good’.

At this inspection we found that the quality and safety of the service had deteriorated. We found shortfalls in relation to the management of risks associated to receiving care. This was because staff had not always sought medical advice when people had suffered unwitnessed falls and had failed to report serious injuries to safeguarding authorities; quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and failure to drive improvements. There was a failure to notify the Care Quality Commission of serious incidents in the service and notifications of death had not been submitted.

We found there were five breaches of the Regulations. These were breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 16 and 18 of Care Quality Commission (Registration) Regulations 2009. You can see what action we told the registered provider to take at the back of the full version of the 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'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The systems and processes for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. There were medicine audits, care plan audits and health and safety audits however we found concerns that had not been identified by the audits. Internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. However, the risk assessments were not always reviewed in line with people’s changing needs. In addition there was lack of appropriate risk assessments and risk management processes relating to the people who are at risk of falling out of bed.

Staff had received safeguarding training however, local authority and national safeguarding reporting guidelines had not always been followed. Some significant incidents had not been reported to the local authority and the Care Quality Commission. Accident and incidents had been recorded and staff had sought medical advice where required. We found this was not always consistent in all cases especially incidents involving unwitnessed falls. Improvements were required to demonstrate what support people had received following incidents such as repeated falls.

People received their medicines as prescribed and staff had been trained in the safe management of medicines. However, there were some shortfalls in medicine management practices in the home.

The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. However, some improvements were required to ensure staff understanding of the requirements of the Mental Capacity Act 2005 (MCA). People’s consent to various aspects of their care was considered and where required Deprivation of Liberty Safeguards (DoLS) authorisations had been sought from the local authority. However, mental capacity assessments were not decision specific and DoLS conditions had not been fully met.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. However, improvements were required to the recruitment procedures.

Care plans were in place detailing how people wished to be supported. People and their relatives were involved in care planning. However, this had not always been recorded. People’s independence was promoted.

Feedback from people and their relatives regarding the care quality was positive. People who lived at the home told us that they felt safe. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider.

There was an infection control policy and the risk of infection was adequately managed.

Risk associated with fire had been managed and fire prevention equipment serviced in line with related regulations.

The environment was clean and adaptations and decorations had been adapted to suit the needs of people living at the home.

The provider had sought people’s opinions on the quality of care provided.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Comments from people who lived at the home were all positive about the quality of meals provided.

We observed people being encouraged to participate in activities of their choice. People who lived at Mill Lodge Residential Care Home and their relatives, knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

Some staff had received induction and training. There was a policy on staff supervision and appraisals and staff had received regular supervision. We saw some staff were in the process of completing their training.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home.

Mill Lodge Residential Care Home is situated in a residential area towards the outskirts of Great Harwood, Lancashire. The accommodation includes a small lounge and a dining room with a conservatory. There is one double bedroom and 14 single bedrooms over two floors. A passenger lift provides access to the first floor. The home accommodates older people who may also have dementia.

At the time of this inspection there was a registered manager who had been in post since December 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported in her role by the home’s assistant manager.

The service was last inspected on the 18 June 2014. We found it was meeting all legal requirements applicable at that time.

During this inspection, we found the service was meeting the current regulations.

People indicated they felt safe whilst living at the service. People also added they were happy with the care they received and felt the care received was delivered by professional, caring and compassionate staff.

The provider ensured processes were in place to maintain a safe and appropriate environment for the people using the service, their visitors and staff members. Training was in place for staff to ensure they were competent in recognising the signs of abuse and could appropriately and confidently respond to any safeguarding concerns and notify the relevant authorities when required.

The service conformed to the requirements of fire safety by ensuring fire audits were up to date and relevant checks were carried out on a weekly basis to fire equipment and lighting. People using the service had personal evacuation risk assessments in situ and an additional contingency plan provided direction about what to do in the case of an emergency or failure in utility services or equipment.

The service had sufficient number of staff to support the operation of the service and provide people with safe and personalised care. People told us they never felt rushed and staff were responsive to their needs. A suitable amount of training was offered to all staff to ensure staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner. Recruitment processes were suitable and designed to protect people using the service by ensuring appropriate steps were taken to verify new employee’s character and fitness to work.

The service had processes in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Appropriate referrals had been submitted to the local authority by the home's manager and a good audit trail was seen.

The provider had considered and implemented adequate documentation to support the development of the care planning process and support the delivery of care. This was done by providing a detailed plan covering essential information care staff needed to follow, each plan was individual to the person’s need and were kept under regular review. Effective systems were implemented to maintained people's independence with daily living skills.

Staff interacted and engaged well with people. Staff were caring, respectful and understanding in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires enabling them to influence the service they received. Feedback we received from people during the inspection supported these observations.

Positive feedback was received from people using the service, visitors, and staff about the management structure. People described the registered and assistant managers as caring and approachable. Staff informed they felt well supported and that they could approach either manager with any concerns.

Care workers told us that training was on-going. One care worker said, 'We're doing a lot of training.' We saw records which identified when members of staff had completed training and when further training was required.

There were records to demonstrate that a programme of staff appraisal and supervision was in place. Two care workers told us they had found their appraisal meetings helpful.

We found that significant improvements in the standard of cleanliness in the home had been made since the last inspection. The home was clean, tidy and free from offensive odours. There was evidence to demonstrate that all members of staff had commenced training in the prevention and control of infection.

We saw that an extensive programme of redecoration and refurbishment of the home was in progress in order to improve the environment for people using the service. One visitor told us their relative had a nice room and they were happy with the care provided.

We found that members of staff were not receiving the training and support from management they needed in order to provide safe and effective care for people using the service.

We saw that significant areas of the home were dusty and dirty. Appropriate procedures for the prevention and control of infection were not in place. This meant the provider had failed to maintain appropriate standards of cleanliness and hygiene in relation to the premises.

We found that some areas of the home were cold in particular the bedrooms. One person said, 'I sit on my hands to keep them warm.' Repairs to furniture and fittings were required in some areas of the home. This meant the provider had not protected the people living in the home from the risks associated with unsafe premises.

We found that suitable arrangements were in place for the safe keeping and handling of medicines.

We noted that recruitment procedures were thorough in order to protect people from the employment of unsuitable staff.

We saw that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.

We found some unsafe practices in the management of medication which could put people using the service at risk.

We observed members of staff speaking to people in a polite and friendly manner. One person told us she didn't have to wait long when she rang the call bell for assistance.

Although we found that some improvements had been made to the system for monitoring the quality of the service provided this did not include the standard of cleanliness. We found several areas of the home were contaminated with dirt and dust.

People were enabled to make some decisions about matters which affected them. People were encouraged to maintain their independence skills. They told us they liked the food provided and they had choice menus. They told us they were treated with respect and their privacy was maintained. However we found there were some practices which did not effectively promote choices, privacy and independence.

We found some parts of the home were unclean, untidy and in disrepair which did not promote the wellbeing of people living in the home. However, the manager assured us action would be taken to address these matters.

People told us the care was good, they were getting support with their healthcare needs and they had ongoing attention from health care professionals. However we found some care plan records were not detailed and up to date, which meant peoples' needs and choices may not be known and properly planned for.

People said they felt safe living at the home and they liked the staff. We found people using the service were supported by trained, capable staff.

We found there were shortfalls in systems for monitoring and checking the quality of the service. This meant reasonable steps were not being taken to ensure people receive safe, appropriate care.