Archived: Primley Court

Primley Court is a large service located over two sites, providing nursing care for up to 80 people. Primley Court (New Wing and Old Wing) can accommodate and provide nursing and personal care for up to 51 people. A neighbouring building called The View is also part of Primley Court. This building is further up the road, it is not attached to Primley Court and provides nursing care for up to 29 people. There were 44 people living at Primley Court and 25 people living at The View at the time of the inspection.

The service provides care for older people, many who have complex health needs and are living with dementia or a cognitive impairment. Some people required a high level of staff supervision (one to one care) and support to promote their independence and safety.

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

People received care and support specific to their individual needs, choices and preferences. Staff were skilled and knowledgeable about people’s physical and mental health needs and were aware of people’s life histories and things that were important to them.

People’s risks were known and well managed and there were sufficient numbers of experienced staff available to meet people’s needs. People received their medicines as prescribed although, improvement was required in relation to recordings.

Staff were able to explain people’s individual needs and how they should be met. Care records were in the process of being transferred across to an electronic system and information was being updated to reflect people’s current needs.

People were cared for by staff who treated them with dignity, respect and compassion. Staff were exceptionally kind and caring ensuring people’s emotional needs were met which enhanced people’s well-being.

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

The service was led by a registered manager who was passionate and committed to their role and who empowered their team to continually improve the quality of care people received. The registered manager was an integral part of different initiatives to improve and develop care practice.

Significant investment in developing and training staff had resulted in good outcomes for people, particularly those who were living with dementia. People had access to a wide range of different activities which were person-centred and held either in groups or individually.

The premises were undergoing refurbishment and consideration had been given to people’s varying needs. The service had created an environment that supported people living with complex health conditions or people living with dementia or behaviours that may at times challenge.

The service was well-managed. There was a culture of continued learning, development and improvement in order to achieve good outcomes for people. Everyone felt supported by the management team and the registered manager had a good oversight of the service. The provider had systems in place to monitor and continually improve the service. The Registered manager and staff team worked collaboratively with external agencies to continually improve care practice and delivery. Clear communication processes were in place and good practice was shared.

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

Rating at last inspection

The last rating for this service was good (published 21 August 2018).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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

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

Follow up

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

The service provides care for older people, many who have complex health needs and are living with dementia or a cognitive impairment. Some people required a high level of staff supervision (one to one care) and support to promote their independence and safety.

This inspection took place on 25, 26 and 27 July 2018. The first day of the inspection was unannounced. At the last inspection on 5 and 7 July 2017, the service was rated as Requires Improvement as we found issues related to the environment, infection control. The governance procedures in place at the time of that inspection had not recognised this. In line with our enforcement policy we took action to impose a positive condition on the provider's registration, which meant on a monthly basis they were required to audit the cleanliness and standard of the environment and equipment and send us a report on actions arising from the audit. The provider took action and at this inspection we found there had been positive changes to ensure the service had improved from “Requires Improvement” to “Good”.

Why the service is rated as Good:

People were protected from the risk of infection. In the July 2018 survey 91% of people said the home was clean and hygienic. One person told us, “Always hoovered and spring cleaned thoroughly, she gets rid of all the spiders.” Relatives shared, “You don’t smell any kind of odour”; “Room is always pristine clean”; “Mum’s room is spotless, and is her personal hygiene and clothing” and “My husband’s room is ultra clean – it’s spotless.” Staff confirmed they knew when to use protective equipment such as gloves and aprons to help reduce the likelihood of cross infection. Handwashing posters in bathrooms reminded people of the importance of good hand hygiene. Infection control training and food hygiene training was in place for staff. A laundress was employed to undertake laundry duties such as people’s personal items, and an external contractor undertook the linen laundry. Bedrooms were being refurbished with many having furniture, furnishings and carpets replaced to support cleanliness, for example carpeted areas had been changed to flooring. We visited all areas of the service, checked many of the bedrooms at both locations and found all areas smelled as clean and fresh as possible. A new environmental audit continued to monitor the cleanliness of the service and equipment.

The service was very well led by the registered manager and provider and supported by a dedicated team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which might require improvement. Complaints and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. The service kept abreast of changes to maintain quality care.

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

People and their relatives told us staff were dedicated, caring and kind. One person told us, “Staff are polite and courteous, super-duper!” and “They sit and talk and sometimes I have to say I have things to do! It is lovely here; I am interested in all of them – I feel like their grandfather!” Staff demonstrated compassion for people through their conversations and interactions. They did special things which made people feel they mattered for example they celebrated birthdays and anniversaries.

We observed staff treating people as individuals with different needs and preferences. Staff understood that people’s diversity was important and something which needed to be upheld and valued. Examples were given to demonstrate how staff respected people’s different disabilities, sexual, cultural and faith needs.

People told us their privacy and dignity was promoted. People where possible and relatives all said they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the assessment and care planning process. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were very personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted. People were supported by staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by encouraging their skills and involving them in decisions. “They always ask me before helping me. Sometimes I might not want a shave and they ask.”

The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were safely managed and given to them on time. People told us, “I always have my medication regularly on time” and “I take a heck of a lot of pills. They come regularly, three times a day.” We found the temperature where medicines were stored was over the recommended 25 degrees and have made a recommendation in relation to this.

People received care from staff who had undertaken training to be able to meet their unique needs. Some staff were undertaking specialist dementia training. People’s human rights were protected because the registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known, for example, choking. People commented, “Very good food – they look after me”; “I am happy with the choices here. The food is nice and clean and tasty. It’s better to have smaller portions with a good taste rather than a load of rubbish”. People were supported to access health care professionals for example physiotherapists, dieticians and mental health nurses to maintain their health and wellbeing.

Policies and procedures across the service were in place and available for people in different formats when required. People were treated equally and fairly. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and pictures. Information about the service was available in larger print for those people with visual impairments.

We have made a recommendation in relation to the storage temperature of medicines.

Primley Court is a large service set over two sites, providing care for up to 80 people. The Court (New Wing and Old Wing) can accommodate and provide nursing and personal care for up to 51 people. The View is also part of Primley Court. This building is up the road and not attached to The Court and provides care for up to 29 people. There were 48 people living at The Court and 18 people living at The View at the time of the inspection.

The service provides care for older people, mainly people who have more complex needs and are living with dementia or a cognitive impairment. The service is part of a family run group of four other homes in the South West, two specialising in mental health care. Many people are physically fit but the nature of their condition may require a degree of staff supervision and support to maintain their safety, promote independence and well being. Other people were at the end stage of their dementia and less mobile and responded at varying degrees to sensory stimulation and one to one engagement. For example, one person with limited focus or verbal communication had tea and biscuits with their relative as staff knew this made them more receptive to their loved one’s visit.

People had their needs met. However, during our inspection we found a breach of regulation relating to some issues relating to the environment and infection control such as a dirty kitchenette and fridge on the New Wing, dirty mobility aid equipment and a poor standard of cleanliness of furniture in one room in particular.

There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

On the day of the inspection people were going about their day as they wished. On the Old Wing there were two lounge/diners, one upstairs and one downstairs and people were sitting relaxing or mobilising freely with discreet staff supervision at all times to ensure they were safe but remained as independent as possible. Staff were very visible and allocated to manage certain areas and named individuals at higher risk. Staff were vigilant in monitoring people’s body language to help them ascertain what they needed, such as company, food and drink or support with pain or anxiety. There was a calm and relaxed atmosphere on the Old Wing where the communal areas were smaller. For example, although the four people in the upstairs Old Wing lounge had very limited verbal communication, staff were always present and engaging with people, enabling one person who liked to constantly mobilise to do so freely, and reassuring another person who had little spacial awareness to move up and down off the chair safely which they liked to do. Staff sat with another person who made regular vocal sounds reassuring them when they recognised the sounds changed, indicating possible anxiety. People appeared comfortable with the staff who were knowledgeable about their individual needs.

The New Wing at The Court was a purpose built extension comprised of a large communal space, divided into an open plan area and dining area leading to a kitchenette. Seating around the large windows and space led into a smaller seating area and cinema/TV room. There was a quiet seating area off the corridor where people were listening to music or napping. The majority, (26 of the 29) people living with dementia on the New Wing were independently mobile with limited verbal communication but displayed frequent vocal noises. In response to clear risk assessments, staff were allocated to discreetly supervise and provide care and support to small groups of 3 to 5 people or on a one to one basis. This enabled people who had a need to constantly mobilise to do so safely without restriction in a circular way throughout the communal spaces. 19 people also had regular disturbed nights having minimal orientation to time despite encouragement from staff to rest. This meant some people could be very sleepy during the day. Staff knew people’s routines and which people liked to nap in the day and where they liked to be. Staff encouraged those who were constantly walking to have periodic rests if the person was looking tired. For example, one person liked to nap at a particular time of day in a particular place which staff ensured was free.

Because staff were very knowledgeable about people’s background, routines and needs. Staff were able to keep people as safe as possible. 27 people living with a cognitive impairment could often display behaviours, including aggression, which could be challenging for staff. Staff knew, and care plans supported, what potential triggers each individual could react to. However, most people displayed unpredictable behaviour based on their past history and background memories. Staff were visible and vigilant to ensure they recognised changes in mood, used distraction techniques, chatting, retreating or introducing a focus to minimise those people presenting with aggressive/destructive behaviours. For example, staff used humour to manage and diffuse any potential issues with a person who displayed overly familiar behaviour and staff ensured they did not speak to one relative in front of the person as they became angry and territorial. One relative told us they felt relieved that they could leave the home and know their loved one was safe because staff would look after them. Another relative said in a recent letter, “We must say how wonderful everyone was to Dad at Primley Court. At times he was not the easiest but that did not mean he was treated any differently. In fact it endeared him to the staff even more!”

The New Wing was a busy space but there were easily accessible quieter areas. The design of the space had been a concern during the previous inspection. During this inspection we felt the open plan space was used well. Staff knew how to encourage people towards a quieter area if they noticed a person showing signs of anxiety. However, during our inspection people did not appear distressed with staff minimising any potential triggers. Some people did not like to pro-actively engage with staff and preferred to be passively watching. Staff allowed people to be quiet and knew which people liked to watch events or activities rather than join in and included them. One relative told us, “Staff are marvellous, they allow people to be who they want to be in that moment. There is a lot to do and watch. I’m very happy.” Their relative liked to touch things and was encouraged by staff in a safe way, for example encouraging them to help with taking lunch plates to the kitchenette and fold napkins. This minimised the risk of them picking up random items and leaving them around such as shoes.

The View has a separate nursing wing and a dementia care wing. Both homes had patios and outside space. It was stormy during our inspection but staff said people did use these spaces. All the areas were in the process of being made more pleasing ready for better weather. There was a small patio through french doors on the Old Wing and a larger patio on the New Wing. A small patio area at The View was accessible from the dementia care unit. A relative said they did use this area and told us the home were planning to upgrade it. The home planned to make this more secure. One relative had suggested an outside tap to the provider so they could water the plants and this had happened. Staff said they usually accompanied people especially on the New Wing where most people required supervision to keep them safe.

People and their relatives at The View said, and we saw, staff throughout Primley Court interacted with people in a friendly and respectful way. As they supported people they all acknowledged people as they passed, stopping to chat to people walking around or sitting next to people to see if they wanted to wake and talk. Their comments were pertinent to individuals, such as asking about ballroom dancing with a ex-ballroom dancer or discussing military self defence with an ex-military trainer. One person had a very short attention span so the care worker kept popping over when they looked responsive to look at photos of dogs on an electronic tablet which the person was able to smile at.

People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff, despite their cognitive limitations. For example, choice of clothes to wear (many people liked to wear no shoes or constantly removed their socks). Two people looked unkempt but when we asked why, staff told us the people became aggressive if pressed to wipe their mouth or tuck in their top. They offered assistance when one person was calmer and left wipes within the other person’s reach.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. On occasion there were incidents between people as they met as they mobilised but staff quickly diffused the situations. They recorded any events looking at triggers and location to inform future care. Staff had previously informed the local safeguarding team of each incident between people or people and staff but had recently been sent a letter saying only to report any incidents resulting in actual harm. There had not been any recently. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

Relatives said they would not hesitate in speaking with staff if they had any concerns. They knew how to make a formal complaint if they needed, with information included in the

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

During our previous inspection on 27 April 2015, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home was rated as 'Requires Improvement'. At this inspection we found some improvements had been made. There had been financial investment in the environment and improvements had been made around safety and auditing such as the medicine systems and processes. The home had implemented an electronic care planning system that had enabled care planning to be more effective and individualised. Primley Court’s ethos was to enhance the quality of life of residents by providing a home for people that had the flexibility to adapt to the needs of individuals. Throughout the inspection we saw they were continually working to improve the service provided to ensure that people who lived at the home were content with the care they received.

However, we found there were still some aspects of the service that needed improvement. Although the service responded to concerns raised with them, the governance systems in place were not yet established or operating sufficiently robustly to always identify and address improvements that were needed, in a timely way.

People were not provided with consistently kind and compassionate support. Although some staff were kind and respected people’s privacy and dignity, we observed this was not always the case. Some staff were rushed in their interactions with people and we saw that people were not always spoken about in a respectful manner. We also saw some good examples of practice such as staff comforting people by putting their arm around them or holding their hand.

Sufficient action had not been taken to ensure the environment was safe and suitable for people. For example, in the View Unit we saw some windows did not have window restrictors and chemicals were left in an unlocked room.

The Court Unit’s ‘new wing’ presented a difficult environment for people to feel safe or experience a homely living environment as the room was noisy and busy. The Court Unit did however, have a small quiet room with a more peaceful environment, and two smaller units with lounge areas for people to use.

The View Unit had an area designed for people living with dementia with a homely feeling lounge and comfortable chairs.

People living at Primley Court can only access the garden from the ‘new wing’ of the Court Unit. People living in the View Unit and older side of the Court Unit had no access to outside space.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.

Some risk assessment and management plans included guidance for staff to enable them to support people with behaviours that might present risks to themselves or others. However, some of these needed more detail to ensure care could be given consistently and safely. For example, guidance for staff of how to support people with their anxiety and identify triggers for aggressive behaviours.

Improvements had been made to the reporting and reviewing of incident forms, which allowed for a better understanding of the incident, actions taken and to allow for a management review of actions to prevent a re-occurrence.

Prior to the inspection we received concerns about staffing levels at the View Unit regarding the provision of one to one support. We found people requiring one to one support were prioritised and regular staff, who knew them well, were employed from agencies to cover. We saw staff did not appear rushed or stretched to meet the needs of people. Staff spent time talking with people and were on hand to provide support with care needs when required. People, relatives and staff told us they felt there were enough staff on duty.

People who were able, told us they felt safe at the home. Some people were living with dementia and were unable to tell us if they felt safe. From our observations of interactions between staff and people using the service we found that people felt safe at the home.

People were protected against the risks of potential abuse. Policies were in place in relation to safeguarding and whistleblowing procedures which guided staff on any action that needed to be taken. Records showed staff had received training in safeguarding adults. Staff were able to describe to us the different types of abuse and what might indicate that abuse was taking place.

We saw there were policies, procedures in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. Records showed that the service was applying these safeguards appropriately and making the necessary applications for assessments when these were required.

A range of activities were available to meet most people's needs and particular interests. The home had four activities coordinators that interacted with people in groups and on a one to one basis. The home had a programme of organised events that included singing entertainers and a man visiting with animals. People had the opportunity to take trips out. However, there seemed to be little available to aid in reminiscence or sensory stimulation, such as rummage boxes, empathy dolls, sensory aprons or objects to stimulate people’s memories.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. People were promptly referred to health care professionals when needed.

People had enough to eat and drink and were supported to make choices about their meals. People's nutritional needs had been assessed and people were provided with meals and nutrition that met their individual dietary requirements.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. You can see what action we told the provider to take at the back of the full version of the report.

The inspection team who carried out this inspection consisted of an adult social care inspector and an expert by experience. During the inspection the team worked together to answer five key questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

As part of this inspection we spoke with 10 people who use the service, five visitors, the Registered Manager, representatives of the provider, four care staff and three nursing staff. We also reviewed records relating to the management of the home which included nine care plans and observed the care and support people received.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service caring?

We saw that staff spoke of people with a caring attitude and appropriate language. One staff member we spoke with told us about how they tailored care to meet people's individual needs. They said that if the person they were supporting was 'not used to having a shower and are frightened by them, we do the bathing in a way that is comfortable for them. Each individual is different; they need reassurance and to be talked to differently.' This told us staff treated people as individuals and thought about how to provide care to them in a person centred way.

We saw the home and family members of people had worked together to ensure potential distress could be anticipated and alleviated for people with advanced dementia. For example we saw copies of a letter in one person's file to give to the person from their relative in case they became distressed or agitated if their family member was not able to visit. This was used to help reduce the person's distress and reassure them as to why their relative was not there.

We saw staff supporting people throughout the day. The interactions we saw were kind and respectful. We saw a member of staff supporting a person who was sitting bent over in their chair with their head in their hands. We saw the staff member came down to the person's eye level and touched their hand. We saw they spoke gently to the person, starting the conversation by using the person's name and helped them sit upright. They said 'Are you a little bit tired. Do you want to sit somewhere cooler? I'll give you a nice cold drink'. We saw the person responded well and stood up with the staff member to find somewhere else to sit. They were given a cool drink.

However we also saw a few occasions when staff missed opportunities to engage with people or spoke about them without including them in the conversation. This could make people feel undermined or excluded.

Is the service responsive?

We saw the home responded to people's changing needs. A visitor told us 'They are very receptive to (name's) needs because he isn't a people person. There is sensitivity to the fact that he likes to be in his room in private.'

Prior to the inspection we had received some information about the lack of homeliness and comfort at the home and problems with the temperature levels in the conservatory. On the day of our visit this area was very uncomfortable, being hot, bright and noisy. We saw that these comments had been raised along with concerns about the main lounge/conservatory area in a recent relative's forum. A relative told us 'It's institutionalised in the lounge. It needs more homely furniture. No pictures, no curtains. In winter it is very plain. We have given up saying it'.

We saw that the provider was taking action. For example we saw evidence that showed us that air conditioning was being installed the week following the inspection. The provider told us that film was to be fitted to the roof in the conservatory to reduce the brightness and glare in this area. A study had been carried out in conjunction with the local university and older person's mental health team, part of which looked at the impact of the environment on people. We were told further action would be taken to improve comfort in this area.

Is the service safe?

We saw that there were assessments of risk undertaken of the environment, for individual people and for staff safe working practices. These had been regularly reviewed and action taken where necessary to reduce risks.

We saw there were enough staff on duty with the right level of skills to support people. Registered nurses were on duty at all times.

CQC is responsible for monitoring the deprivation of liberty safeguards which applies to care homes. No-one at the home was subject to an authorisation by the Court of Protection, although the home manager had made applications for authorisations in the past. The home manager was aware that following a recent Supreme Court judgement, applications would need to be made to ensure that where people had been deprived of their liberty, through for example locked doors, this was lawful. The manager had taken steps to speak with the local care trust about what actions to take and to prioritise applications. This told us that the provider understood the actions they needed to take to ensure that people's rights were protected and that where people were being deprived of their liberty this was in accordance with the protection of legislation.

Is the service effective?

We saw effective systems for communication within the home. We saw the way information was handed over to staff between shifts and how staff duties were allocated each day. People who needed 1:1 support had this clearly identified and any risks were highlighted.

We saw the plans had been effective in supporting people. For example we saw one person needed their food provided at a soft consistency. A nutritional risk assessment indicated they had been at risk of poor nutrition. We saw that their care plan indicated they ate their meal very slowly with staff support, and that staff needed to help the person focus on the meal even though it took a long time to help them eat at their own pace. We saw that by staff following the care plan the person's weight had increased and they were eating well with staff support.

Is the service well led?

The manager of the home was experienced and knowledgeable. Staff had a clear understanding of their role and lines of authority within the home. Discussions indicated they had a shared ethos and understood people's needs well. Staff told us they enjoyed working at the home.

We saw there were clear quality assurance systems in place. Relatives and visitors told us they were asked for their feedback about the home.

Further work was being undertaken to develop the home. For example we saw they had been involved in initiatives with the local university and older people's mental health team. Staff had developed their individual skills to become champions in specific areas such as end of life care. This had involved attending training and regular meetings outside of the home to share good practice.

At our inspection on 10 April 2013 we found that the home had made significant improvements.

We toured the home looking at six bedrooms, two toilets, two bathrooms and three lounge and dining areas. We found that the home was clean and tidy.

We saw that people's choices about their care were considered. This was supported by what we observed and what we saw in care records. We saw staff respected people's privacy and dignity. We saw staff respected equality and diversity.

We saw from care records that staff were completing mental capacity assessments for people to ascertain consent for day to day personal care and for more significant decisions.

We observed activities going on through out the inspection. People were smiling, laughing, singing and dancing. All interactions that we observed between staff and people were positive.

Staff told us that they felt supported by the manager. We saw that staff received training and regular supervision.

The home had effective systems in place for monitoring the quality of the service. The home had notified us of incidents when appropriate.

At the inspection on 8 January 2013 we looked at the care records of people who were referred to in the Warning Notice. We looked at all documents within the care records of four people who lived at the home. This included care plans, risk assessments and daily care records. We looked at incident report records and audits.

We found that people were protected from physical aggression from other individuals who lived at the home, because the home had an appropriate system in place to manage acts of violence and aggression. The home had implemented a system to monitor incidents of violence and aggression. We found that the home completed incident forms and identified patterns of aggression.

There was evidence that the manager offered staff support and guidance through immediate supervision. We saw that the home received support from external agencies which the manager and provider confirmed had been helpful. We found that the home was now compliant with the Warning Notice.

We looked at all documents within the care records of three people who use the service. This included looking at care plans, risk assessments and daily care records. We looked at incident report records in relation to an incident of physical abuse from one service user to another service user.

People were still at risk of physical aggression from other service users because the home did not have an appropriate system in place to manage acts of violence and aggression. We found that one person had been physically assaulted by another service user and that the follow up action was not complete.

We visited six bedrooms, three lounge diners, four toilets and two bathrooms and saw that some of the facilities were not clean.

People who use the service were not fully involved in decisions made about their care and treatment. We found that mental capacity assessments had not been completed. People were at risk of physical aggression from other service users because the home did not have an appropriate system in place to manage acts of violence and aggression. People's dignity was not always protected and on the day of this inspection people were not offered choice.