• Care Home
  • Care home

The Laurels and The Limes Care Home

Overall: Requires improvement read more about inspection ratings

115 Manchester Road, Broomhill, Sheffield, South Yorkshire, S10 5DN (0114) 266 0202

Provided and run by:
Hill Care Limited

All Inspections

29 November 2022

During an inspection looking at part of the service

About the service

The Laurels and The Limes Care Home is a care home providing personal and nursing care to up to 88 people. The service provides support to older adults with a range of support needs, including people living with dementia. The service has 2 separate buildings within the same grounds; The Laurels and The Limes. The Laurels predominantly supports people living with dementia. The Limes is the larger building and supports people who require nursing or residential care. At the time of our inspection there were 60 people using the service.

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

Risks to people were assessed, however the records made by staff did not always evidence risks were managed effectively. People received safe support with their medicines and infection risks were mostly well-managed. Staff understood their responsibility to protect people from the risk of abuse.

There were enough staff deployed to keep people safe and staff were recruited safely. The provider used agency staff to ensure there were enough staff on each shift, but this had placed pressure on the regular staff team who had to spend time supporting agency staff to get to know people.

People were not always meaningfully occupied or stimulated. People told us they were often bored as there was not enough to do. Improvements were therefore needed to ensure people consistently experienced a good quality of life whilst using the service. We have made a recommendation about daily activity provision.

People’s care plans described people’s preferences for receiving care, however their care plans were not consistently updated when people’s needs changed. Staff worked alongside the GP and district nurses to manage people’s health needs. People received effective support with their nutrition and hydration needs.

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 provider’s audit system had not identified all the issues we found during this inspection. However, some audits completed by the provider and managers had identified concerns and ensured issues were resolved.

We received mixed feedback about the culture of the service. Staff morale was not positive, and most staff told us there were not supported to do their jobs effectively. Staff had not received one to one supervision meetings recently and many staff were not up to date with the training the provider expected them to complete.

People and their relatives had opportunities to provide feedback about the service. Most people were happy with the care they received and felt they could approach the managers if they had any concerns.

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

Rating at last inspection

The last rating for this service was good (published 25 February 2020).

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 key question ‘is the service safe?’. 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 undertook a focused inspection to review the key questions of ‘is the service safe?’, ‘is the service effective?’ and ‘is the service well-led?’ only. For those key questions not inspected at this inspection, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

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

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

Enforcement and recommendations

We have identified a breach of regulation in relation to the provider’s governance system. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about the daily activity provision in the service.

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.

26 May 2021

During an inspection looking at part of the service

The Laurels and The Limes Care Home is a care home which can accommodate up to 88 people who require accommodation for nursing and personal care. At the time of our inspection there were 66 people living in the home.

We found the following examples of good practice.

The home had systems in place to support relatives to visit their family members, minimising the risk of infection. Relatives and friends were encouraged to keep in contact with their loved ones via telephone and video calls. They were also able to visit in person, by appointment, inside the home or using the visitor pod in the garden.

The home had implemented cohorting effectively, with staff allocated to either The Laurels (building one) or The Limes (building two), and they did not mix between the two buildings.

We observed signage around the home to guide staff on the use of protective personal equipment (PPE) and appropriate handwashing technique. The premises were clean and hygienic. Frequent touch points, such as handrails and door knobs were regularly cleaned. Staff supported people to keep apart as much as possible to try and maintain safe social distancing. For example, by moving chairs in communal areas further apart.

All people living and working at The Laurels and The Limes Care Home had been offered a vaccine and were regularly tested for COVID-19 in line with government guidance.

Risk assessments were in place to consider and reduce any impact to people who used the service and staff who may be disproportionately at risk of COVID-19. These included Black, Asian and Minority Ethnic groups (BAME), people with learning disabilities and people with dementia.

29 January 2020

During a routine inspection

About the service

The Laurels and The Limes Care Home is a nursing and residential home. The service comprises of two neighbouring buildings. The Laurels predominantly supports people living with dementia. The Limes supports people who require nursing or residential care. At the time of this inspection the service was providing personal and nursing care to 67 older adults, some of whom were living with dementia. The service can support up to 88 people.

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

People received a good standard of care and we saw examples where people had experienced a better quality of life after moving to the home, made possible due to the dedication and skill of the staff team. People received care from a knowledgeable staff team who had access to a wide variety of training and support.

The service was safe. Risks to people’s health and safety were assessed and mitigated. Medicines were managed in a safe and proper way. Staffing arrangements had improved so there was enough permanent staff available each day to provide people with stimulation, interaction and ensure they were safe. Incidents and accidents were logged and investigated and learnt from where appropriate.

The management team was supportive, responsive and promoted a culture of person-centred care at the service. The registered provider had an effective system of governance in place to monitor and improve the quality and safety of the service. The service used a number of methods to ensure people and relevant persons involved in their care had a voice, which was valued and listened to.

Throughout the inspection we saw very caring interactions between staff and people who used the service. Everyone involved in the service provided very positive feedback about the overall quality of the service. There was a person-centred culture with the management and staff team and all were highly involved in peoples’ care and support.

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

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

Rating at last inspection

The last rating for this service was requires improvement (published 11 May 2017). There was also an inspection on 13 June 2018 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

22 March 2017

During a routine inspection

This inspection took place on 22 March 2017 and was unannounced, which meant no-one at the service knew we would be visiting.

At the last inspection on 2 November 2016 we found breaches in three regulations: Regulation 9, Person-centred care, Regulation 12, Safe care and treatment and Regulation 17, Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan and to confirm that they now met all of the legal requirements. We saw that sufficient improvements had been made to achieve compliance.

The Laurels and the Limes is a nursing home that provides care for up to 88 people. The service operates from two separate buildings on the same site in the south of Sheffield. The Limes building is purpose built. The majority of bedrooms are single and some have ensuite facilities. There are well maintained gardens and car parking is available. At the time of the inspection there were 43 people living at the service. The Laurels building is a residential unit primarily used for people living with dementia. At the time of the inspection there were 11 people living in the Laurels. The Limes building has three floors and a lower ground floor where the service’s kitchen, laundry and staff rooms are based. At the time of the inspection there were 32 people living in the Limes.

The service did not have a registered manager in post at the time of the inspection. The registered provider had recently appointed two managers, one to manage the Laurels and one to manage the Limes. 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.’

There had been some improvements with concerns identified at the last inspection in relation to the management of medicines, but there were some actions that we identified during the inspection that were attended to during the inspection. The senior managers assured us that measures would be put in place to ensure these shortfalls did not reoccur.

At this inspection we saw improvements had been made in managing individual risk, including behaviour that challenged, but staff would benefit from further training in completing behaviour analysis charts.

At the last inspection we found the recruitment of staff was not safe. At this inspection we found sufficient improvements had been made by the registered provider.

Improvements had been made to the meal time experience for people living at the Limes.

At this inspection we saw improvements had been made for people living with dementia, so that they did not become disengaged with their surroundings.

Regular resident and relative meetings had been held at the service since the last inspection. People and relatives we spoke with told us their views about the service were being actively sought.

People we spoke with told us they felt ‘safe’ and had no worries or concerns. Relatives we spoke with felt their family member was in a safe place. Since the last inspection the registered provider had improved the systems in place to ensure people were safeguarded from the risk of harm.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

We saw that sufficient improvements had been made to ensure people with DoLS conditions received appropriate care and treatment. 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’s preferences and dietary needs were being met. We received positive comments from people regarding the quality of the food.

People we spoke with made positive comments about the quality of care they had received. Relatives we spoke with were satisfied with the quality of care their family member had received.

There was evidence of involvement from other health care professionals where required and staff made referrals to ensure people’s health needs were met.

We saw that people responded well to staff and they looked at ease and were confident with staff. Staff were respectful and treated people in a caring and supportive way.

Staff had undertaken training to ensure they had the skills and knowledge to support people effectively.

There was a complaints procedure available to people and their relatives. People and relatives we spoke with felt confident senior staff would listen and take appropriate action to address their concerns.

During the inspection we found some shortfalls relating to records.

At the last inspection in November 2016 we found that there were not effective systems in place to monitor and improve the quality of the service provided. At this inspection we saw there had been some improvement, however we found that further improvement was required in some areas.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

2 November 2016

During a routine inspection

This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The inspection took place on 2 November 2016.

The service was last inspected on 13 July 2015. At the last inspection we found the service was not meeting the requirements of the following regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe care and treatment, Regulation 17 Good Governance and Regulation 11 Need for consent. As a response to the last inspection the registered provider sent a report to the Care Quality Commission of the action they would take to become compliant with the regulations. The registered provider told us they would complete all the action to achieve compliance by the end of 2015.

The Laurels and the Limes is a nursing home that provides care for up to 88 people. The service operates from two separate buildings on the same site in the south of Sheffield. The Limes building is purpose built. The majority of bedrooms are single and some have ensuite facilities. There are well maintained gardens and car parking is available. At the time of the inspection there were 53 people living at the service. The Laurels building is a residential unit primarily used for people living with dementia. At the time of the inspection there were 14 people living in the Laurels. The Limes building has three floors and a lower ground floor where the service’s kitchen, laundry and staff rooms are based. At the time of the inspection there were 39 people living in the Limes.

There was a registered manager in post at the time of the inspection. 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 a 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 we saw the registered provider had not ensured DoLS authorisations had been obtained for some people living at the service. We saw that sufficient improvement had been made for to achieve compliance in Regulation 11, Need for consent.

We checked that improvements had been made in the safe handling of medicines. We saw that insufficient improvement had been taken to achieve compliance. We found the service continued not have appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

The outcome of the inspection identified the service continued to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014, plus a further three breaches were identified. These findings showed the registered provider’s processes to monitor and improve the quality of the service were still ineffective in practice.

Although people told us they felt ‘safe’ and relatives spoken with felt their family member was in a safe place, we found that people were not safeguarded from the risk of harm. We saw the service had not always followed the local safeguarding protocols and made a safeguarding alert in line with the local multi agency agreement.

Staff recruitment records reviewed showed that information was not always obtained in accordance with Schedule 3. This meant we could not be confident that people were cared for by suitably qualified staff who had been assessed as safe to work with people.

At the last inspection we found that people’s daily charts were not maintained to ensure they were accurate, complete and contemporaneous. We saw that insufficient action had been taken so that we could be confident that people’s daily charts were completed accurately and were contemporaneous.

Most people and relatives spoken with told us the activities provided at the service could be improved to meet the needs for all the people living at the service.

At the last inspection we raised concerns regarding the lack of stimulation provided for people living in the Laurels. We found that insufficient action had been taken by the registered provider to ensure people living with dementia did not become disengaged with their surroundings.

People and relatives made positive comments about the staff and the manager at the service.

In the Limes building we observed a lot of laughter and friendly ‘banter’ between people and staff. We saw that people got on well with staff and that people’s relatives and visitors were greeted in a friendly way.

In the Laurels building we observed the interaction between staff and people was centred on tasks. This lack of engagement between staff and people created an unstimulating atmosphere.

People spoken with were satisfied with the care they had received.

Relatives told us they were involved in their family members care planning and were satisfied with the care their family member had received.

In people’s record we saw evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

We reviewed one person’s Deprivation of Liberty Safeguards authorisation which had been granted with conditions in May 2016. These conditions are legally binding and had not been met. This showed there was a risk that people would not receive appropriate care and treatment to meet their needs.

We found that there was a risk that people’s behaviour was not managed consistently and the risk to their health, welfare and safety was not managed effectively.

People’s preferences and dietary needs were being met. We received mixed views regarding the quality of the food provided.

We saw the environment in the Limes dining area was not a calm and conducive atmosphere for people to eat in.

Accidents and untoward occurrences were monitored by the registered provider to ensure any trends were identified.

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, 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.

13 July 2015

During a routine inspection

This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. A scheduled inspection took place on 13 July 2015.

The service was last inspected on 19 January and 2 February 2015. At the last inspection we found the service was not meeting the requirements of the following regulations: care and welfare of people who use services, supporting staff, the management of medicines and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report to the Care Quality Commission of the action they would take to become compliant with the regulations. The provider told us they would complete the action for care and welfare of people who use services and the management of medicines by 30 November 2015. The provider told us they would complete the action for supporting staff and assessing and monitoring the quality of service provision by the 30 December 2014.

The Laurel and Limes is a nursing home that provides care for up to 88 people. The service operates from two separate buildings on the same site in the south of Sheffield. The Limes building is purpose built. The majority of bedrooms are single and some have ensuite facilities. There are well maintained gardens and car parking is available. At the time of the inspection there were 43 people living at the service. The Laurels building is a residential unit primarily used for people living with dementia. At the time of the inspection there were 16 people living in the Laurels building. The Limes building has three floors and a lower ground floor where the service’s kitchen, laundry and staff rooms are based. At the time of the inspection there were 27 people living in the Limes building.

There was not a registered manager for this service in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. One of the registered provider’s senior managers was managing the service.

During our inspection we check that improvements had been made in the safe handling of medicines. We saw that improvements had been made. However the provider still needed to make more improvements to ensure that people were protected against the risks associated with the unsafe management of medicines.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We saw examples where people had been appropriately supported to make decisions in accordance with the MCA. However, we found the provider had not ensured DoLS authorisations had been obtained for some people living at the service.

In people’s records we saw a care plan for identified risks had been completed. We saw evidence of monthly reviews. However, the monthly reviews did not evidence what information had been used to inform the review or how the person and their relatives were involved in the process. We also found gaps in people’s records. For example, two people had gaps in their repositioning records. Both people were able to tell us that staff supported them to be repositioned when they were in bed. It is important that people’s records are accurate, complete and contemporaneous, including a record of the care and treatment provided to the person.

People told us they felt safe and were treated with dignity and respect. People were satisfied with the quality of care they had received and made positive comments about the staff. One person suggested that staff had further training in supporting people with a sensory impairment. We shared this information with the senior home’s manager.

Relatives spoken with felt their family member was in a safe place.

Our observations during the inspection told us people’s needs were being met in a timely manner by staff. We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

People’s preferences and dietary needs were being met. Most people made positive comments about the food.

Relatives told us they were involved in their family members care planning. In people’s record we saw evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

Our discussions with staff told us they were fully aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

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

19 January 2015 and 2 February 2015

During a routine inspection

This was an unannounced inspection which meant the staff and provider did not know we would be inspecting the service. The service was last inspected on 19, 20 and 27 August 2014. At the last inspection we found the service was not meeting the requirements of the following regulations: care and welfare of people who use services, supporting staff, the management of medicines and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report to the Care Quality Commission of the action they would take to become compliant with the regulations. The provider informed us they would be compliant by the end of December 2014.

The Laurel and Limes is a nursing home that provides care for up to 88 people. The service operates from two separate buildings on the same site in the south of Sheffield. The Limes building is purpose built. The majority of bedrooms are single and some have ensuite facilities. There are well maintained gardens and car parking is available. At the time of the inspection there were 52 people living at the service. The Laurels building is a residential unit primarily used for people living with dementia. At the time of the inspection there were 19 people living in the Laurels building. The Limes building has three floors and a lower ground floor where the service’s kitchen, laundry and staff rooms are based. At the time of the inspection there were 33 people living in the Limes building.

There was not a registered manager for this service in post at the time of the inspection. The manager had left their post shortly before the inspection took place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt “safe” and that they would speak with staff and/or a family member if they had any concerns. Relatives spoken with felt their family member was safe.

Most staff had received training in safeguarding vulnerable adults as part of their induction training. Our discussions with staff told us they were aware of how to raise any safeguarding concerns.

People gave mixed views about the staff and how they were treated by staff. We observed that the interaction and communication between staff and people was mainly focussed around completing tasks. People told us staff rarely had time to sit and talk or interact.

A pharmacist inspector from the Care Quality Commission inspected the service on 19 January 2015 to check whether improvements had been made to the management of medicines and that these improvements had been maintained. We saw that some improvements had been made, however we found that the provider had still not made enough improvements to protect people against the risks associated with the unsafe use and management of medicines.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. However, records showed that these procedures were not always being adhered to. For example, one staff member’s reference from their previous employer had not been obtained before they started working at the service.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. However, we found that some people’s medication risk assessments had not been completed.

There was evidence in peoples care plans of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s dietary needs were being met but we found that people were not always asked for their preference regarding the food they would like to eat. We also found the assistance provided by some staff whilst supporting people to eat could be improved.

We found that some staff had not received all their induction training suitable for their roles when they started employment at the service. We also found that staff had not completed refresher training in some areas of training relevant to their role.

Staff had not received regular supervisions and appraisals, which meant their performance was not formally monitored and areas for improvement may not have been identified.

There was a complaint’s process in place in the service and people and/or their representative’s concerns had been investigated and action taken to address their concerns.

Meetings had been held with people’s representatives since the last inspection. We saw evidence that a catering audit had been completed with people at the service in August 2014. However, we found no evidence that the outcome of the audit or the action that was being taken had been shared with people living at the service. We found that no meetings had been held with people living at the service since the last inspection. This meant people did not have opportunities to be kept informed about information relevant to them.

Our findings demonstrated the provider had not ensured there were effective systems in place to monitor and improve the quality of the service provided. This meant they were not meeting the requirements to protect people from the risk and unsafe care by effectively assessing and monitoring the service being provided.

We saw evidence that checks were undertaken of the premises and equipment and action was taken to ensure peoples safety.

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

19, 20, 27 August 2014

During an inspection in response to concerns

An adult social care inspector and a specialist advisor visited the service. At the time of the inspection nineteen people were living in the Laurels building, a residential unit primarily used for people living with dementia. There were forty people living in the Limes building including twenty five people who were receiving nursing care. We observed the care people received; spoke with eleven people and two relatives. We also spoke with the senior home's manager [the home's acting manager], operational manager, senior regional manager, the Laurel's unit manager, one senior care worker, four care workers, two domestic staff and a maintenance worker. The acting manager had recently started working at the home. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

Most of the people we spoke with felt 'safe' and had no worries or concerns. Relatives felt their family member was in a safe place although one person told us they didn't feel safe due to the number of changes of staff at the home.

We observed individual staff members treating people with respect. However, we observed some staff did not explain their actions when they were supporting people to be moved with a hoist.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The home was aware of the need to submit applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

We found the arrangements in place to safeguard people using the service from financial abuse could be more robust.

People were not protected against the risk associated with medicines because the provider had not got appropriate arrangements in place to manage medicines.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to the management of medicines.

Is the service effective?

People's health and care needs were assessed and care plans formulated. However, people's needs were not always being met in accordance with those plans.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people's care and welfare.

People were cared for by staff who were not supported deliver care and treatment safely and to an appropriate standard.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to supporting staff.

Is the service caring?

People spoken with told us they were satisfied with the quality of care they had received. Their comments included: 'the foods okay, there isn't a great deal of choice, but it's not bad', 'we are treated very well, I get up at eight o'clock, go to bed at 10 o'clock, I have got a decent room and a television', 'we get decent meals' and 'I'm happy here, I mostly stay in bed and when I call them [staff] they usually come quickly, but they are very busy'. People also made positive comments about the staff. Their comments included: 'the [staff] are alright', 'some of the staff are alright', 'they [staff] are very kind' and "I've got no complaints about the staff'.

We spoke with two relatives about the quality of care that had been provided to their family member. Their comments included: 'they don't cut [family member's] finger nails and clean them, I always have to ask for them to be done', 'mainly it is very good', 'I'm really happy with mum here, the activities co-ordinator did a life scrap book with her, but I don't know where it is'.

Is the service responsive?

The provider's complaints process was displayed in different parts of the home.

Our observations told us staff were not meeting people's needs in a timely and responsive way. For example, staff were not available to support someone to drink and staff were not available to support someone who became upset when their assistance was needed.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people's care and welfare.

Is the service well led?

There was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. However, our findings indicated the audits in place had not effectively identified the concerns we found during the inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to identifying, assessing and managing risks to health, safety and welfare of people who use the service and others.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

4 February 2014

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us: 'They [staff] let me know when breakfast is and I can have a lie in if I want.'

Food and drink met people's individual dietary needs. One person told us, 'I had toast and jam [for breakfast] it was nice.'

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

6 February 2013

During a routine inspection

Some people living at the home were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people at this inspection to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI). During the observation we saw some examples of good communication skills by staff that utilised eye contact and touch to engage people who used the service.

People that we could communicate with told us that they were happy living at the home and that they were very satisfied with the care they received. People's comments included, "it's not home but it's good." Another person said, 'I'm very happy here, everybody is nice and the staff are wonderful."

We spoke with three relatives who were visiting the home and they confirmed that they were very happy with the care provided. One person told us, "I'm happy with the staff, they are caring, cooperative and friendly."

19 April 2011

During a routine inspection

Relatives visiting the home told us they were generally happy with the service provided and confirmed prompt action was taken to address any issues that were brought to the management's attention.

We saw evidence that meetings with people who use the service and their relatives had not always been well attended well in the past, however we were told a further relatives meeting was due to take place on the evening of our visit to ensure they are consulted about the service and that plans were in place to issue further surveys on different aspects of the home and that the finding from these would 'Be analysed and acted upon positive or negative'.

We observed staff interacting with people who use the service in an open and respectful manner and that generally people were provided with support when required. People living in the home appeared to be well looked after and were observed wearing clean clothing and both they and their relatives told us they were generally happy with the service and that staff were doing a good job. One person said the service 'Couldn't be better' and that staff 'Look after me well'.

People who use the service said they generally enjoyed their food and that choices were available if they didn't like what was served. We observed a meal of chicken, potatoes and vegetables followed by ice cream that was plated up attractively from a hot trolley with staff providing appropriate assistance where needed. The atmosphere at lunch was relaxed and unhurried and we were told that specialist diets could be provided. We observed however, that people using the service were all wearing plastic aprons when given their food.

The results from a recent survey about the quality of food were displayed in the home and the findings from this were generally positive. Comments included 'I enjoy salads and breakfast', 'There are too many meat dishes' and 'I would like my plate warmed before food goes on it'. There was evidence the provider had listened to these comments and an action plan had been developed to include fruit baskets to be made available and for the cook to attend a future residents meeting.

Staff who we spoke to were aware of the correct actions to take should they have any concerns about the safeguarding of vulnerable adults. Staff were observed interacting with people using the service in a friendly and respectful manner and the homes training statistics confirmed all of them had received training on this aspect of their work.

There was a generally calm and pleasant atmosphere throughout the home on the day of our visit, with music playing quietly in lounge and an appropriate level of staff available. Staff were observed offering choices of morning drinks to people who use the service and one was observed supporting an individual with drinking milk from a beaker. Staff said they felt there were generally enough staff available, although some told us more activities should be provided as the last trip out had been to a pantomime in December 2010. Staff told us told us it was not always easy to delegate tasks due to communication difficulties within the staff team and that morale was currently low as a result of the ongoing Local authority safeguarding investigations. Staff told us however that improvements were now being made with more staff completing the food and fluid charts as needed.

Staff were observed to interact with people living in the home in a sensitive and friendly manner and there was evidence of recent meetings between the acting manager and the night manager and of three supervision sessions carried out by him the previous week. However, whilst staff confirmed they had recently had supervision and training sessions on a variety of topics and their files all contained records of this, there was evidence these had not always been regularly held.

People living in the home and their relatives told us they were generally happy with the service and knew how to make a formal complaint and that management responded to concerns that were raised.

Whilst there was evidence the acting manager was doing her job and took the concerns of people who used the service and their relatives seriously; there was some evidence of a further need to develop her role in order to provide clear leadership and support to staff.