The Martlets

The Martlets situated in East Preston, West Sussex. It is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential 'care home' providing care for up to 60 people who may be living with dementia, physical disabilities, older age or frailty as well as up to 20 people who may require nursing care. At the time of inspection there were 48 people living at the home.

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

Since our last inspection the provider had continued to receive support from the local authority and external healthcare professionals to improve the care people received and the overall governance of the service. At this inspection we found that significant improvements had been made to ensure that the risks identified during the last inspection were addressed. It was evident that the manager and staff had worked hard to raise standards and improve people’s care. Feedback from people, their relatives and professionals confirmed this.

Some improvements were still needed with regard to the providers understanding and implementation of the Mental Capacity Act. This meant that people were not always supported to have maximum choice and control of their lives, and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People told us they felt safe and were cared for by a consistent team of staff who knew them well. Significant improvements had been made to ensure that people received safe care and were protected from avoidable harm. When incidents or accidents had occurred, appropriate investigations were carried out and actions taken to reduce the risk of reoccurrence. Medicines were managed safely and given in accordance with prescriber’s instructions and care recommended by healthcare professionals was implemented and recorded appropriately. Staff had received training in infection prevention and control (IPC) and IPC practice within the home was in line with current guidance.

Staff were recruited safely and had the skills, training and competence to provide safe and effective care. The manager had recently recruited staff who received a comprehensive induction and were assessed as competent before supporting people. Agency staff had received the same training and were also assessed as competent before commencing work. Staff received regular supervision which provided opportunity for feedback, focused on their strengths and identified areas for development.

The culture of the service was positive, person-centred and promoted good outcomes for people. People told us they enjoyed a range of activities which considered their emotional and social needs, and they were treated with kindness and respect. Our observations of staff engaging with people confirmed this.

The provider had reviewed and revised their quality assurance systems which had improved oversight of the care and support people received. People and their relatives told us they received regular updates about the service and any changes required as a result of Covid-19. The manager provided leadership for the staff who felt valued, supported and part of a team.

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 overall rating for this service was ‘Inadequate’ (report published 14 January 2021). The home had failed to make enough improvements to meet the requirements of the warning notice and remained in breach of multiple regulations. The home was placed in special measures and the provider served a notice to impose conditions on their registration. The provider was required to submit monthly reports to CQC to demonstrate what actions they were taking to improve, by when, and how this would be monitored. The home was required to make significant improvements within a six-month time frame to prevent us taking action in line with our enforcement procedures and starting the process of cancelling their registration.

At this inspection enough improvements had been made and the provider was no longer in breach of regulation 12 (safe care and treatment), regulation 18 (staffing) and regulation 17 (good governance).

Why we inspected

We undertook this unannounced, focused inspection on 8 April 2021 to check the provider had complied with the conditions imposed on their registration. We also needed to ensure that actions submitted in their monthly reports were embedded and confirm they now met legal requirements.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from ‘Inadequate’ to ‘Requires Improvement’. This is based on the findings at this inspection. As a result of these findings, the home is no longer in special measures.

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

The Martlets is situated in East Preston, West Sussex. It is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ providing care for up to 60 people who may be living with dementia, physical disabilities, older age or frailty as well as up to 20 people who may require nursing care. At the time of inspection there were 68 people living at the home.

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

The provider had received support from the local authority and external healthcare professionals to help support them to make the required improvements, yet had not always implemented these. We found the provider lacked oversight to ensure actions were taken to improve the safety of some people’s care and treatment and had not taken enough action before the COVID-19 pandemic to ensure improvements were made. Because of this, when staff had to deal with the unprecedented and daily challenges the pandemic posed, the pre-existing concerns about people’s safe care and treatment were compounded. The provider and staff had worked hard to help ensure people were protected from the risks posed by COVID-19, yet had not always acted to ensure people received safe care and treatment when there were other concerns about their health. This included poor medicines management and a lack of action when there were changes in some people’s health needs. People were not always protected from the risk of malnutrition or dehydration. One person had been provided with the incorrect texture-modified diet and this exposed them to risk of harm. Lessons had not always been learned when people experienced falls and injuries to their heads as the provider had not always ensured people were adequately monitored to help identify changes or deterioration in their condition.

People, relatives and staff provided mixed feedback about staffing levels and staff’s ability to appropriately respond to people’s needs in a timely way. Not enough action had been taken by the provider to ensure staff were fully supported, trained and competent to meet all people’s needs. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider had not met the enforcement actions that were served at the last inspection.

People and relatives spoke of a dedicated staff team who had worked hard throughout the pandemic to ensure people were protected from the risk of COVID-19. They told us staff were kind and caring and our observations of staff’s interactions with people confirmed this.

Rating at last inspection and update

The last overall rating for the home was ‘Requires Improvement’ (Report published 19 December 2019). The home had been rated ‘Requires Improvement’ on five consecutive occasions. There were multiple breaches of regulation. We served three Warning Notices and the provider was required to be compliant by 31 January 2020. The provider also completed an action plan after the last inspection to inform us what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was in continued breach of regulations.

Why we inspected

We undertook this announced, focused inspection on 3 September 2020. This was based on the previous rating and enforcement action to check the provider had complied with the Warning Notices issued at the last inspection and to confirm they had followed their action plan and now met legal requirements.

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 home can respond to coronavirus and other infection outbreaks effectively.

We contacted people, staff and relatives and viewed records in relation to people’s care on 4, 5, 6 and 7 August 2020. We gave the provider 24 hours notice of the inspection to enable CQC and the provider to consider any infection prevention and control protocols due to the COVID-19 pandemic. We also established if people had COVID-19 or associated symptoms. This report only covers our findings in relation to the Key Questions of Safe, Effective 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 home has changed from ‘Requires Improvement’ to ‘Inadequate’. 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 The Martlets on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to people’s safe care and treatment, staffing and the leadership and management of the home. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added after any representations and appeals have been conducted. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account when it is necessary to do so.

Follow-up

We fed back our findings to the provider prior to the site visit, on the day of inspection and following it so they could take action to mitigate risk. Due to the serious concerns we found at the inspection, we wrote to the provider to seek assurances and evidence of the care people had received following the inspection. The information received did not always provide assurances that risks to people's care had been minimised.

We will continue to maintain ongoing monitoring of the home and work with the provider and partner agencies. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least ‘Good’. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

If the provider has not made enough improvement within this timeframe, and there is still a rating of ‘Inadequate’ for any Key Question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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 or overall, it will no longer be in special measures.

The Martlets is situated in East Preston, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 80 people some of whom are living with dementia, physical disabilities, older age or frailty and who require support with their nursing needs. At the time of the inspection there were 77 people living in the home.

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

People’s safety was not always maintained. Medicines were not always administered according to prescribing guidance or people’s assessed needs. People who required a modified diet were sometimes provided with high-risk food that increased the potential risk of choking. Staffing levels were not always sufficient and people, relatives and staff provided consistent feedback that people often had to wait for support due to the levels of staffing. Lessons had not always been learned and improvements implemented when care had not gone according to plan. Infection control was maintained, and the home was clean.

People, relatives and staff were not complimentary about the provider’s systems and processes. They told us they were inflexible, and people were not cared for in a person-centred way. The provider’s aims and values were not always implemented in practice. Quality assurance processes were not always effective and had not always identified shortfalls that were found as part of the inspection. Learning from the reoccurring themes that have been found at some of the provider’s other services within the Sussex area had not always been shared to ensure improvements were made. The provider was working in partnership with external health and social care professionals to help ensure improvements were made to the delivery of care. People, relatives, staff and an external health professional praised the practice of the registered manager and told us that they valued the efforts they had made to improve the care people received.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were supported by staff that had not always had access to training that the provider considered essential for their roles and that would enable them to provide effective care to meet people’s specific needs. For example, people who were living with dementia were not always supported in a way that met their needs or in accordance with best practice guidance. The provider's procedures when employing agency staff were not always demonstrated in practice and competency assessments had not always been completed before they started work. People had access to external health care professionals and were supported to maintain their health. People had access to enough food to ensure they received a balanced diet.

People’s privacy and dignity were not always well-maintained, and they did not always receive respectful or person-centred care. People’s needs had been assessed but the support provided had not always met their assessed needs. People did not always have access to meaningful occupation and interaction with staff. Some people spent extended periods of time without interaction or stimulation with others. People told us that staff were kind and caring and they were complimentary about staffs’ compassionate nature. Most observations showed staff were considerate and caring.

We have made a recommendation about providing appropriate and meaningful environments for people living with dementia.

Rating at last inspection and update

The last rating for this home was Requires Improvement. (published 18 October 2018). There was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was in continued breach of the regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence that the provider needs to make further improvements. We have identified six breaches in relation to person-centred care, privacy and dignity, need for consent, safe care and treatment, staffing and the leadership and management of the home. You can see what action we have asked the provider to take at the end of this full report.

Follow-up

We will continue to monitor the intelligence we receive about this home. We will request an action plan from the provider and meet with them to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The Martlets is situated in East Preston in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. The Martlets is registered to accommodate 80 people. At the time of the inspection there were 58 people accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs.

The home did not have a registered manager. A registered manager is a ‘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 home is run. Since the previous inspection on 29 and 30 January 2018, the registered manager had left. A manager from one of the provider’s other homes had been managing The Martlets for six months and was in the process of applying to become registered manager. The management team consisted of the manager, a deputy manager, a clinical lead and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 29 and 30 January 2018 the home received a rating of ‘Requires Improvement’ for a third consecutive time. The provider was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, the provider completed an action plan. This informed us of what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good.

There were concerns with regards to the management of medicines. There were sometimes insufficient stocks of medicines. People, who required their medicines to be administered at specific times, consistently had their medicines late. There was a lack of guidance and inconsistent information to inform staff’s practice in relation to when to administer ‘as and when required’ medicines.

Records for people who had been assessed as being at high-risk of developing pressure wounds and those that required their fluid and food intake to be monitored, were not completed accurately. It was not evident if people had received appropriate care or if staff had failed to document their actions.

Assessments and reviews, to ensure that the guidance provided to staff was up-to-date and met people’s current needs had not always been completed in a timely way.

There was a lack of understanding about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People had mixed experiences with regards to stimulation and meaningful activity to occupy their time.

Complaints that had been raised had not always been dealt with in accordance with the provider’s policy. There was a lack of stimulation, interaction and engagement to occupy people’s time.

There were concerns about quality assurance procedures and oversight. Feedback about the leadership and management was poor. Audits had not always identified the shortfalls that were found at inspection. When these had been identified, there had not been sufficient action to ensure improvement.

At this inspection, it was evident that the management team and staff had worked hard to implement improvements. Feedback about the leadership and management of the home was overwhelmingly positive. There was a positive, welcoming atmosphere. The management team strived for improvement and people’s experiences were more positive than at the previous inspection. There were however, further areas that needed to be improved, embedded and sustained in practice. These areas related to the management and oversight of DoLS authorisations. Guidance to inform staff’s practice, in relation to risk and people’s specific healthcare conditions, was not always sufficient. Reviews of people’s care had not always been conducted. These were areas of concern.

People did not always have access to stimulation and interests that were meaningful to them. We made a recommendation in relation to person-centred care and people’s access to meaningful activity, stimulation and engagement to occupy their time.

People received support from sufficiently trained and experienced staff. There were sufficient staff to meet people’s physical needs. People were protected from harm. Staff knew the signs and symptoms of abuse and knew what to look for if there were concerns about a person’s care. The manager had worked with the local authority when there had been concerns about people’s wellbeing. Reflective practice ensured that lessons had been learned when care had not gone according to plan.

Risks were managed and people received safe care. Medicines management had improved and people received their prescribed medicine on time. People were protected from infection and staff demonstrated correct techniques to ensure that cross-contamination was minimised.

People’s needs were assessed in a timely way. People had access to healthcare professionals and told us they had faith in staff’s abilities to recognise when they were not well. There was a coordinated approach to people’s healthcare. People’s hydration and nutrition was maintained.

People were involved in their care; their consent was gained and their preferences respected. People were aware of how to raise concerns and complaints. 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 supported this practice.

People told us that staff were kind, caring and compassionate. People’s privacy and dignity was maintained. People were supported to remain comfortable at the end of their lives.

People had access to a purpose-built building and told us that they liked the layout of the home. Communal spaces as well as private rooms enabled people to choose how they spent their time. Signage and colours enabled people who were living with dementia to orientate and navigate.

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

The Martlets is situated in East Preston in West Sussex and is one of a group of homes owned by a National provider, Shaw Healthcare Limited. The Martlets is registered to accommodate 80 people. On the first day of inspection there were 69 people and on the second day of inspection there were 71 people which accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs. There were gardens for people to access and a hairdressing room.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a unit manager, a clinical lead and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 6 and 19 December 2016 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns with regards to the management of medicines. Areas in need of improvement related to the deployment of staff and the timeliness of assessments when people’s needs changed, incomplete records to document the care people had received and ineffective audits that had not always identified the shortfalls that were found at the inspection. At this inspection we continued to have concerns and the registered manager was found to be in breach of the regulations.

People did not always receive their medicines on time and systems to improve this demonstrated a service that was not person-centred. Records to document the administering of medicines were not always complete and did not always reflect the actions of staff. In addition, guidance to inform staff’s practice on the administration of ‘as and when required’ medicines was not always consistent. The management of medicines was an area of practice that continued to be a concern.

People’s needs were not always assessed nor care plans devised in a timely manner to ensure that staff were aware of people’s needs and preferences. When there were changes in people’s needs, care plans and risk assessments were not always reviewed to reflect the changes to ensure that people were provided with appropriate care to meet their current needs. Care plans lacked detail, particularly in relation to people’s social and emotional needs. People’s life history, background and preferences were not documented to inform staff and did not provide an insight into people’s lives before they moved into the home.

Some people, particularly those who were less independent, spent large amounts of time with very little stimulation or interaction with staff, other than when providing support to meet their basic care needs. Although sufficient staff to meet people’s physical needs, the provider had not ensured that staffing levels enabled staff to spend quality time with people, engaging in meaningful conversations and occupation. Person-centred information was minimal and as a result people were not provided with stimulation or interests that were meaningful. The lack of person-centred practice was an area of concern.

There was mixed feedback with regards to the leadership and management of the home. There was low staff morale and although staff told us that they felt supported from their direct line managers, told us that the registered manager and provider were not approachable. Some staff demonstrated discontent, and although happy to provide care for people, were not happy with the management of the home. Some relatives told us about the tension that existed between staff and management and felt that this had contributed to a decline in their opinion about the home.

Quality assurance processes were not always effective. When audits had been conducted by external senior managers, actions to improve the shortfalls had not always been taken by the registered manager. In addition, the provider had not always followed-up to ensure that actions from previous audits had been completed. The registered manager and provider had not consistently monitored the systems and processes within the home to ensure that they were meeting people’s needs and to continually improve the service.

Records did not always contain sufficient detail and were not always completed in their entirety. This related to people’s end of life and healthcare plans, as well as records to document people’s daily care. It was not evident if people had received appropriate care or if staff had failed to update the records. The leadership and management of the home is an area of concern.

Areas in need of improvement related to a lack of understanding and the practical application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) as well as the untimely response to responding to complaints that had been received.

We also made a recommendation about the planning of end of life care for people.

Despite the concerns found, people and relatives told us that staff were kind, caring and compassionate and our observations confirmed this. Comments from people included, “Kindness when they speak to you” and “Yes they do, it makes me feel at home with family”.

People’s privacy and dignity were maintained and they were treated with respect. One person told us, “They knock the door and shut the door when they do my care. They ask you before they do anything”. People were protected from abuse as they were supported by sufficient staff that knew the signs and symptoms to look for and who knew what to do if they had any concerns about people’s safety. Staff learned from instances and changed practice to ensure that people’s well-being was promoted and maintained. People were protected by the prevention and control of infection.

People received support from external healthcare services when required and told us that they had faith in staff’s abilities to notice when they were unwell. Staff were trained and competent and supported people in accordance with their needs and preferences. People’s hydration and nutritional needs were met and people told us that they enjoyed the food.

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

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

At our last inspection to the service in November 2015 we found two breaches of regulations. We found the service did not have sufficient staff to support people effectively and the registered person did not ensure the care and treatment of people was person centred. We asked the provider to take action and the provider sent us an action plan in December 2015 which told us what action they would be taking.

At this inspection we found that improvements had been made to safe staffing levels. However, further improvements were needed to ensure that staffing deployment would be based on changes in people’s dependencies. The registered manager told us that staffing levels were in accordance with people’s dependency levels. However not everyone’s dependency levels had been assessed if their needs had changed so it was not possible to establish what the correct staffing levels should be. We have made a recommendation that the provider establish dependency levels of people who's needs had changed in order to ensure staffing levels remain safe.

At this inspection we found improvements to person-centred care had been made and the requirement was now met.

The arrangements for managing medicines (including obtaining, prescribing, recording, handling, storing, security and disposal) did not always keep people safe.

People told us they felt safe. Relatives told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm. Risk assessments were in place to help keep people safe and these gave information for staff on the identified risk and guidance to mitigate the risks. Safe recruitment practices were followed and recruitment procedures ensured only those suitable to work in care were employed.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were 29 people living at the home who were currently subject to DoLS. The registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. People were generally able to make day to day decisions for themselves. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Staff had undertaken training to ensure that they were able to meet people’s needs. The provider supported staff to obtain recognised qualifications such as Qualifications and Credit Framework (QCF). or Health and Social Care Diplomas (These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard). All staff completed an induction before working unsupervised. Staff had completed mandatory training and were encouraged to undertake specialist training from accredited trainers. Staff received regular supervision and monitoring of staff performance was also undertaken through staff appraisals.

Each person had a plan of care which was person centred and provided staff with the information they needed to support people. However new care plan formats were being introduced and we discussed these with the registered manager as they were large documents which could make information difficult to find.

People received enough to eat and drink. People spoke positively of the food and the choice they were offered. We were told, “The food is good, there is always a choice”. People who were at risk of malnourishment were weighed on a monthly basis and referrals or advice were sought from suitable professionals where people were identified as being at risk.

Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handover meetings at the beginning of each shift. The home was supported by a range of health professionals.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

The provider had a clear complaints procedure but people would benefit from further information when responses to complaints are provided.

The registered manager welcomed feedback on any aspect of the service. The staff team said communication between all staff at the home was good. However some staff felt they were not listened to by the provider’s senior management.

The registered manager acted in accordance with the registration regulations and sent us notifications to inform us of any important events that took place in the home of which we needed to be aware.

The provider had a policy and procedure for quality assurance. The registered manager was visible and the operations manager visited the home regularly. The registered manager operated an open door policy for both staff and people using the service and their relatives. Weekly and monthly checks were carried out to help monitor the quality of the service provided, however these checks had not identified the shortfalls we found at the inspection. There were regular residents’ meetings and people’s feedback was sought on the quality of the service provided.

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

We spoke with people who told us they were happy with the care in the home. They also confirmed that they participated in activities and outings at the home. One relative told us that their family member had enjoyed lunch in the garden and a trip to a garden centre recently. One person told us "They [staff] try to keep you smiling".

Care staff had been redeployed to improve care worker numbers with the people. The home had a recruitment drive and had recruited 10 new care staff. This would reduce homes reliance on agency staff.

We saw evidence that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

A pharmacy inspector saw evidence that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people's needs. People told us there was often not any staff in the sitting room so they had to wait for assistance. During our SOFI observation we saw that for some people there was not any staff interaction for long periods of time.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with four relatives who were all happy with the care but one expressed some concerns regarding pressure relieving equipment use. Another told us that the home was always asking his family member about wishes in relation to food and bathing habits and that they were very good at dealing with any challenges.

A social work professional visiting to review one of the people living in the home told us that they were very happy with the persons care in the home and that the relatives who were also in attendance for the review were very pleased with their family members progress.

There were enough qualified, skilled and experienced staff in the home to meet people's needs.

The home was clean and warm and has units painted in different colours to help people know where they are in the home.