Homebeech

Homebeech is a care home providing personal and nursing care to up to 66 people. The service provides support to younger and older adults who live with physical disabilities and/or mental health needs, some people were living with dementia or learning disabilities. At the time of our inspection there were 55 people using the service.

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

People were not always protected from risks. COVID-19 infection prevention and control measures were not robust; visiting professionals were not always asked to provide proof their lateral flow device test results. People’s medicines were not always stored and disposed of safely, expiry dates of medicines were not always checked.

People were not always treated with dignity and respect. Staff did not always communicate with people before assisting them in their wheelchairs. Some confidential information about people were accessible to others who did not require to know them.

People did not always experience person-centred care. For example, people’s care records did not always contain person-centred techniques to help support people when they were anxious. Some people receiving end of life support had care plans which contained basic information which meant staff could not provide them personalised support.

The provider did not demonstrate a full understanding of regulatory requirements. Consideration had not been given to CQC’s publication ‘Right support, right care, right culture’ to support people living with a learning disability. The provider had not updated their registration with CQC to include providing a service to people living with a learning disability but subsequently did so following our inspection. Quality assurance processes had not identified areas of improvement highlighted at the inspection, such as, recruitment records not being in line with CQC regulations and care records not reflecting people’s current needs.

People were supported to maintain a healthy diet. We received mixed feedback about the food provided. One person told us, “The food was good but some of it I don’t like, some not cooked properly but you get fish and chips.” A relative told us, “They come round and get [person’s] food choices for the three meals.”

People’s associated health risks were appropriately assessed, and care planned for. People were protected from risk of abuse; staff and management demonstrated a good understanding of preventing and reporting concerns. People had access to healthcare services and staff supported them to attend appointments. Professional guidance had been recorded in people’s care documentation and followed by staff.

People, their relatives and staff gave positive feedback about the leadership and management at the service. Comments included, “They are very approachable and always been there for me in personal and work situations.” And, “The management are fine. I love my room, it's beautiful, I asked to move to the ground floor, when a room became available, I got the room.”

People and their relatives were complimentary of the staff. Comments included, “I can’t rate the staff highly enough.” And, “I can’t say a bad word about any of them.” Staff were mostly observed to be kind and considerate to people. Staff spoke in fond terms with the people the supported. One staff member told us, “The best thing is the residents, always, they come out with funny little things, they just make your day.”

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 and update

The last rating for this service was requires improvement (published 28 August 2020). There were no breaches of regulation, the inspection looked at safe and well-led only and had met the breach of regulation 17 at that time.

The rating for the previous inspection was requires improvement (published 26 April 2019) and there were multiple breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. We looked at all of these breaches at this inspection. This service has been rated requires improvement for the last six consecutive inspections.

At this inspection some improvements had been made and the provider was no longer in breach of regulation 14 (Meeting nutritional and hydration needs) and regulation 18 (Staffing). Not enough improvement had been made and the provider remained in breach of regulation 9 (Person-centred care). We found new breaches of regulation 10 (Dignity and respect), regulation 12 (Safe care and treatment) and regulation 17 (Good governance).

Why we inspected

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 inspection was prompted in part due to concerns received about medicines and pressure area care. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on actions we told the provider to take at the inspection (published 26 April 2019).

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection prevent and control, medicines management, dignity and respect, person centred care and good governance.

We have made a recommendation for the provider to research and make improvements to create a dementia friendly environment.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will 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.

Homebeech is a residential care home providing nursing care and support for up to 66 people. At the time of the inspection the service was supporting 50 people. People were living with a range of needs associated with the frailties of old age, some people were living with dementia or other mental health needs.

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

At the last inspection in February 2019, we identified four breaches of regulations. These were in relation to Regulation 9 (Person Centred Care), Regulation 14 (Meeting nutritional and hydration needs), Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, the provider sent us an action plan. This included information about the steps they had taken to make improvements at the service. However, due to the Covid-19 (coronavirus) pandemic and the subsequent lockdown on visitors, their priorities had to change. The provider and staff worked hard to ensure the appropriate infection control procedures for the pandemic were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of personal protective equipment (PPE) were available. Staff completed training in relation to Covid-19 (coronavirus). We were assured the provider managed infection prevention and control through the coronavirus pandemic.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff understood the risks associated with the people they supported. Risk assessments provided guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

Despite the need to keep people safe during the Covid-19 (coronavirus) pandemic taking priority, the provider and staff team had worked hard to address the areas for improvement following the last inspection. For example, quality assurance systems had been introduced and embedded. This included audits of medicines, care plans, training and supervision, infection control and health and safety.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 26 April 2019). There were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 February 2019. Breaches of legal requirements were found. We imposed a condition on the provider’s registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection in light of concerns we had received in respect to the care people were receiving. Concerns included quality monitoring, assessments of risk, and the management of nutrition, pressure care and medicines. A decision was made for us to inspect and examine those risks. Therefore, this report covers our findings in relation to the Key Questions: Is it Safe? and Is it Well-led?. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

For those key questions not looked at on this occasion, the ratings from the previous comprehensive inspection were used in calculating the overall rating at this inspection. Despite the rating of the key questions Safe and Well led improving to Good, the overall rating for the service has not changed from Requires Improvement. This is based on the findings at this inspection.

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

Follow up

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

Homebeech is a care home registered to provide care and accommodation for 66 people with nursing and physical care needs. There were 44 people living at the service on the day of our inspection. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Since the previous inspection, sufficient improvements in relation to quality monitoring and governance had not been made. The provider still did not have effective quality assurance systems to ensure a good level of quality and safety was maintained.

Since the previous inspection, sufficient improvements in relation to staff training had not been made. Staff had received essential training. However, some staff had not received training in topics that the provider considered mandatory, and updated training for staff had not routinely gone ahead.

Since the previous inspection, sufficient improvements in relation to people being encouraged and supported to eat and drink well had not been made. Recording of people’s food and fluid intake was not always accurate.

Since the previous inspection, sufficient improvements in relation to person centred care had not been made. Care plans described people’s preferences and needs, including their communication needs. However, staff did not routinely follow people’s agreed plans of care.

Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately. However, the provider’s audits of medicines had not routinely picked up gaps and omissions in medicines records.

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were treated with dignity and respect, and they were encouraged to be as independent as possible. However, confidential information relating to people’s care was not always stored securely.

Systems were in place for the recording of incidents and accidents. They were monitored and analysed over time to look for any emerging trends and themes.

People were cared for in a clean and hygienic environment. Appropriate procedures for infection control were in place. The provider carried out routine audits of infection control procedures.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

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

There were sufficient staff to support people. People felt well looked after and supported. We observed friendly relationships had developed between people and staff.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

Healthcare was accessible for people and appointments were made for regular check-ups as needed. People’s end of life care was discussed and planned and their wishes had been respected.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the management team was always available to discuss suggestions and address problems or concerns. Staff had received supervision meetings with their manager and formal personal development plans.

Rating at last inspection: Requires Improvement (report published 24 December 2018).

Why we inspected: We inspected Homebeech on 11 February 2019 in light of information of concern that we had received in respect to specific incidents in people’s care. We previously inspected Homebeech on 19 and 26 June 2018 and 25 September 2018. We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. Three of these actions have been completed and the provider was now meeting legal requirements in these areas. However, at this inspection, we found additional and continued breaches of the Regulations and further areas of practice that needed improvement.

Follow up: We will be in contact 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.

In February 2016, we undertook a comprehensive inspection of this service and found breaches of regulations in relation to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. We undertook an unannounced comprehensive inspection of this service on 28 February and 30 March 2017. At the inspection we found that insufficient improvements had been made in relation to these three breaches of regulation. The service was rated as Requires Improvement in each domain and overall. As a result of our findings at the inspection, we took enforcement action and issued three Warning Notices on 4 April 2017, against each regulation, to the provider and to the registered manager.

Details of each breach were stated to the provider and registered manager in each Warning Notice. Regulation 12: Risks to people had not been identified or assessed adequately to ensure staff received guidance on how to support people safely. Records were not always reviewed consistently to ensure people's most up to date needs were met or communicated to staff. Premises were not always managed to keep people safe. Regulation 10: Not all staff displayed a caring attitude and several instances were observed when staff ignored people. Some people and relatives gave negative feedback about the care and support from staff. Regulation 9: Activities on offer to people had not been organised to reflect people's interests or to provide mental stimulation. Systems were not in place to ensure that records relating to people's care were accurate or contemporaneous.

We also found that the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns that the provider had not ensured that effective systems and processes were in place to assess, monitor and improve the quality and safety of the service. The provider’s audit systems were not effective in demonstrating action had been taken regarding identified shortfalls. In addition, systems were not in place to demonstrate the service operated effectively to ensure compliance with the Regulations.

We undertook a focused inspection on 30 July 2017 to check that the provider had met their legal requirements and the provider and registered manager had met the Warning Notices served under Section 29 of the Health and Social Care Act 2008. We found that improvements had been made and the requirements of the three Warning Notices were met. However, further work was needed to sustain the improvements already implemented and to drive continuous improvement.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had sustained the improvements and to confirm that the service now met legal requirements. We found the provider had not sustained improvements and were in breach of Regulations.

Homebeech is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. It is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. On the day of our inspection there were 50 people living in the service, who required varying levels of support. Homebeech is arranged into three units. The main part of the home called 'Oakside', but commonly referred to as 'Homebeech,' supports people who have health care needs. Daffodil unit is for people under the age of 65 years who have a range of physical disabilities. Beechside unit accommodates nine people living with dementia, it has a locked door with a key pad entry / exit system. The main part of the home has a large sitting room and dining room, with an adjacent conservatory. A further sitting room is available to people on the ground floor. The Beechside unit has separate facilities, including a lounge and dining area. All bedrooms have a toilet and sink en-suite. Accommodation is provided over three floors and lifts enable easy access. People have access to outdoor spaces.

There was a manager in post, who began their employment at the service approximately two weeks before the first day of this inspection. At the time of our inspection, they were not registered with the CQC. However, since the conclusion of our inspection they have begun the process to register with the commission. 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’s safety was sometimes being compromised as people commented they had to wait for care and assistance.

People told us that they were happy with the care. However, care was not personalised to the individual. People’s preferences were not followed when they had personal care. For example, people did not always receive assistance getting into bed at the time they wished. Care was task driven, meaning that staff did not routinely meet people’s preferences in relation to how their care was delivered.

There were some arrangements in place to meet people’s social and recreational needs and in response to the previous inspection, the service now employed a part-time activities co-ordinator. However, we could not see that activities were routinely organised for everybody or for people who remained in their rooms. Staff did not engage socially with people, due to the care delivery being task centred. We observed occasions when people were ignored by staff.

The provider had a range of quality assurance audits. However, action had not been taken in response to shortfalls identified by the audit systems. Therefore, the audits had not ensured that people received a consistent and good quality service that met individual needs. The provider had also not met all of the required improvements set out in their action plan identified at the previous inspection. Systems were not in place to demonstrate the service operated effectively to ensure they met the Regulations.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Accidents and incidents were recorded appropriately. Risks associated with the environment and equipment had been identified. Emergency procedures were in place in the event of fire. There was a nurse who was responsible for managing an evacuation in the event of a fire. However, they had not received any training specific to the geography of the building.

When staff were recruited, their employment history was not always completely checked and valid references were not always obtained. Recruitment checks did not ensure new staff were safe to work within the care sector.

Medicines were stored safely and in accordance with current regulations and guidance. However, medicines were not always given in line with safe practice. Medicines prescribed to be taken ‘as required’ were not given in accordance with people’s needs.

Staff had not received training specific to the needs of the people living at the service. Only two staff members had received training on, ‘Working in a person-centred way’ and only one had undertaken training in dignity and respect.

People were not always enabled or encouraged to eat and drink well. Special diets were not always adequately catered for. People requiring soft diets told us they received very little choice. We have made a recommendation about staff training on the subject of meeting people’s nutritional needs. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were not able to express their views and had limited opportunity to feedback about the service they received.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. Homebeech is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. At the time of our inspection, 48 people were living at the home. Homebeech is arranged into three units. The main part of the home called ‘Oakside’, but commonly referred to as ‘Homebeech’, supports people who have health care needs. Daffodil unit is for people under the age of 65 years who have a range of physical disabilities. Beechside unit is a secure unit that accommodates nine people living with dementia. The main part of the home comprises a large sitting room and dining room, with an adjacent conservatory. A further sitting room is available to people on the ground floor. The Beechside unit has separate facilities, including a lounge and dining area. All bedrooms have a toilet and sink ensuite. Accommodation is provided over three floors and lifts enable easy access. People have access to outdoor spaces.

In February 2016, we undertook a comprehensive inspection of this service and found breaches of regulations in relation to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. We undertook an unannounced comprehensive inspection of this service on 28 February and 30 March 2017. At the inspection we found that insufficient improvements had been made in relation to these three breaches of regulation. The service was rated as Requires Improvement in each domain and overall. As a result of our findings at the inspection, we took enforcement action and issued three Warning Notices on 4 April 2017, against each regulation, to the provider and to the registered manager.

Details of each breach were stated to the provider and registered manager in each Warning Notice. Regulation 12: Risks to people had not been identified or assessed adequately to ensure staff received guidance on how to support people safely. Records were not always reviewed consistently to ensure people’s most up to date needs were met or communicated to staff. Premises were not always managed to keep people safe. Regulation 10: Not all staff displayed a caring attitude and several instances were observed when staff ignored people. Some people and relatives gave negative feedback about the care and support from staff. Regulation 9: Activities on offer to people had not been organised to reflect people’s interests or to provide mental stimulation. Systems were not in place to ensure that records relating to people’s care were accurate or contemporaneous.

We undertook this focused inspection to check whether these three regulations had been met. This report only covers our findings in relation to the topics written about in the preceding paragraph. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Homebeech on our website at www.cqc.org.uk

A registered manager was 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.

Concerns relating to premises arising out of the last inspection had been addressed. However, at this inspection, maintenance staff working at the home had left the door to the boiler room unlocked and radiator covers were not affixed to walls, which meant that parts of the home were unsafe. Risk assessments had been improved and provided detailed information and guidance to staff about people’s particular risks and how to mitigate them. Relatives felt their family members were safe living at Homebeech. Staff had been trained to recognise the signs of potential abuse and knew what action to take if they had any concerns.

Relatives talked about the caring nature of the staff at the home. Our observations at inspection demonstrated staff were kind and caring and positive relationships had been developed. Care staff were busy and did not always have time to sit and chat with people. There was no evidence to show how relatives and people were involved in planning their care.

No activities co-ordinator was in post and the registered manager told us they were in the process of recruiting to this post. Efforts had been made to provide meaningful activities for people, however, these were not always organised to reflect people’s personal interests and hobbies; this was work in progress. Some external entertainers came into the home. Trips or outings into the community were not available and people had to rely on relatives or friends for visits out if they were unable to access the community independently. Staff had a lack of understanding of the concept of person-centred care.

We have made two recommendations to the provider as a result of our findings at this inspection. Improvements have been made and the requirements of the three Warning Notices have been met. However, further work is needed to sustain the improvements already implemented and to drive continuous improvement.

The last inspection took place on 11 February and 9 March 2016. As a result of this inspection, we found the provider in breach of three regulations relating to safe care and treatment, dignity and respect and person-centred care. We asked the provider to submit an action plan on how they would address these breaches. An action plan was submitted which identified the steps that would be taken. At this inspection, we found that insufficient improvements had been made and that these three regulations were still not met. We are in the process of considering our regulatory action to respond to this and will publish the action we have taken. In addition, we found one further breach of regulations.

Homebeech is situated close to the seafront in Bognor Regis and within walking distance of the town centre. Homebeech is registered to provide accommodation and nursing care for up to 66 people with a variety of health conditions, including dementia, physical disability and frailties of old age. At the time of our inspection, 51 people were living at the home. Homebeech is arranged into three units. The main part of the home called ‘Oakside’, but commonly referred to as ‘Homebeech,’ supports people who have health care needs. Daffodil unit is for people under the age of 65 years who have a range of physical disabilities. Beechside unit is a secure unit that accommodates nine people living with dementia. The main part of the home has a large sitting room and dining room, with an adjacent conservatory. A further sitting room is available to people on the ground floor. The Beechside unit has separate facilities, including a lounge and dining area. All bedrooms have a toilet and sink ensuite. Accommodation is provided over three floors and lifts enable easy access. People have access to outdoor spaces.

A registered manager was in post and their registration had been completed recently. Prior to their appointment, the registered manager post had been filled by the person who is now the senior 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 2008 and associated Regulations about how the service is run.

People were at risk of unsafe care or treatment because risk assessments did not provide sufficient information and guidance for staff on how to support people safely. People’s risk of malnourishment was not managed consistently nor were regular assessments carried out. Referrals were not always made to healthcare professionals in a timely manner where people had sustained falls. We observed instances of poor communication relating to moving and handling. Premises were not always managed to keep people safe.

Staff did not always treat people with dignity and respect. We observed occasions when people were either not listened to or ignored. People and their relatives had mixed views about the care and support provided by staff. Staff did not always treat people in a warm and caring way.

An activities co-ordinator arranged activities for people on a daily basis, but these did not reflect people’s interests or hobbies. Some people felt the same activities were offered every day, such as jigsaws, painting or colouring. No programme of activities was on display and a record to confirm group activities had taken place had not been completed since October 2016.

People were at risk of not receiving personalised care that was responsive to their needs. Care records were inaccurate or incomplete and documents relating to people’s individual care needs were not kept in one place. Some care plans were printed off and located in people’s rooms, some assessments were stored electronically and other records were stored in the nurses’ office. This meant that staff may not always have had ready access to people’s information or guidance on how to support them. Hourly checks on people were not always completed on time.

Opportunities had been missed to create a dementia friendly environment, especially in the Beechside unit. We have made a recommendation to the provider about this.

There was no evidence to confirm that staff received regular supervision or annual appraisals. Staff could not confirm they met regularly with their line managers. Staff meetings had taken place in 2017, but records relating to 2016 were unavailable for us to see.

Residents’ meetings had not been organised in 2017 to date. Systems to obtain feedback from people or their relatives were ineffective and the response to questionnaires sent out by the provider was poor as only two responses had been received. People were not involved in developing the service nor were their views sought.

Medicines were managed safely. Risks to people living with diabetes, or people who had developed pressure areas, were managed safely.

Staffing levels were within safe limits and the service used agency staff on a regular basis. However, some people felt their needs were not addressed by staff in a timely manner. Recruitment systems were in place to carry out checks for potential new staff, however, the registered manager was unclear about the requirements of safe recruitment in one instance.

People told us they felt safe living at Homebeech. Staff had been trained to recognise the signs of potential abuse and knew what action to take.

Staff completed a range of training in line with the standards of the Care Certificate, a universally recognised qualification. In addition, they received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, the registered manager had completed the necessary applications and sent these to the local authority.

People had sufficient to eat and drink and were encouraged with a healthy diet. People had mixed opinions about the food on offer. The lunchtime experience in the main dining area of the home was not always a sociable experience for people. Some people had to wait for their meal to be served. People were encouraged to maintain good health and, in the main, had access to a range of healthcare professionals and services.

Where staff had time to spend with people, positive, caring relationships had been developed. We observed people were involved in day-to-day decisions relating to their care. Complaints were managed satisfactorily.

Staff felt supported by the management team and the registered manager operated an ‘open door’ policy. A range of systems was in place to monitor and measure various aspects of the service. However, these were not always effective in ensuring that areas in need of improvement had been rectified.

We found a number of breaches 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 report.

The service 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 2008 and associated Regulations about how the service is run.

Risks to people’s health and safety were assessed prior to admission and were regularly reviewed. We found however that there was not always sufficient detail to tell staff what action should be taken when risk is identified, particularly in relation to malnutrition risk. Risk assessments stated that the aim was to reduce the risk of weight loss and dietician contact details were in place, but there was no information on when staff should take action in response to body mass index (BMI) data or weight loss. There was a risk that people may not receive appropriate support to mitigate the risk of weight loss and malnutrition.

People had mixed responses when asked about the caring manner of staff. One person told us, “There’s a percentage of staff that don’t speak”. From our observations staff did not always respond in a caring way towards people.

People told us they did not feel there were enough activities, commenting “There’s nothing to do”, and “That’s something we could do with more of”. While people’s social needs were assessed there was a lack of activities or opportunities for people to be occupied in a meaningful way and in line with their interests.

Staff were aware of their responsibilities in relation to keeping people safe. Staff felt that reported signs of suspected abuse would be taken seriously and knew who to contact externally should they feel their concerns had not been dealt with appropriately.

People told us staff responded to them when they needed help and were not left waiting. For example one person said, “I’ve never had to wait. The staff are very good. If they are busy with other jobs they say, ‘I will be five or ten minutes’.

Safe recruitment practices were in place and records showed appropriate checks had been undertaken before staff began work.

Staff had undertaken appropriate training to ensure that they had to skills and competencies to meet people’s needs. There was a formal supervision and appraisal process in place for staff and action which had been agreed was recorded and discussed at each supervision meeting.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) had been adhered to.

People’s hydration needs were met. Fluid charts were used to ensure that people received enough to drink. People received enough to eat and drink. People spoke positively of the food and the choice they were offered.

Relatives told us they felt staff made them feel welcome and made time to speak with them about any changes to their relative’s health or the care they received. A relative told us, “They always say hello and give a smile”.

People received care that was responsive to their needs and included information on their life history. People’s care plans were reviewed monthly or more often if needed to ensure that they reflected people’s current level of need.

The provider had a quality monitoring system in place, which had been effective in actioning areas for improvement.

We found a number of breaches 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 report.

This inspection was carried out by an inspector who was accompanied by an expert by experience.

We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at a selection of records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There were enough staff on duty, including nursing staff, to meet the needs of the people living at the service.

The provider had effective recruitment and selection processes in place to ensure staff employed at the service were appropriately screened before the worked with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were advised three DoLS applications had been made. Documentary evidence we looked at indicated applications made met the necessary criteria.

Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty.

There was a system in place to make sure that the manager and staff learned from events such as falls, accidents and incidents.

Is the service effective?

The provider demonstrated people were asked for their consent before care and treatment had been delivered and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

From our observations people were satisfied with the care that had been delivered and their needs had been met. A relative told us, "Staff are lovely and friendly. My family member is happy; they (the staff) are quite accommodating. They can change plans, like if I take my relative out to lunch on impulse.'

It was clear from the majority of our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew how to provide for them.

People's health and care needs had been assessed and reviewed. Care plans had been drawn up. They included detailed information to ensure staff delivered care consistently to meet people's needs.

Is the service caring?

Care records included information about individual needs and guidance for staff to follow to ensure they had been met.

People were supported by kind and attentive staff. We saw that the staff showed patience and gave encouragement when supporting people.

We observed good interactions between people and staff. Care staff who assisted people to eat their meal ensured the pace was dictated by the person.

Care was delivered in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

Relatives and friends of people using the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

A relative told us, "I see the manager about issues and they are dealt with."

Is the service well-led?

The manager held staff meetings every three months. The manager has used them to communicate issues related to the day to day running of the home.

Staff we spoke with were clear about their roles and responsibilities.

Staff also demonstrated they had a good understanding of the ethos of the home.

Staff informed us they felt well supported by the management team.

People told us they were happy in the home and that they had choices. One person told us "Life here is lovely". Another told us "I am very, very happy here".

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us " I am very comfortable here and I am happy with the way care is given"

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.

People were looked after by a well trained and supported staff.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.