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Archived: Parkfields Nursing Home Good

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Reports


Inspection carried out on 27 April 2017

During a routine inspection

Parkfields Nursing Home is registered to provide accommodation and nursing care for up to 49 people. At the time of our inspection 33 people were living there. The inspection took place on 27 April and 4 May 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.

We previously inspected Parkfields Nursing Home on 28 and 29 June 2016. At the time of our previous inspection we found improvement had been made and two breaches of legal requirement highlighted in the earlier report were met and we rated the service as requires improvement.

People and their relatives we spoke with were confident improvements had taken place within the home which had resulted in the delivery of better care and support.

Staff told us how they would recognise concerns to people’s safety and were aware of the action they would need to take if people were at risk of harm or abuse. People were supported to remain as independent as possible. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

Staff had undertaken training relevant to their role and in order to meet the needs of people. Staff were confident they had the skills needed and felt supported by the management team. There were sufficient staff on duty to meet the needs of people who lived at the home.

Risks associated to the care and support of people were assessed and staff were aware of these risks. The registered manager had introduced new systems to ensure accurate records were maintained and was aware further improvement was needed with these

Improvements had been made in the recruitment of staff and the measures taken to ensure staff were suitable to work with people living at the home. We found improvement to the systems in place for the safe management of medicines. The registered manager introduced additional systems to ensure people always received their medicines as prescribed during the inspection process.

People were supported by staff in a kind and caring way. People were involved in planning their care and how they spent their day. Staff were aware of people’s interests and sought to engage people in these to stimulate them. The cultural needs of people were respected and met. Staff sought permission from people before care and support was provided. The registered manager and staff were aware of the importance of gaining consent and were aware of the need to involve other relevant people if looking at people’s best interests. People were confident they could raise concerns if they had any with the management team. Staff spoke highly of the management and of the changes they had brought about.

Inspection carried out on 28 June 2016

During a routine inspection

The inspection took place on 28 and 29 June 2016. The inspection was unannounced.

At our previous inspection of the service on 18, 19 November 2015 and 12 January 2016 we identified two breaches of legal requirements. This was because the provider’s systems for minimising and mitigating risk had not been effective, and systems were not robust enough to ensure risks relating to the health, safety and welfare of people were responded to. The overall rating after the previous inspection was inadequate and the location had been in Special Measures since August 2015. We found the provider had met the regulations at this latest inspection, and the overall rating had changed to Requires Improvement this meaning we have taken the decision to take the service out of Special Measures.

Parkfields Nursing Home provides care and treatment for up to 49 older people that may have a physical disability. The home provides nursing care, which means qualified nursing staff are always available. There were 25 people living at Parkfields Nursing Home when we inspected.

The service had a registered manager at the time of our 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff knew how to protect people and reduce risks but this information was not always reflected in people’s assessments. Staff were confident in escalating any allegations of abuse, so these would be investigated, and people protected. People said there was sufficient staff to ensure they were safe and received assistance when required. People were satisfied with how their medicines were managed. There were not always records in place to show pre-employment checks for new staff were carried out.

People’s consent was sought, but assessments to establish if people had capacity to make decisions were not always accurate and did not show how staff gained people’s consent in accordance with their rights. People felt staff were skilled and competent. The training staff needed had been identified and was been prioritised, so that more important areas of learning were provided first. People had a choice of food and drink available to them and said they enjoyed these. People’s health care was promoted, and risks to their health escalated to appropriate external health care professionals.

People said they were treated well by staff who were kind and caring. People’s privacy was respected and they were able to make choices before and during the care staff provided to them. People’s independence was promoted.

People did not always have access to pastimes they enjoyed and found meaningful. People had involvement in the care and support they received. Staff were knowledgeable about people’s individual likes and dislikes, although this information not always captured in people’s records. People felt able to complain and were confident any issues would be addressed.

People had confidence the provider was improving the service they received. The provider had made improvements to ensure risks to people’s safety were identified and minimised. The registered manager recognised further improvements were required to improve people’s experiences. People were able to approach staff and felt listened to. Staff were well supported and happy in their work.

Inspection carried out on 18, 19 November 2015 and 12 January 2016

During a routine inspection

The inspection took place on 18, 19 November 2015 and 12 January 2016. The inspection was unannounced.

Our previous inspection of the service on 16 and 18 June 2015 identified three breaches of legal requirements. This was because people’s medicines were not managed safely, people’s consent to care was not always sought and effective systems were not in place to ensure people were protected from unsafe care and treatment. The provider wrote to us after this inspection to say how they were going to meet legal requirements in relation to the breaches. This inspection was undertaken to see if the provider had made improvement to meet the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We found the provider had met the regulations with respect of medicines and consent although there was still some scope for improvement in respect of how people’s medicines were managed. The provider had not completed all the actions needed in respect of management of the service and remained in breach of this regulation. We also found a further breach of regulation with regard to the safe care and treatment of people who used the service.

The overall rating for this service is ‘Inadequate’ and the service remains 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 improvements are made within this timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This service will continue to be kept under review.

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.

Parkfields Nursing Home provides care and treatment for up to 49 older people that may have a physical disability. The home provides nursing care, which means qualified nursing staff are always available. There were 29 people living at the service when we commenced this inspection.

The service did not have a registered manager at the time of our inspection but the manager has since registered with CQC. 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. An application for the manager to register has now been received.

People told us that they felt safe; however we found moving and handling practices the service used were not always appropriate for people’s individual needs and may have put them at risk. Improvement had not been made to this, despite the provider being made aware that a significant injury a person sustained was very possibly, although not conclusively, due to the use of an inappropriate lifting sling.

People told us they were happy with their care but there were occasions where staff did not show them respect or promote their privacy and dignity. The manager and staff had a good understanding of how they should keep people safe but concerns about people’s welfare were not always escalated appropriately and so appropriate action had not always been taken. People said they sometimes had to wait for assistance although this had not led to people feeling unsafe. People told us they were given their medicines when needed.

People told us, and we saw care and support was not consistently provided in a way that showed staff were kind and considerate. Staff told us they were aware of people’s care and support needs, and the provider was progressing training for staff to develop their skills and knowledge. People were supported to make their own decisions and choices in accordance with their best interests. People’s healthcare needs were promoted through contact with appropriate healthcare professionals.

People told us they were satisfied with the food and drink they had and this was provided for most people when requested and in sufficient quantities. Records showed some people did not have as much to drink as they were assessed as needing and these concerns were not recognised in November 2015. Systems to identify when people did not have enough to drink had improved in January 2016. We saw staff provided appropriate assistance to people that needed help to eat and drink although the timeliness of this support was not always consistent. We found systems were in place to ensure people at risk of weight loss were monitored.

People told us staff were kind to them, but we saw some staff did not support people in a way that was caring. We did see some people had good relationships with the staff who supported them. Some staff demonstrated a good knowledge of what was important for people and what was recorded in their care records; although there were occasions when staff did not know what was important for people or communicate effectively with them.

People's needs were assessed and their support plans provided staff with guidance about how they wanted their individual needs met, although there was some occasions where there was a lack of clarity about where nurses recorded people’s changing needs. People’s care needs were not always reviewed and updated in consultation with the person. People did not have access to many activities and pastimes in accordance with their individual interests and preferences, and we did not see staff having time to support people with these pastimes. People knew who to speak with if they had any concerns and the provider responded to complaints received.

The provider had introduced systems for the assessment and monitoring of the quality of the service, but these were not robust enough to ensure risks to people’s safety and welfare were identified and responded to. There was improvement in the systems in place to gain people’s views on the service. People and staff told us they found the manager and other senior staff approachable although some people said they did not see the manager very often. The manager told us they were trying to resolve some issues with poor staff relationships and some staff were concerned about morale. Some staff said they felt well supported and were positive about the changes the provider was making.

The manager had not always notified CQC of events they were required to by law.

We found the provider was not meeting the requirements of the law in regard to ensuring people were kept safe. We found the service was not well led. Measures identified to ensure people were safe when transferred with the use of lifting sings had not ensured they were safe. Systems for the management of the service were not robust to ensure risks to people were addressed.

We found two breaches of legal regulations. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 16 and 18 June 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 4 and 9 December 2014 and identified four breaches of legal requirements. This was because people’s medicines were not managed safely, allegations of abuse had not been reported, people’s care was not always planned and delivered in a way that protected them and effective systems were not in place to ensure people were protected from unsafe care and treatment.

After the comprehensive inspection, the provider wrote to us and told us how they were going to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 16 and 18 June 2015 to check that they had followed their plan and to check whether they now met legal requirements. We found that the provider had not fully met their legal requirements in relation to some of the breaches, although they had addressed others. We also found one additional breach of regulation 11 in respect of people’s consent to care.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Parkfields Nursing Home’ on our website at www.cqc.org.uk.

Parkfields Nursing Home provides care and treatment for up to 49 older people that may have a physical disability. The home provides nursing care, which means qualified nursing staff are always available. There were 34 people living at the service when we undertook this focussed inspection.

The registered manager had left the home since our last inspection. A new manager had commenced managing the home three weeks before this focussed inspection and told us they were going to apply to be the 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.

At this focused inspection we reviewed the breaches we had identified and told the provider about. We found that the provider had made some improvements in the way they monitored the quality of care and treatment people received. We found that there were more robust systems in place to monitor risks to people’s health and well-being. We saw staff were respecting people’s dignity and privacy. Systems were being introduced to ensure that staff were better deployed. Most people told us staff responded to their requests for assistance better. We found there was still scope for the provider to improve systems. For example, ensuring the safe management of medicines, consistent involvement of people in their care and record keeping. This meant the provider had not fully addressed this breach in respect of how the quality of the service was monitored.

We found the provider had improved the frequency of their auditing for medicines and we saw that there were some improvements that ensured people received their medicines as prescribed. However, we found gaps in these audits and saw the systems for the management of people’s medicines were not always safe. This meant the provided had not fully addressed this breach.

In response to the breach regarding allegations of abuse or incidents of actual harm to people not being reported to the appropriate agencies we found improvements. The manager and staff were aware of how to raise safeguarding referrals and we have received prompt notifications of such incidents and allegations when they had been made since our previous inspection. We found the provider had addressed this breach.

We found that the care and treatment of people’s fragile or broken skin had improved and some people’s broken skin had healed. There were still some areas where improvements could be made to ensure the progress of people’s fragile skin was better monitored. Based on the improved outcomes for people with fragile skin, we considered the provider had addressed this breach.

Some people had not been involved in the planning of their care and as a result their choices as to how, for example the medicines were given to them, had led to a potential breach of their human rights.

You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘requires Improvement ’. The rating for the domain safe has remained at inadequate and as a result the service has been placed into ‘special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which the providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measure will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 4 and 9 December 2014

During an inspection looking at part of the service

Parkfields Nursing Home provides care and treatment for up to 49 older people that may have a physical disability. The home provides nursing care, which means qualified nursing staff are always available.

The service is overseen by 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.

At the last inspection on 2 April 2014 we asked the provider to make improvements. This was due to concerns in respect of how people were respected and involved in their care, provision of food and drink, staffing and assessing and monitoring the quality of service provision. We received an action plan from the provider who told us that all the improvements would be made by 31 July 2014.

We inspected Parkfields Nursing Home on 4 and 9 December 2014. The inspection was unannounced.

The action to address our concerns about people having a choice of, and sufficient food and drink was completed. People were able to have a choice of foods and access to drinks. Where people needed specialist diets these were available, as were meals that reflected people’s cultural preferences.

We saw and heard from people that staff provided care in a kind and compassionate way and promoted people’s privacy, dignity and independence. However, this approach was not consistent and some staff did not show people respect, dignity or offer choices.

There were occasions where we found there was an impact on the times care was provided, for example with meals and medication, this due to how staff were deployed. Most people thought there was enough staff although some mentioned having to wait for assistance. We found that the systems to ensure enough staff were deployed to allow a consistent response to people’s care needed improvement.

We found that a number of weaknesses in the home’s quality monitoring systems. For example, audits had not always identified areas where the service needed to improve and there were concerns we had previously identified the home had not fully addressed.

People were supported by external healthcare professionals, when required, such as district nurses and doctors, although some people had not seen a dentist recently. We had concerns that not everyone’s health care needs were met as planned as we saw some people with fragile skin were not always repositioning in accordance with their risk assessments. This presented a potential risk to their health.

Most people told us they felt safe at the home, although we heard one person told us they were not. We reported these concerns to the local safeguarding authority. Systems for ensuring allegations of abuse were reported to the appropriate statutory agencies, to ensure they were fully investigated were not robust. An allegation of abuse that involved harm to a person was not reported to Wolverhampton City Council by the registered manager.

We found that people were not always protected against the risks associated with safe management of medicines. For example, we found medicines were not always available to treat people’s diagnosed health conditions, there were gaps in some people’s medicine administration records and medicines were not stored safely.

Staff were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs), which help to support the rights of people who lack the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We saw that applications for a DoLs for had been made where this was appropriate.

We saw that a number of people had the opportunity to participate in recreation and occupation, with some commenting positively about this. The views of some visitors indicated that people did not always receive stimulation and we saw for example that some people, who stayed in their rooms, received limited support in this area.

The home had a complaints procedure, which showed that one complaint had been received since January 2014. Some people and relatives told us they were not aware of how to complain. The registered manager did not have a clear knowledge of the escalation route if a complainant was dissatisfied with the provider’s response to their complaints.

Not everyone felt they were asked their views about the service. We found there was limited evidence of people completing surveys or questionnaires about their views of the service, although some people were aware of meetings that took place in the home.

There was a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations in respect of assessing and monitoring the quality of service provision. We also found further breaches in respect of safeguarding service users from abuse, management of medicines and the care and welfare of service users. This meant that the law about how people should be cared for was not met. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 2 April 2014

During a routine inspection

The inspection team was made up of an inspector and an expert by experience. We set out to 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, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

Some people told us they felt safe and we found that staff were knowledgeable and trained about safeguarding procedures so that they understood their role in safeguarding the people they supported.

There were some improvements since our previous inspection in August 2013 that showed that the manager and staff learnt from some events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider responded to the specific concerns that were identified from these and our previous inspection. They were not able to demonstrate how they would routinely identify and assess risks and put systems in place to minimise these risks as a matter of routine practice though. This meant there was an increased danger that the risk of harm to people may not always be identified and there may be a failure to ensure that lessons are learned from mistakes.

We found that there were times where people's needs were not always met appropriately by staff, with staff focusing on the task they needed to do but not engaging with people when they provided care and supported them. We were concerned that staff seemed less able to respond to people�s needs during the morning period, with observation showing us that people had later breakfasts as staff did not get them up until mid-morning. We asked the manager about what sort of tools they used to measure people�s dependency so they were able to plan how many staff were needed and how they should be deployed. They told us that they did not use one. This raised concerns as to whether there was sufficient staff, or whether they were deployed appropriately, so that people�s needs were met and they were kept safe.

We looked at staff training records and saw that the provision of training to staff had improved in mandatory areas. Staff we spoke with presented as having better knowledge in some areas related to people�s safety. There was still scope for improvement in areas relating to staff awareness of, for example, how to ensure people�s dignity was consistently respected and the Mental Capacity Act.

We asked staff about people who may have a restriction agreed through a Deprivation of Liberty Safeguard (DoLS) (a restriction agreed with social services that is in the person's best interests), and there was a lack of understanding about one person�s DoLS having ceased. Discussion with the same staff showed that the restriction was not being applied though, as these were not needed to promote the person�s safety. Although this meant that restrictions were not applied inappropriately following the cessation of this DoLS it is important that staff are aware of the status of any DoLS in place to ensure that any restriction is not used unlawfully.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events, and ensuring there is sufficient staff available to ensure people�s needs are met in an appropriate and timely manner .

Is the service effective?

People�s health and care needs were usually assessed with them present, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Specialist dietary needs were assessed and included. We saw improvement in that all the care plans we looked at had been reviewed since our last inspection. Care plans identified people�s health and care needs and staff showed an understanding of these. This meant that information was available to staff to allow them to offer support consistently to meet people�s needs.

People�s mobility and other needs were not always taken into account in ensuring people had equipment available to them to ensure they could be independent and be enabled to move around freely and safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care and promoting their dignity, privacy and independence.

Is the service caring?

People were not consistently supported by kind and attentive staff. We saw that although some care workers showed patience and gave encouragement when supporting people, others did not. People commented, �They allow me to have a bath on my own. They just support me getting in and out, also in and out of my bed�. Another person said, �Staff are always too busy to talk to me. I have to wait for staff to take me (to the toilet) and now they move me in a wheelchair�. A relative said, �I�m not totally happy with the care in this home. Today (my relative�s) shirt is all crumpled and scruffy and my relative has still got their pyjama bottoms on.�

People who used the service, their relatives, friends and other professionals involved with the service were able to complete satisfaction surveys. There were some shortfalls, and concerns had been raised by relatives. The registered manager was able to tell us what actions they have taken to address some of these shortfalls. Some people told us they would complain to the manager if they were not happy with the care, but one person told us they did not know how too, another that they were not confident in raising concerns. People were at risk of not having their concerns and needs properly taken into account.

People�s preferences, interests, aspirations and diverse needs were recorded, although what we saw showed that care and support was not always provided in accordance with people�s wishes, for example the times that people received their meals.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We looked at how the service worked with other health care professionals to ensure people�s health care needs were addressed. We did see improvement in how the staff had responded to people�s changing health needs to ensure appropriate health professionals were involved as and when needed. We saw that there was more regular assessment and review of people�s care needs in place.

Is the service well-led?

All of the staff we spoke with said that if they witnessed poor practice they would report their concerns.

The service did not have a robust quality assurance system. Not all of the shortfalls identified by us at our previous inspection had been addressed. We saw that the provider had responded to some of the specific issues we identified during our previous inspection but had not identified other issues of concern that we observed during this inspection. This meant issues of concern were not routinely identified and responded to by the provider through continuous monitoring of the service.

The manager told us that the service worked in partnership with key organisations, including the local authority and safeguarding teams, to identify any concerns about care provision. The manager had informed us of any concerns about people�s safety where this indicated potential abuse.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to developing their assessment and monitoring of the quality of the service so as to ensure they can learn from this.

Inspection carried out on 15 August 2013

During a routine inspection

During this inspection we spoke with ten people, three relatives, five staff members and the home manager.

We found that people's dignity was not always maintained. Some people we spoke with told us they were not involved in their care planning. One person said, "I am not sure if I have a care plan."

People did not consistently receive care that met their needs. We found that there was lack of stimulation and interaction. One person told us, �I�m content here, I have to be but I can�t say I�m happy.�

Some improvements had been made around protecting people from harm. However, we found that not all staff were aware of how to protect people.

There were not enough staff to look after people throughout the day. One person told us, �The staff are really busy they don�t have time to sit and talk to me, how do they know what I might want.� We observed that some people did not receive appropriate care and support.

Systems were not in place to ensure that the quality of the service was monitored so that improvements could be made. People we spoke with told us they were not happy with some aspects of their care. One person told us, No point in asking for anything, they don�t listen.�

We found that records were not fit for purpose, accurate or up to date in some instances which would put people at risk of inconsistent care.

Inspection carried out on 3 October 2012

During a routine inspection

We spoke with eight people that lived at the home.

People told us that the care they received was as they expected. People told us that �Its better than a hotel", �It�s alright, well catered for� and �Couldn't� expect anything better if I was the queen, they have been brilliant to me�.

People told us they had choices about their daily routines. We saw staff interact positively with people but there were some occasions where people�s dignity was compromised.

People told us that they felt able to raise concerns about the service, some saying they felt safe. We spoke with staff and they told us that they would report concerns they noticed. One person said that they did not like having to go to their room when they challenged staff.

We saw that the home had systems in place to promote effective infection control; this reflected by a building that we saw was clean.

We saw that people were able to manage their own medication safely but there was one occasion where a drugs trolley was left unlocked out of the view of a nurse.

We heard that staff usually responded to people in a reasonable time when they needed assistance meaning that there was sufficient staff available.

We heard that people knew about the homes complaints procedures which were available in a range of languages. People told us they were confident that staff would listen to any complaints they raised. One person said that they had "No complaints about the care".

Inspection carried out on 24 November 2011

During an inspection in response to concerns

We found that care plans provided staff with relevant information to enable them to support people appropriately. Staff demonstrated a good understanding of people�s care needs and how best to care for them.

One person who uses the service said, �The staff care for me well.�

Another person who lives there told us, �Its OK living here.�

We observed staff assisting people with their meals and this was done in a caring and dignified manner. Efforts had now been made to ensure people have a say in the meals provided to them. Care plans provided staff with information about people's nutritional needs and how to support them.

People from an ethnic minority background have a choice of meals to reflect their preference. One person who lives there said, �The food is OK, I get Indian food which I prefer.�

During an inspection looking at part of the service

One person said, �The staff do look after me and they do ask how I would like to be cared for.�

�The staff check on me to make sure I�m alright.�

Another person said, �You might as well try and be happy because there�s nothing you can do, you just have to accept the good with the bad.�

We observed that care staff appeared to be very busy but did attend to people�s needs in a caring manner.

One person who uses the service told us that the meals provided were alright. However, care records failed to provide up to date information about the level of support people required to maintain their nutritional needs and this could place the individual at risk.

We found that people�s prescribed medicines were managed safely.

One person who uses the service told us, �Things are a lot better during the night.� They said they disliked being assisted by male carers and their wish to have only female carers was respected.

Another person told us, �It�s alright here you have good and bad staff.�

One person told us, �I�ve never had to complain about anything.�

We observed that the home�s complaint procedure was accessible to people who live there and to visitors.

Inspection carried out on 7 April 2011

During an inspection in response to concerns

One person said, �I always have carers who are from the same cultural background as me, they understand me.�

We spoke to one person about the support they receive from staff and they told us, �The night staff hurt my arm when they assist me with my personal care needs.�

Another person said they were happy with the care provided by the day staff but said, �The night staff take a long time to take me to the toilet.�

We talked to people about staff respecting their privacy and one person said, �The staff never knock on my bedroom door.�

Another person raised concerns that, �The night staff don�t answer my buzzer.�

One person said, �The food is good and we get plenty and we also have a choice of meals.� �There are always drinks available.�

Another person said, �The meals are alright, the staff know what I don�t like and they don�t give it to me.�

One person who use the service said, �The food is not very good but I suppose you have to get use to it, but I�m not impressed.�

Care records show and discussions with a person who use the service confirm they require a special diet, they told us �I�m fed up with being given the same food everyday.�

One person told us �The day staff are good but there is a difference with the night staff they are not so gentle.�

Another person raised concerns about the night staff and said �I don�t like the night staff; they take a long time to answer my buzzer.�

Comments received from another person, �The staff in the day are lovely but I don�t like the night staff.�

We spoke to people about the home's complaints procedure and one person said, �They tell you off if you complain.�

One person said, �I wouldn�t complain, I�m scared of the consequences.�

Another person told us, �I�ve never really complained about anything, if I�m unhappy I just say, I get on well with the staff.�

One person told us they had never seen the home�s complaints procedure.