Lennox House

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

During our last inspection we found systems and processes to support good governance were not effective. At this inspection we found that significant improvements had been made. The home had worked collaboratively with local partners to develop and strengthen governance systems. There was new leadership that was committed to driving change and improving the quality of care. Whilst improvements had been made, there were still some work in progress to embed the changes.

Additionally, there is ongoing fire safety work to ensure that the unoccupied areas of the building were safe before floors could be opened up for people. Therefore, we have judged that in as much as the home had made progress, there was still some work to be achieved and further embedding of systems and processes.

Improvements had been made to manage risks to people’s safety. There were adequate systems to assess and monitor safety. The home had systems to safeguard people from abuse. Policies were regularly reviewed and were accessible to all staff.

The home learned and made improvements when things went wrong. There was a system for recording and acting on significant events and incidents. Staff understood their duty to raise concerns and report incidents and near misses. The home demonstrated that they had acted on recent safety concerns.

Significant improvements had been made for providing effective care. People’s needs were assessed, and care and treatment were delivered in line with current legislation, standards and evidence-based guidance. The home had improved their systems to ensure all people whose symptoms indicated serious illness were followed up.

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 home supported this practice.

Staff treated people with kindness, respect and compassion. They understood and respected the personal, cultural, social and religious needs of people. This ensured the home organised and delivered services to meet people’s needs.

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

Rating at last inspection: The last rating for this service was inadequate (published 25 March 2020).

The home completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This home has been in Special Measures since January 2020. During this inspection the provider demonstrated that improvements have been made. The home is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose-built accommodation in a residential area of North London. At the time of our inspection there were 38 people living at the home.

People’s experience of using this service:

We found the provider had made improvements in the specific areas we looked at.

There was evidence of recent effective liaison with the local safeguarding team and the wider multi-disciplinary team. Reports of potential abuse had been referred to the local authority safeguarding team. Relatives gave consistently good feedback about the quality of care. They told us people were safe and protected from avoidable harm.

There were examples of good practice in relation to diabetes care. People received diabetes care that matched with their needs. Those at ‘high-risk’ of hypoglycaemia (low blood sugar levels) were identified and received targeted interventions. This was also true of pressure ulcer care.

The medicines administration records we reviewed showed people were receiving their medicines as prescribed. Medicines errors were being recorded and investigated. Monthly medication audits were completed. They showed improvement in how medicines were being managed with action plans developed for issues identified.

The provider ensured that lessons were learnt from accidents and incidents. We found that following each untoward event, risk assessments and risk management plans had been reviewed and updated. Actions to reduce the risk of similar incidents and accidents occurring had also been taken.

Infection risks to people using the service had been assessed and managed. The provider had reviewed and harmonised infection prevention and control practices with current guidance.

We noted there had been input from the local authority and the wider Care UK support structure to improve quality of care. This was continuing at the time of the inspection. As a result, it was too early for the provider to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time, including when support from the local authority and Care UK was withdrawn. However, it should be noted the recent appointment of a new clinical lead, manager and new permanent staff had been viewed positively by staff. The new manager was described in complimentary terms by staff in relation to his leadership.

Rating at last inspection:

The last rating for this service was inadequate (published 25 March 2020) and there were three breaches of regulations. At that inspection we identified breaches in relation to the quality and safety of people’s care, lack of suitably qualified staff and quality assurance.

Why we inspected:

We undertook this targeted inspection to check on specific concerns we had about the quality and safety of people’s care. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Lennox House is registered to provide personal care and accommodation for up to 87 people. At the time of this inspection there were 61 people in residence. This is because the home was under an embargo imposed by the local authority, and so had temporarily stopped admitting new people until improvements were made. The home is divided over four floors. The ground floor was not currently occupied. Residential care for people using the service who did not require nursing care was provided on the first floor. Nursing care was provided on the other two floors.

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

People were not always protected from potential harm. Risk assessments had not always identified potential risks or included sufficient guidance for staff about how to minimise the potential risk to people. Additionally, the service did not have an effective system to manage accidents and incidents to reduce the risk of them reoccurring. Importantly, performance data was not properly analysed in order to understand and interpret its significance.

The service did not have enough suitably qualified staff to meet people’s needs. As a result, there was an overreliance on agency staffing. This negatively impacted on quality of care. It meant increased weakening of teams in different units because agency staff did not know people well. Therefore, although there was a variety of essential training available for staff, including an induction, there was a reduction of skills within teams because of the ever presence of agency staff. The pressure on permanent staff was further intensified by limited support from management. Staff did not have access to regular appraisals and supervision.

There was limited evidence of person-centred care. This was related to the absence of effective teamwork and collaboration within the service as well as with members of the multidisciplinary team. Communication between the service and the members of the multi-disciplinary team was not structured and consistent. We judged the onus was on the service to establish effective collaboration to promote effective coordination and delivery of person-centred care.

Quality assurance systems had not been used effectively to identify concerns, errors and omissions we identified during the inspection. The culture at the service did not effectively support high quality sustainable care. The service had continued to be inconsistently managed. The managers could not demonstrate they had the capacity and skills to deliver high quality sustainable care.

We observed kind and caring interactions between people and staff. People and their relatives responded well to staff. They told us staff were caring. However, people and their relatives reported standards dropped when agency staff were on shift. We judged the concerns we found at this inspection did not demonstrate a caring approach. The high turnover of staff and high use of agency staff meant they may not have had enough time to get to know people and offer them compassionate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

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

Rating at last inspection

The last rating for this service was requires improvement (published 11 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the service had deteriorated to Inadequate.

Why we inspected

The inspection was prompted in part by notifications of concerns received about the care people using the service received. The Care Quality Commission were also aware that the Local Authority had on-going concerns about the service. A decision was made for us to inspect and examine those risks and we found significant improvements were required.

We have found evidence that the provider needs to make improvements. Please see the Safe, Well-led, Responsive, Effective and Caring 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

We have identified breaches in relation to staffing, safe care and treatment and governance.

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 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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘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 6 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 rating, 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 the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This unannounced inspection was carried out on the 10, 11, 13 and 20 September 2018.

At the time of the inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection of this service was on 30 and 31 August 2017 and we found concerns relating to regulation 11, 12 and 17 of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not effectively operated systems and processes to monitor and improve the quality and safety of the service. The provider was not following the requirements of the Mental Capacity Act 2005 (MCA). We also found that people at risk of falls were not properly assessed and monitored.

At this inspection, we saw that methods of monitoring the quality of the service had been largely improved. The service had put in place a range of audits to review people’s care. There were systems for reviewing and investigating when things went wrong. However, we found the registered manager still required support from the provider to deliver high-quality and sustainable care.

Risks to people had been identified, assessed and reviewed. Each person's care plan had several risk assessments, including the associated hazards and what measures could be taken to reduce risk. The previous inspection had identified unsafe practices in the management of falls. At this inspection we saw that improvements had been made.

The service had continued to operate systems to keep people safe from abuse. The service carried out appropriate staff checks at the time of recruitment and on an ongoing basis. Although there was a high staff turnover, overall, there were sufficient staff deployed to keep people safe.

The service had learned and shared lessons from incidents. There were adequate systems for reviewing and investigating when things went wrong. Equipment within the home had been serviced and maintained on a regular basis. A fire risk assessment was in place and regular in-house fire safety checks had been carried out. There was an effective system to manage infection prevention and control.

The previous inspection identified that staff had not consistently received supervision and appraisal. At this inspection we found that although there were arrangements for ongoing staff support, they were not effective.

We found staff had the skills, knowledge and experience to carry out their roles. They supported people to have maximum choice and control of their lives. People confirmed they were involved in planning their care. Their care records showed relevant health and social care professionals were involved in their care. The service was working within the principles of the Mental Capacity Act (MCA) 2005. People told us they liked the food offered, they could choose what they wanted to eat.

We found staff to be compassionate and caring. People we spoke with were happy with the care and support they received. Staff showed a concern for people’s wellbeing in a caring and meaningful way. People’s rooms appeared to be usable in a safe manner. They were clear of trip hazards and clutter. We noted they were personalised with paintings, photographs and matching bedding, curtains and had adjustable tables and armchairs with personal items in reach. Staff understood the need to protect and respect people's human rights. They had received training in equality and diversity.

The service organised and delivered services to meet people’s needs. The records we reviewed set out people’s preferences and addressed their individual needs and risks. The service ensured people’s activities were taken seriously. This was reflected in people’s care records we read. We found that people’s assessments had taken account of their choices. Activity preferences had been recorded, including how best to support people in their chosen activities. The service organised and delivered services to meet people’s needs. The records we reviewed set out people’s preferences and addressed their individual needs and risks.

The service took complaints and concerns seriously and responded to them appropriately to improve the quality of care. Information about how to make a complaint or raise concerns was available.

The last inspection was carried out in January 2017. The overall rating for the service was inadequate. We found the provider was in breach of Regulations 12 (safe care and treatment), 13 (safeguarding) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in August 2017 the service demonstrated to us that improvements had been made and no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose built accommodation in a residential area of North London. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors. At the time of our inspection there were 68 people living at the home.

The home did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim regional manager had been appointed.

We found that the registered provider had made improvements in their quality monitoring systems. They had received support from the local authority and this was continuing at the time of the inspection. It was too early for the provider to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time, including when support from the local authority is withdrawn.

Although, we saw some improvements, there had been a lot of input from the local authority. We were concerned about the length of time taken to address the concerns raised at the last inspection. However, recent developments such as the appointment of a new clinical leads, interim manager and new permanent staff had helped. However, we still received some negative feedback from some people using the service and some relatives about staffing and activities.

The provider has acknowledged this is work in progress. We saw evidence there was an active recruitment drive and a number of new staff had been appointed.

Overall, there was evidence risks to people had been identified, assessed and reviewed. The home had improved how it managed accidents and incidents, including falls.

Whilst we noted, that best interest meetings had been held with relatives and relevant health and care professionals for some people, this had not been consistently applied. We saw that the service did not always meet the requirements of the Mental Capacity Act 2005 in supporting people.

Improvements had been made in supporting people to meet their nutritional needs. People were able to make choices about the meals and drinks they wanted.

People were supported to meet their health care needs and had access to a range of external health care professionals.

Improvements had been made in ensuring people’s privacy and dignity were respected. Staff cared for people in ways which recognised people's rights to make their own decisions. People’s privacy and dignity were respected.

We saw positive interactions between staff and people. Staff knew about people’s needs and interests.

People's religious and cultural needs were now being met. People were supported to worship if they wished to. Representatives of local churches visited the care home regularly for prayers with people. Where people could visit their preferred places of worship, we saw that this was supported.

People's needs were assessed and there were care plans and risk assessments in place. The care plans provided guidance for staff to follow.

There had been improvements in people’s activities. However, further improvements were still required. Whilst we saw evidence the home was working to provide meaningful activities to people, progress had been slow since our last inspection.

We found two 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 end of this report.

This inspection took place on 16, 18 and 22 January 2017. At our previous comprehensive inspection on 28 July and 10 August 2015 the service was meeting all but one the regulations we looked at, in relation to staff not all having had appraisals. This breach had been met by the time of the unannounced focused inspection on 30 June 2016 that we undertook to look specifically at that previous breach of regulation. Subsequent to the June 2016 focused inspection we were informed of serious concerns about a safeguarding incident, that CQC had not been informed of, which had occurred in March 2016. We carried out a further focused unannounced inspection on 5 and 9 August 2016. As a result of that inspection we identified three breaches of regulations Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and Regulation 18 of the registration regulations 2009 in respect of notification of incidents. Please refer to the remainder of this report in respect of our findings in relation to those breaches.

There was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not managed safely for everyone using the service. We found significant errors and people had missed their medicines due to a lack of supply or other administration and recording errors. Medicines audits carried out in November and December 2016 had identified similar issues, but no action had been taken to address these serious concerns since as the issue of medicines not being ordered in time had been identified again at a recent staff meeting on 11 January 2017. We also found errors in administration and recording of medicines during this inspection.

Apart from medicines audits in November and December 2016, an infection control audit carried out by the housekeeper in January 2017 and a current review of accident and incident trends, no other audits were provided, despite several requests. Audits were not therefore being used to effectively assess and improve the service. The provider informed us that they were undertaking a full review of the service in light of management and oversight failures that had been identified. This review was on-going and not been completed at the time of the inspection. CQC asked for a copy of the plan for reviewing the service, but this was not provided.

There had been significant management change. Since the previous registered manager’s departure in August 2016, the service had been managed by two of the provider’s operational support managers, one until late November 2016 who was then replaced by another from late November and was in place at the time of this inspection. There was no registered manager in post, although the provider was attempting to recruit to the post at the time of the inspection.

The staff of the service had access to the organisational policy and procedure for protection of people from abuse. They also had the contact details for the safeguarding team at the local authority in which the service is located. The members of staff we spoke with said that they had training about protecting people from abuse, which we verified on training records and staff were able to describe the action they would take if a concern arose. However, we found that although improvements had been made to reporting concerns there had been two instances where these responses had not been timely enough.

We saw that risks assessments concerning falls, healthcare conditions and risks associated with skin care and the prevention of pressure sores were detailed, and were regularly reviewed for most people. However, we found a small number of instances where these reviews and actions required did not receive a timely response or follow up to care already known to be required. Staff were not always ensuring specific individual support was provided consistently.

The service had experienced staff changes among the activities co-ordinator team. There was insufficient effort being made to engage and stimulate people with activities, including people who remained in their rooms.

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

People were usually supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. Staff told us they felt that healthcare needs were met effectively and we saw that staff supported people to make and attend medical appointments, for example at hospital. However, there were a small number of occasions when healthcare needs were unclear and where follow-ups had not taken place as quickly as they should be.

Almost everyone we spoke with who used the service, relatives and friends, praised staff for their caring attitudes. We saw that most staff were approachable and friendly towards people and based their interactions on each person as an individual. However, there were exceptions where staff were not engaging with people or were uncertain about how to respond to people living with dementia.

Staff we spoke with felt more positive about the way the service operated and that their views were being sought and listened to more than they had previously experienced.

As a result of this inspection we found that the provider was in breach of Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

This inspection took place on 5 and 9 August 2016 and was unannounced. This inspection was carried out by two inspectors and an inspection manager. This report only covers our findings in relation to the specific concerns that were raised and our findings are reported under safe and well- led in this report. You can read the reports from our last comprehensive and focused inspections of the service by selecting the 'all reports' link for Lennox House on our website at www.cqc.org.uk

Lennox House provides accommodation for up to up to 87 older people, some of whom also suffer with dementia. On the day of the inspection there were 82 people residing at the home. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

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

On 5 July 2016 CQC attended a meeting with Islington Social Services Department. We were informed of an alleged incident of abuse that had occurred in March 2016. Islington Social Services Department had not been informed of the safeguarding concern until 6 May 2016 and CQC had not been alerted via a statutory or other notification by the provider. At this focused inspection, we found that the service had not properly considered the risk posed by a client to others or taken sufficient steps to monitor that risk or respond to it. This meant that some people at the home had faced unnecessary risks to their safety and wellbeing.

The service had failed to notify CQC of the alleged serious incident of abuse in March 2016, as they were required to do by the regulations. We found that the manager of the home had not followed the provider’s procedures for notifying incidents and responding to them. The provider was aware of the incident by at least 9 May 2016 when they met with the local authority to discuss it, but no notification to CQC had subsequently been made.

As a result of this inspection we found that the provider was in breach of Regulations 12 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the CQC Registration Regulations 2009.

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

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

This inspection took place on 30 June 2016 and was unannounced. This inspection was carried out by a single inspector. This report only covers our findings in relation to staff appraisals within the effective section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lennox House on our website at www.cqc.org.uk

Lennox House provides accommodation for up to 87 older people, some of whom are also living with dementia. On the day of the inspection there were 82 people residing at the home. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

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

We were assisted during our inspection by the registered manager and deputy manager.

We spoke in passing with three people using the service and a visiting relative. We did not ask these people about the specific area we were visiting to look at but had brief conversations about what they thought of the home. The responses we received did not raise any cause for concern. We noted that when a relative raised a suggestion to improve the storage of their own relative’s clothing the registered manager responded immediately and informed the person what they would do. The relative told us that they appreciated the response and action promised.

The issues we had found regarding staff appraisals at the last inspection had been addressed. The records of all staff appraisals showed that the entire staff team had undergone an appraisal within the last year and for newer staff the service highlighted when this was due.

The provider was no longer in breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of staff appraisals.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

The home was periodically visited by the local authority in partnership with the local NHS trust nursing specialist team. This team visited all care homes within the London Borough of Islington to randomly sample care plans for action each service takes to address areas such as tissue viability, falls and falls prevention and nutrition. At the most recent visit to this service in May 2014 the focus was on falls prevention. The specialist team found that the home was within acceptable levels of compliance. Recommendations were made in this area and the specialist team had provided an eight point action plan for the service to address. We looked at progress on this during our inspection and the home manager was able to provide evidence to us that most of the action needed had been taken.

During our visit we spoke with staff about their understanding of the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court ruling which affects the range of issues covered by MCA and DoLS assessments. The manager informed us that they had attended a training session hosted by the local authority and staff had all recently undertaken updated mental capacity training, which staff we spoke with confirmed.

Is the service effective?

We saw care plans were reviewed regularly by the nursing and care staff. The service required staff to record care plan entries and daily notes on a computer data base and we saw staff doing this at regular intervals during our inspection. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Is the service caring?

We spoke with two people using the service and five relatives. These people complimented the staff and told us that they believed the service had people's best interests at heart and that staff were caring. One person told us 'I like to help', and we later saw this person assisting a member of staff. Another person told us 'staff don't make assumptions; they talk to me as a person'. Relatives we spoke with us said 'staff, especially the unit manager really know my relative and what they need', 'staff sometimes look a bit rushed, but then it is a care home and things do get busy' and ' staff are great, I like the way my relative gets involved in activities as they were so lonely before coming here.'

People told us that they enjoyed the activities available at the home although some people preferred not to join in. We looked at the weekly activities schedule and saw that activities were available for people who could not leave their room, although most people were able to join in activities in the communal areas.

Is the service responsive?

We looked at the care plans for five people, all of whom had been assessed by the nursing team when they visited in May 2014. The format used provided a means for staff to make continuing assessments of people and to develop care plans and risk assessments. It prompted staff to consider issues such as falls and risk of pressure sores. It also gave room for people to tell staff about their life history and this was added to whenever new information was provided. However, we found that although care plans were detailed and updated the home had not fully implemented the hourly night checks that had been recommended for some people. We raised this with the manager who told us that this would be addressed with night staff without delay as an instruction had previously been given to staff to ensure this happened.

People's religious, cultural and personal diversity was recognised by the service. The service had links with local places of worship and ministers of different religions made regular visits to the home.

Is the service well-led?

The provider had a detailed induction and training process for new staff. The staff we spoke with all confirmed that they had undergone the induction and had the opportunity to expand on their qualifications and training. We found that the provider took action to ensure that the staff team were suitably skilled to perform their duties.

The provider had a system for monitoring the quality of care. We were provided with a copy of the most recently published customer satisfaction survey from October 2013. This showed that most people rated the service as highly satisfactory in a wide range of areas, care provision and quality of life being examples. This survey showed an improvement on the previous year with most areas achieving an overall rating of between 80 to 100 %, although most answers were toward the upper 100% limit.

We spoke with one of the activities coordinators, the registered manager and the deputy manager as well as five members of care staff during our visit.

We found that people's dignity was respected and that people's choices were promoted. We found that care staff supported people to be independent where possible and prompted and encouraged people to complete tasks.

We found that care plans and risk assessments were regularly reviewed and updated and that care plans reflected people's current needs. We found that people's care needs were being met and that staff had a good understanding of people's current care needs.

We found that people were protected from risks and that the provider took appropriate steps to prevent risks for happening and to address identified risks. We also found that staff were appropriately supported and provided with relevant training and guidance.

We found that the records used to support both the delivery of the service and to provide care and treatment were appropriate and current.