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Culm Valley Care Centre Good

Reports


Inspection carried out on 11 December 2019

During a routine inspection

About the service

Culm Valley Care Centre is registered to provide accommodation for 63 people who require nursing and personal care. There were 57 people living at the service, they consisted of 22 people who had been assessed as requiring nursing care were having their nursing needs met by the nurses at the service. There were also 36 people whose nursing needs were met by the community nursing team. One person was admitted on the day of the inspection and one person was discharged.

Culm Valley Care Centre is a service in a detached building over three floors in the centre of the market town, Cullompton in East Devon. The home is in walking distance of the town centre and local amenities. Since the last inspection the provider has had a large extension with an additional seven bedrooms and an additional communal lounge.

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

People felt safe at the home and with the staff who supported them. The staff understood their responsibilities and how to protect people from abuse. There were enough suitably skilled and knowledgeable staff to meet people’s needs. People said their needs were met in a timely way.

Staff were safely recruited and received the training and support they needed to undertake their role. Peoples' medicines were managed safely. Processes were in place for the timely ordering and supply of medicines and medicines administration records indicated people received their medicines regularly. Measures were in place to control and prevent the spread of infection. There were checks and audits in place to protect people from the risks of unsafe and unsuitable premises.

People were cared for by staff who knew them well and were kind and compassionate. Staff were happy in their jobs and wanted to provide the best care they could. Staff were attentive, caring and kind. Staff had received the provider’s mandatory training and had regular supervisions and appraisals with their line manager’s

People’s needs had been assessed prior to going to the home and they had a care plan in place. We discussed with the registered manager that people staying at the home for a period of respite had summary care plans. These did not give enough information to guide staff to support their complex needs. The registered manager said they would review these.

The provider employed an activity co-ordinator who was based in the main communal area to support people’s social needs. The provider also employed a staff member for six hours a week to provide social support to people in their rooms who could not leave for health reasons or because they chose to stay in their rooms.

People, their relatives and staff expressed confidence in the registered manager and deputy manager. People’s views were sought on an informal basis, through regular meetings and an annual satisfaction survey. There were effective systems in place to monitor the safety and quality of the service.

People were supported to eat and drink enough to maintain a balanced diet. People were supported to access healthcare services. Staff worked closely with health professionals, including the GP and community nurses and referred people promptly. The home provides end of life care and staff ensured people received the appropriate support which included having appropriate medicines available for people nearing the end of their life, to manage their pain and promote their dignity.

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

People knew how to make a complaint if necessary. Where the registered manager had received complaints, they had followed the provider’s complaints policy.

More information is in the full report.

Rating at last inspection and update: The last rating for this service was Good overall (published 29 June 2017). At this inspection we found th

Inspection carried out on 22 May 2017

During a routine inspection

We carried out an unannounced comprehensive inspection on 22 and 25 May 2017.

Culm Valley Care Centre is registered to provide accommodation for 56 people who require nursing and personal care. There were 47 people living at the service on the first day of our inspection. They consisted of 22 people who had been assessed as requiring nursing care were having their nursing needs met by the nurses at the service. There were also 25 residential people whose nursing needs were met by the community nursing team. There were two further admissions on the first day of the inspection and a person arrived for a respite visit on the second day of our visit.

There was 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.

We had previously carried out a comprehensive inspection of this service in June 2016. Three breaches of legal requirement had been found at that inspection. The breaches were because risks assessments were not always completed correctly to assess people’s individual risks. Environmental risks were not always being safely managed, which could put people at risk in the event of a fire. Care plans had not always been put into place to reflect people’s emotional and mental health needs. The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. However these were not fully effective as they had not identified the breaches of regulations found at this inspection. At this inspection we found action had been taken regarding these concerns and the requirements had been met.

There were adequate staffing levels to meet people’s needs. People and staff felt there were adequate numbers of staff on duty to complete people’s personal care but said they were often busy which meant they did not always have time to interact with people. People had mixed views about the response time to call bells with some people saying they did not feel their call bells were responded to promptly. The registered manager regularly assessed the dependency levels of people and adjusted staff levels accordingly to ensure there were sufficient staff on duty. They undertook random bell audits to monitor staff response times which were all promptly responded to. During our visits bells were responded to promptly. We had concerns that people using the outside terrace could not alert staff if they required assistance. The registered manager put in place regular checks and was looking at ways this could be addressed.

Risks assessments were completed correctly to assess people’s individual risks. Care plans were developed when people came to the service following a pre admission assessment involving people and their families. Care plans were personalised and recognised people’s health and social needs. They were regularly reviewed and updated to reflect people’s changing needs. However improvements were needed to ensure there were care plans in place for people’s oral care. Action was taken to put these in place.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Staff were following the MCA in regard to people with capacity consenting to their own care at the service. Where a power of attorney (POA) was appointed for a person, there was a system to identify whether the POA was authorised for making care and treatment decisions, financial decisions or both.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff received regular training, supervision and appraisals. Staff relationships with p

Inspection carried out on 30 June 2016

During a routine inspection

We carried out an unannounced comprehensive inspection on 30 June, 1 and 6 July 2016.

Culm Valley Care Centre is registered to provide accommodation for 56 people who require nursing and personal care. There were 47 people using the service on the first day of our inspection. They consisted of 26 people having their nursing needs met by the nurses at the service and 21 people whose nursing needs were met by the local health authority community nursing team. The registered manager made us aware that four people were receiving intermediate care which was where health professionals also supported people to rehabilitate with the aim of returning home.

There was 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 in May 2015, a breach of a regulation was found. This was because there were concerns about staffing levels, as the provider did not have a systematic approach to determine the number of staff required in order to meet the needs of people using the service and keep them safe at all times. We found some improvements had been made at this inspection. However people were still not having their needs met promptly.

Staffing levels were regularly assessed and dependency levels of people monitored to ensure there were sufficient staff to meet people’s individual needs and to keep them safe. The registered manager adjusted the staffing levels to meet those needs. People and visitors expressed concerns about the staff response times to call bells, and as a result felt there were not adequate staff to meet people’s needs safely. Following the inspection the provider made us aware that they had increased the volume of the call bell panels. This was because staff had said they could not always hear the bells in all areas of the home. They said they had seen improvements in the response times. We made a recommendation to the provider to monitor call bell response times and staff deployment.

Risks assessments were not always completed correctly to assess people’s individual risks. This meant staff might not take the appropriate action to keep people safe. Care plans were developed when people came to the service following a pre admission assessment involving people and their families. However the nurses were not updating people’s care plans to reflect their changing needs and were not recording health care professionals’ visits and their instructions. Care plans had not always been put into place to reflect people’s emotional and mental health needs.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. However these were not fully effective as they had not identified the breaches of regulations found at this inspection. Environmental risks were not always being safely managed, which could put people at risk in the event of a fire.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. However staff were not following the MCA in regard to people with capacity consenting to their own care at the service. Where a power of attorney (POA) was appointed for a person, there was no clear system to identify whether the POA was authorised for making care and treatment decisions, finances or both. This increased the risk they may make decisions on behalf of a person they were not legally authorised to make.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and had developed knowledge to meet people’s needs. Further steps we

Inspection carried out on 5, 11 and 19 May 2015

During a routine inspection

We carried out an unannounced comprehensive inspection on 5, 11 and 19 May 2015. We had decided to bring forward a planned inspection because we received three alerts from the local authority safeguarding team. These were regarding people allegedly experiencing poor care at the service and not having their manual handling needs met safely. Concerns had been expressed by health professionals regarding how quickly staff identified people’s changing health needs. At the inspection people’s manual handling needs were being met. We identified no evidence that people were receiving poor care and were not being referred appropriately. However these concerns were still being looked into by the local authority safeguarding team and a conclusion had not been reached.

Culm Valley Care Centre is registered to provide accommodation for 56 people who require nursing and personal care. There were 53 people using the service on the first day of our inspection. We last inspected the service in August 2014, at that inspection the service was meeting all of the regulations inspected.

There was 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. Everyone gave us positive feedback about the registered manager. They said they were happy to approach her if they had a concern and were confident that actions would be taken if required. People said the registered manager was very visible at the service and undertook an active role. Staff said they felt supported by the registered manager and the clinical lead nurses.

Staffing levels were not regularly assessed and monitored to make sure there were sufficient staff to meet people’s individual needs and to keep them safe. People and staff expressed concerns about the staffing levels because they often did not have enough time to spend quality time with people. They felt there were not adequate staff to meet people’s needs safely. The registered manager had taken action to address these concerns by increasing the care staff ratio in line with the occupancy at the service. However the provider did not have a robust system to continually monitor and assess the adequacy of staffing levels to meet people’s changing needs.

People were not being given a choice regarding when and how frequently they required a bath or shower. People were only being given the option of one shower or bath each week. If they refused on the day allocated to them they were unable to have an alternative day and had to wait for the following week.

People received their medicines safely and were supported by staff who were trained and had the skills and knowledge to meet their needs. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely.

There were arrangements in place for people to have their needs regularly assessed, recorded and reviewed. People were kept informed on a day to day basis about their changing care needs. People had not always been involved in their formal reviews. This had been recognised by the registered manager and clinical lead nurses and action had been taken.

There were emergency plans and protocols in place to protect people and guide staff in the event of an emergency or untoward event.

People said they felt safe and were cared for by staff that treated them with kindness and compassion. Staff could recognise signs of abuse and knew how to raise any safeguarding concerns.

People had access to health professionals when staff had identified concerns. There had been two alerts made to the local authority safeguarding team where staff had not recognised people’s changing needs and taken appropriate action. This was being addressed with the registered manager by the local commissioners and district nurse team.

People were supported to eat and drink enough to maintain a balanced diet. They were able to make choices about what they wanted to eat and drink and were positive about the food at the service.

Incidents and accidents were accurately recorded and the registered manager monitored them to identify any themes or trends in order to recognise risks and take action when required.

People knew how to raise a concern or complaint, and they felt comfortable to do so. Complaints were dealt in line with the provider’s policy. The registered manager dealt with day to day concerns as they occurred to prevent them from escalating.

There was an activity program in place and people were informed by a regular newsletter. The registered manager had discussed with the local church about people in their rooms being at risk of social isolation. This had resulted in two volunteers visiting the service to spend one to one time with people, if they wished.

The provider had a robust recruitment process. New staff had a thorough induction and received training to meet people’s needs. Staff were supported in their role by receiving regular supervision and annual appraisals. They were kept informed and able to contribute to the running of the service by attending staff meetings, daily handovers and completing an annual quality assurance survey.

The provider had a thorough quality assurance and monitoring system in place. This included regular audits, quality monitoring visits and annual surveys for the provider to assess the effectiveness of the service provided. People, relatives and friends were asked their views about the service and had the opportunity to attend meetings and make their views known.

We found one breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

Inspection carried out on 18 August 2014

During a routine inspection

The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? Before our inspection we reviewed all the information we held about the home. We examined previous inspection reports and notifications received by the Care Quality Commission.

The inspection was carried out by two inspectors. At the time of our visit there were 37 people living in the home. We looked at six care plan files and tracked the care these six people had received since moving into the home. We spoke with ten people who lived in the home, ten staff, two relatives, a community nurse, a manager from the local Adult Community Care team, the hairdresser, the registered manager and a senior representative of the provider who was visiting the home that day. We also spoke with a number of visitors to the home. We observed people in the lounges and dining rooms throughout the day and saw how staff supported and communicated with them.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe because people�s health and care needs were understood by trained and supported staff. Risks to people�s health and welfare were understood and managed in line with their agreement. One of the staff we spoke with told us their priority was �to keep people safe and to monitor their needs�. Another said, �We must take safety and security seriously�.

There was monitoring of events and incidents and measures were put in place to minimise a repeat of any issues. This included changes to health care needs and some medication incidents. People�s medicines were being managed on their behalf, where appropriate in a competent way.

Care plans included considerations of the Mental Capacity Act (2005) and staff demonstrated an understanding of the Act and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People�s human rights were therefore properly recognised, respected and promoted.

Is the service effective?

The service was effective because people�s health and well-being was promoted. Care plans provided instructions to staff about the care each person wanted and needed. We saw evidence of multi-professional visits and appointments, for example GP, speech and language therapist and community nurses.

Is the service caring?

The service was caring because we saw staff communicating in a warm and caring manner. We saw staff asking people for their consent before carrying out tasks, for example by asking �Would you like to..?� or �Is it alright if I help you with..?� Where people were unable to verbally communicate staff interpreted facial expressions and behaviours to help them understand the person�s intention. We observed staff who explained to people what they were doing and asked people if they wanted help or a drink.

One person said, �the staff are very friendly here� and a relative said,� we pop in at least twice a week. We are always welcomed and think the care is very good�.

Is the service responsive?

The service was responsive because people�s wishes and their likes and dislikes were taken into account. We saw advice and treatment had been sought appropriately when staff recognised people�s needs had changed. For example, a person told us they had been given advice on how to reduce risks to their health. Where they had chosen not to follow the advice their wishes had been respected.

Staff we spoke with understood each person�s needs. They were able to describe people�s care needs, including the medicines they required and how their medicines should be administered.

Care files were regularly reviewed and updated and provided staff with sufficient information about each person�s needs to ensure their health and welfare needs were met safely.

Is the service well-led?

There were good management systems in place to make sure all daily routines were monitored, reviewed and adjusted where necessary. Monthly audits were carried out by the manager.

Residents meetings were held twice a year which included family members and friends if they wished to attend. We were told that informal feedback was encouraged from anyone visiting the home and were told the receptionist on duty was often the first person to pick up on feedback and issues raised by visitors.

Staff meetings were held at least twice a year. Staff handover sessions took place twice a day. One member of staff, employed at the home for many years told us the quality of the service was continually improving. They said �the quality of care is great now. It�s just gone up and up�.

Inspection carried out on 4 February 2014

During an inspection in response to concerns

We carried out this inspection because of concerns raised with the Care Quality Commission about the service. The concerns related to respecting people�s privacy and dignity, the care and support provided to people, and about moving and handling practices by staff. Concerns were also expressed about how the service managed systems for infection control. There were 38 people living at the home when we visited.

During this inspection we met and spoke with 25 people who used the service and with one visitor. We spoke with 12 staff, the registered manager and one of the providers� senior managers. We spoke with three healthcare professionals who were visiting the home. We looked at records relating to people�s care and support and for managing the service. We also obtained information from the local social and healthcare safeguarding teams, including occupational therapists who had reviewed moving and handling practices in the home.

We found that people who lived at Culm Valley were well cared for and were treated with dignity and respect. One person said, �They treat me very well here, I can�t fault them�. A second person said, �I am well looked after� and a third person said, �It�s all very well organised here�.

People�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We found the home were meeting people�s personal care needs, confirmed staff managed people�s health needs and used safe moving and handling techniques. People were cared for in a clean, hygienic environment and were protected from the risk of infection because appropriate infection control systems were in place and policies and procedures were followed.

Inspection carried out on 26 June 2013

During a routine inspection

At the time of the inspection there were 38 people living at the service; we met with or saw the majority of people. We spoke in depth with seven people to hear about their experiences. People told us they were happy with the level of care and attention they received and that they felt safe at Culm Valley Care Centre. Comments included, "I am very well cared for. They (staff) are all very friendly�, �The nurses are particularly nice but all staff are kind and considerate�, �I have nothing but praise. It really is excellent here�, �They help me to be independent. My independence is really important to me�, and �I am comfortable and well looked after here. We don�t want for much�.

We spoke with six relatives, and six visiting health professionals (including members of the Complex care team, two occupation therapists (OT), a GP, a community nurse and a tissue viability nurse). We also spoke with Devon County Council contracts team. Relatives told us they had no concerns about the care of their family members. Comments included, �We have found that it is first class here�, �We have no complaints or concerns at all�, �It is lovely here. X is settled and we can see that she has improved greatly here over time�, and �The staff appear to be on the ball. We have no worries about X�.

Visiting professionals told us that the service always made appropriate referrals in a timely way. A social services practice manager told us, �There is no question that care isn�t good at Culm Valley�. Comments from OT included, �The service is brilliant. Couldn�t be better at the moment�, �We have noticed a massive improvement over the past months� and �The service is responsive and well managed�. A GP told us, �In 20 years of visiting this is the best it has ever been. In the past six months it has been run as we would like�. The tissue viability nurse said �We have no concerns. They are very attentive and they know what they are doing�. Devon County Councils contracts officer told us they had no concerns about the service, they added, �The provider has put the effort in to improve the service�.

We spoke with ten members of staff, including the registered manager and the deputy. The majority of staff told us they felt well supported and they felt they had access to a range of training to help them do their job safely and competently. Comments for staff included, �The home is better organised�, �We have stronger leadership� and �everyone (staff) knows what they are doing now and what is expected of them�.

We found that Culm Valley Care Centre was meeting of the outcomes we inspected.

Inspection carried out on 4 January 2013

During an inspection looking at part of the service

In June 2012 we found that the provider was failing to meet a number of the essential standards of quality and safety. We issued warning notices and compliance actions in order to ensure that the necessary improvements were made. At our last inspection in August 2012 we found that action had been taken to meet the warning notices. The focus of this inspection was to review the action taken by the provider to meet the compliance actions.

During this inspection we spoke with six people living at the home, two relatives and eight staff members. People living at the home told us they were happy and well cared for. Comments included, �I am ever so happy here�, �I am very happy with the care I get� and �Everything is fine, much better than it was�. People told us that staff were polite and respectful and that they felt safe at the home.

As part of the inspection we contacted six health and social care professionals, including community nurse, tissue viability nurse, placing social workers and Devon County Council�s contract officer. All those contacted made positive comments and spoke about the improvements made at the home. No concerns were raised. Comments included; �I was happy with their assessment and admission process�, �We are very impressed with the overall improvements�� and �They have made a great effort to achieve compliance�. The present leadership team at the home was highlighted as having a significant and positive impact on the home.

Inspection carried out on 17 August 2012

During an inspection looking at part of the service

At our last inspection of this service in June 2012 we found that the provider was failing to meet a number of the essential standards of quality and safety. We issued warning notices to the provider in order to ensure that the necessary improvements were made in relation to outcome 4 - Care and welfare of people who use services; and outcome 8 - Cleanliness and infection control. The focus of this inspection was to review the action taken by the provider to meet those warning notices.

Prior to this inspection in August 2012 we contacted external stakeholders so they could provide information prior to our visit. Members of the multidisciplinary safeguarding group, including health and social care professionals and Devon County Council contract team, told us that during the safeguarding process, the provider had been open and cooperative. Visiting professionals told us that there had been a �definite� improvement in care records and the monitoring of pressure area care and other wound care. Professionals felt there had been an improvement in communication between the staff generally at the home and with outside professionals such as the community nurses.

The suspension of placements imposed by Devon County Council, as a result of previous serious concerns, had been lifted. A supervisory notice remained in place to ensure that any referrals made for admission via health or social care commissioners were appropriate. During the safeguarding process the service had been monitored through a combination of visits by social services staff and the community nurse team, as well as multidisciplinary safeguarding strategy meetings. During the safeguarding process assurances were received from the provider in relation to the immediate actions to be taken to improve outcomes for people.

During this inspection we spoke with five people using the service, two relatives, 13 staff members, including the operations manager, nursing and care staff and domestic staff. We also spoke with two visiting community nurses and a physiotherapist.

People using the service told us they were happy at the home and that they were receiving the care and attention they needed. One person told us, �I can�t grumble about anything. The staff are lovely, very gentle and kind�. Another person told us, �I have no complaints. The staff come when I need them. They are all very nice. I have no problems at all�.

One relative told us, �X is happy enough here. We have no overall concerns about the care that X is receiving�. Another relative told us that the home communicates well with them about any changes to their family member�s health; they added, �I have no concerns at all�.

We met with three visiting health professionals during this inspection. The community nurses told us that the home was communicating well with them; that they were alerted to people�s changing needs in respect of pressure area care and skin care and that a good system was now in place to ensure that recommendations made by the community nursing team for interventions were being acted on.

Since our last inspection the provider had committed additional resources to the home. Two experienced managers from other care homes within the group had worked with staff to deliver training and offer support to nursing and care staff. An experienced registered nurse had been seconded to the home until November to offer additional clinical expertise and support. Staffing levels had been increased by two care staff in the morning. All staff had attended training in relation to infection control and moving and handling. All nursing and care staff had received training in relation to tissue viability (skin care). New equipment had been purchased and existing equipment had been serviced.

Inspection carried out on 20 June 2012

During an inspection in response to concerns

Unannounced visits were undertaken to the service on 14 June 2012, 19 June 2012 and 20 June 2012 to follow up concerns raised by the multidisciplinary safeguarding team. Concerns related to people not receiving the correct level of pressure area care and wounds were not being identified by the nursing team at the home. Other concerns related to people not being transferred using the correct equipment and basic moving and handle procedures were not being followed. We found evidence to substantiate these concerns during the inspection.

All placements to the home had been suspended temporarily as a result of the safeguarding concerns.

There were 38 people living at the home at the time of the inspection. During our time at the service we saw or met with the majority of people. We spoke in depth with 10 people about their experience of living at Culm Valley Care Centre. We also spoke with three people's relatives, six visiting health professionals, 11 care and ancillary workers, two registered nurses, the manager for the home and a senior manager within the company.

We found a number of areas of concerns. We found that the early signs of pressure damage were not being recognised and adequately managed in order to reduce the risk of serious pressure damage developing. Care plans did not always contain up to date and detailed information about peoples' assessed needs and preferences. This means that people did not always receive care or treatment that was appropriate or safe.

We also found that staff had not received the training necessary to enable them to meet people�s changing needs, particularly in relation to pressure area care and pressure ulcer prevention. We were concerned about the moving and handling equipment used on occasions. Whilst we saw that some staff used safe and appropriate techniques when assisting people to move, other staff used techniques which put people at risk.

The service had a number of quality assurance arrangements in place, for example; monthly audits, which failed to detect the serious areas of concern found during this inspection.

We found a number of areas of good practice. People told us that staff treated them with respect. We saw that the staff were friendly and kind in their approach when supporting people. People were happy with the activities provided at the home and several people told us that the activities co-ordinator worked hard to provide interesting things to do. People told us they liked the food at the home, comments included, �The food is good. I get plenty to eat�, �The food is lovely� and �The food is very nice�. We saw that people�s person care was well attended to, for example, clothes were clean and co-ordinated, men were shaved and female residents had make up and jewellery on.

Inspection carried out on 23 December 2011

During an inspection in response to concerns

This unannounced visit to the home took place on Friday30 December 2011. Information received by the Commission had indicated that staffing levels at the home may be low and this may have resulted in some people not receiving the care they needed. During this visit we looked at the staffing levels and checked that people were safe and well cared for. We also looked at the quality assurance systems in the home and how the information gathered through these systems helped the management team calculate safe staffing levels.

On the day we visited the home there were 41 people living there. We met with ten people using the service, eight of whom were in their bedrooms during the inspection. We also met with four visitors at the home.

People were very complimentary about the home. One person told us �Staff are wonderful, they are very kind, and it�s like a hotel�. Their family told us that their relative was treated as �a person, not a �case�, and that the staff communicated well with the family if there were any problems. Someone who had been at the home for a short period of time said �the staff are very good. It�s home from home. The staff are very kind, there are no problems at all�

Several people told us that staff always came when they rang the call bell and that they didn�t have to wait, whilst others said that although the call bell was answered quickly it might be some time before the staff could come back to deliver the care needed.. During our visit we heard the call bell ringing frequently but usually it was answered quite quickly. Although staff were busy, they were able to deliver care in a person centred way and on the day of the inspection we could see that people�s needs were being met in a timely way.

People�s needs were attended to during the inspection. Drinks were close to everyone and people were assisted with their meals and drinks during the day. Some people using the service had requested a special lunch of rabbit stew and were very pleased to have this request met on the day of our inspection.

We also received some information from health and social care professionals who said that they have had positive working relationships with the staff and that no concerns had been raised with them regarding the quality of care.

We looked at four care plan files. We saw that assessments had been carried out on all care needs and these had been reviewed regularly. When people had become very frail or poorly recording systems had been put in place to provide evidence of the care provided. However, there were gaps in some of the records and this meant we could not be confident that people had actually received the care they needed.

The Operations Director for Ashdown Care Ltd was visiting the home on the day of our visit and we talked to her about the recording systems in the home. During our visit she met with the trained nurses on duty and agreed that in future all daily recording charts will be monitored closely at the end of each shift. Any gaps in care provided will be investigated and action taken to prevent recurrence. We will review this again in the near future to ensure this action is sufficient to ensure people are safe and well cared for.

During an inspection looking at part of the service

The visit took place on 29 September 2011 and was unannounced. The purpose of the review was to check the compliance actions made at the previous responsive review in May 2011 were met.

Everyone we spoke to told us they were very well looked after and they praised the kind and caring nature of the staff team. We observed that people were treated with dignity and respect and their privacy was maintained. There were lots of activities provided that people enjoyed. People told us they were well cared for and the food provided was very good with lots of choice. We observed the home was kept clean. Staff were well trained and knowledgeable about the needs of people who lived there.

Staffing levels have improved since our last visi. Most people we spoke to commented that staff were very busy and whilst they received all essential care, there are not enough staff to to promote greater choices for people about moving around the home. People said they would prefer staff to have a bit more time to chat to them. Auditing systems, actions to improve medicines management were other areas identified for further improvement. Some problems were identified with items of clothing getting lost in the laundry, which have yet to be resolved.

Inspection carried out on 18 April 2011

During an inspection in response to concerns

People who could talk with us told us that they get the care that they need. One person said �you get it but you wait a long time�. Another person said �the bells ring all the time, there are so many people who need help�. Another person told us that the staff are lovely, but that �there are not enough of them to see to everyone as quickly as they would like�. One person told us they did not want lunch because they wanted to go to the toilet so badly. They said they had rung their bell, and each time someone came to answer it they told them they would have to come back because they were busy. When we asked other people about what happens when they ring their call bell, they told us �it seems a long time when you�re waiting�; �it depends how busy staff are, it can take some time�; and �staff come eventually�.

A visitor said that staff are �caring and supportive�, and that some �go the extra mile�. They said �staff are never idle�, meaning they are always busy, and �staff don�t have a lot of time�. This person expressed some concern that staff are so busy that they might not have to time to help with people who need support to eat.

People told us they enjoy the food served. One person commented �If I don�t like the choice, I can have a jacket potato�.

Reports under our old system of regulation (including those from before CQC was created)