Aaron Crest Care Home

The home is set across 2 floors, with the dementia unit on the ground floor. There are good sized communal areas for people to use and facilities for visitors to park.

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

We have made a recommendation about the recording of some medicines. People were supported by enough staff who had the right skills and experience. People were kept safe, one person said, “I don’t worry about anything. The girls are straight there if I need them, but I’m ok.” Risks to people's health and wellbeing was assessed. People were protected from the risk of mistakes being repeated due to the provider monitoring incidents.

People were cared for by staff that enjoyed their jobs. There had been recent changes to management however the provider was managing this well. The provider assessed and monitored risk. There were development opportunities for staff.

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

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

Rating at last inspection

The last rating for this service was good (published 30 July 2021).

At our last inspection we recommended that the provider reviewed their recruitment processes regarding DBS checks. At this inspection we found the provider had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aaron Crest Care Home is registered to provide personal and nursing care for up to 66 people. There were 39 people at the service at the time of the inspection. The home is divided into two units, one for people living with dementia and the other supports people who require nursing care.

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

People and their relatives told us they were happy with the care and support and provided positive feedback about the staff.

People felt safe and were protected from harm. Staff understood how to protect people from abuse. Risk assessments were carried out to enable people to retain their independence. Medicines were safely managed and the provider had processes to record and investigate accidents and incidents to ensure lessons were learned.

There were enough staff on duty to meet people’s needs in a timely manner. Staff received training and support to enable them to effectively meet the needs of the people they supported. Staff had been recruited following the providers policies and procedures.

We have made a recommendation about the recruitment of staff.

Staff used PPE appropriately and followed infection control practices which helped protect people from the risk of transmitting COVID-19.

The service was well-led. The provider had systems to assess and monitor the quality of the service. The provider and registered manager demonstrated a commitment to continuous improvement in the service. Staff told us they received good support from the registered manager and felt their views were listened to.

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 4 June 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to how the service was being managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Follow up

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

People’s experience of using this service:

There were shortfalls in staff training and competency checks to ensure staff had the skills to provide safe and effective care.

People at risk of falling were not always risk assessed against avoidable harm.

People at risk of developing pressure damage to their skin were not always provided equipment set correctly in accordance with their weight and needs. This placed them at risk of avoidable harm.

The provider did not always ensure people's consent to care and treatment was sought in line with the Mental Capacity Act 2005.

Records showed some staff had not undertaken training in mandatory courses. This meant we could not be assured staff were suitably qualified and competent to undertake their roles and responsibilities. For example, 55% of staff had not undertaken practical moving and handling training.

The provider had made improvements around safe recruitment of staff. Before staff started to work at the service appropriate character checks were undertaken.

People’s medicines were managed in a safe and person-centred way.

The provider had made improvements around meeting people’s nutritional and hydration needs. People had choice and control over their meals and snacks.

The service supported people in a person-centred way and staff understood the needs of people they supported.

The service considered ways to promote communication this included; communication aids for non-English speaking service users and picture boards. The service was in the process of implementing picture menus to help aid understanding of the choices available at meal times for people living with dementia.

There were sufficient numbers of staff deployed across the service.

People were protected against bullying, harassment and abuse.

The service worked in partnership with external health care professionals and their advice was acted on.

People were supported in a kind and compassionate way. We observed staff encourage people to maintain their life skills and remain independent.

Staff told us they felt supported and listened to.

People had access to the complaints procedure and the registered manager responded to people’s concerns and complaints in a timely way.

People were not routinely asked for their feedback. There had been one survey issued since the last inspection and this was in relation to catering. We have made a recommendation about this.

Since the last inspection the service had changed ownership. This meant changes in legal directorship and senior leaders however, the provider’s registration remained the same. There was also a new registered manager.

The registered manager was transparent and understood their role and responsibilities.

There were quality assurance systems to identify, monitor and improve the service. Issues identified at this inspection had already been highlighted by the provider and they demonstrated what action would be taken. This was with exception of the failings found around consistent assessment of people’s mental capacity.

Staff were encouraged to have their say and told us they were involved in decisions made at the service.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 17 April 2018). The service remains rated requires improvement. This service was rated requires improvement at the last three consecutive inspections.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection, we found the provider had made improvements in relation to the breaches of regulations we found at the last inspection. However, we found further breaches of regulations.

Why we inspected: This was a scheduled inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to safe care and treatment, staff training and asking people for their consent at this inspection.

Please see the ‘action we told provider to take’ section towards the end of the full report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Our last inspection of the home was carried out 25, 26 and 31 May 2017. At that inspection we rated the service as ‘Requires Improvement’ overall and for the domains of responsive and well-led. We rated the home as ‘Inadequate’ for the safe domain and ‘Good’ for the domains of effective and caring. At the last inspection we found the home to be in breach of five regulations of the Health and Social Care Act Regulated Activities Regulations 2014. These were Regulation 9, Person-centred care, Regulation 12, Safe care and treatment and Regulation 17, Good governance, Regulation 18, Staffing and Regulation 19, Fit and proper persons employed. At this inspection we found the home had met three of the previous regulation breaches, however were still in breach of Regulation 9 and Regulation 19. We also found the home to be in breach of Regulation 14 meeting nutritional and hydration needs. We have made a further six recommendations for areas needing further improvements.

We saw evidence of enough improvements made to show that the home was no longer rated as ‘Inadequate’ in any of the domains and therefore the home was removed from special measures. The overall rating of the home remains as ‘Requires Improvement’.

The home is situated in Skelmersdale and is easily accessible by public transport. The home provides nursing or residential support for up to 66 people. Nursing care is provided on the top floor of the two story building with the ground floor area supporting people mostly living with dementia. At the time of our inspection there were 56 people living in the home.

Each floor has a lounge and dining room and a smaller quieter lounge used mostly for activities. The kitchen and laundry facilities are on the ground floor of the building and each floor is accessible by a lift and stairs.

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

There was a manager in place at the time of our inspection who was in the process of registering. 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.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had not always been recruited safely and in line with the home’s recruitment policy.

Staff were appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. However formal support in the form of supervisions and appraisals were not, at the time of the inspection, routinely carried out.

Medication procedures observed protected people from unsafe management of their medicines. However processes did vary between the two floors of the home and needed to be made consistent.

Staffing levels were seen to be sufficient to meet the assessed needs of the people at the home. Staffing had been an issue prior to the new home manager coming into post but we saw evidence to show that these issues had been resolved and that agency use was now limited.

We looked around the building and found it had been maintained with pleasant decor, was clean and hygienic and a safe place for people to live.

People’s nutritional needs were not always met due to records not being consistent across the home. For example some people’s care plans were not replicated within the home’s kitchen records.

Capacity assessments were not always in line with other areas of people’s care plans and best interest decisions were not always decision specific or completed in enough detail.

Staff we spoke with had a good understanding of protecting and respecting people’s human rights.

The home had provided information with regards to support from an external advocate should this be required by people living in the home.

Various methods of communication were used with people according to their needs and preferences.

We saw a large range of activities were undertaken within the home setting. It was cold at the time of our inspection but we were told that during the summer month’s people accessed the courtyard and occasional trips out were made by people who were able to and wanted to.

A number of audits were undertaken to ensure the on-going quality of the service was monitored appropriately and lessons were learnt from issues that occurred. A number of the issues raised at this inspection had already been highlighted through the homes audit process and plans were in place to address them.

Our last report and rating was on display within the home and on its website. This helped people to make an informed choice about the quality of the home.

The home was last inspected in January 2016 where six breaches to the regulations were identified. Warning notices were issued for Regulation 12, Safe care and treatment and Regulation 14, Meeting nutrition and hydration needs. Four other Regulations were found to be in breach which included issues with the delivery of person centred care, issues with staff support and recruitment of staff and issues with the governance at Aaron Crest Care Home.

The home is situated in Skelmersdale and is easily accessible by public transport. The home provides nursing or residential support for up to 66 people. Nursing care is provided on the top floor of the two story building with the ground floor area supporting people mostly living with dementia. At the time of our inspection there were 56 people living in the home.

Each floor has a lounge and dining room and a smaller quieter lounge used mostly for activities. The kitchen and laundry facilities are on the ground floor of the building and each floor is accessible by a lift and stairs.

Within recent years Aaron Crest has had a number of managers and interim managers, which have impacted on service delivery. At the last inspection the registered manager was on maternity leave and a temporary manager had been in post for nearly a year. Following that inspection the registered manager resigned and after a period a new manager was found who registered with the commission. After a relatively short time in post they also left the organisation for a variety of reasons. For the three months prior to this inspection different regional and quality managers have been in post. More recently an interim manager was appointed to address areas of concern identified by the quality director and until a suitable permanent manager could be appointed. The new manager will register with the commission. As a consequence the home has seen a period of instability which is now being addressed. The provider informed CQC prior to the inspection that they had anticipated more work had been done to meet the requirements of the regulations. The Home's Improvement plan was further developed to account for any ongoing actions. We have been given assurances by the provider’s senior management team that they are working to address concerns and we could see that steps had made in that direction.

At the time of the inspection the home did not have a registered manager. An interim manager was in place whilst the home secured an appropriate manager to register with the commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new management structure had begun to implement systems to better support the staff and ensure the processes and procedures required for good management of the home were followed. This was a work in progress and the instability of previous management teams had led to a staff led culture as opposed to a manager led culture. The senior leadership team were aware of this and were taking steps to address this.

The warning notice issued at the last inspection for the poor management of medication and for not managing and mitigating risks to people had not been met. We found that the management team were aware of the issues around medication management and had implemented protocols, action plans and increased audit to manage the risk. However staff were not following the protocols, implementing the action plans or routinely completing the audits. We saw the management team were taking disciplinary action against the staff involved and in the three weeks prior to the inspection had attempted to identify where additional training and support was required. We found the home in continued breach of this regulation but acknowledged action had been taken that should have reduced the risks.

We saw that the home was now taking steps to mitigate risks to people and action had been taken to better support people at risk. We saw this specifically in relation to additional specialist support and equipment for those who had fallen or were at risk of losing weight. However, we now found that records of the action taken and why the action had been taken were not sufficient. This was now identified as a breach under a different regulation.

At the last inspection the home were not meeting the needs of people at risk of malnutrition and dehydration. We found at this inspection additional steps had been taken to better support those at risk. This included the availability of snack boxes in the lounges of the home which people could help themselves too. We also saw better referral for specialist support, when this was needed and better records to identify risks, so they could be better managed. The home had now met the warning notice issued and was no longer in breach of this regulation.

At the previous inspection we found the homes policies and procedures for the safe recruitment of staff were not followed. We found this was still the case at this inspection. Some work had been completed with new recruitments but action had not been taken to address previous concerns. We were not assured internal dual roles or promotions were managed as effectively as they should be. We found the home is in continued breach of the regulation associated with the safe recruitment of staff.

Staff at the home knew the people they supported well. People living in the home liked the staff that supported them and spoke highly of them. However, it was clear that there were shortages in staff that impacted on the quality of the support provided. This was particularly prevalent in the early morning hours and when staff called in sick or supported people to appointments off site.

Since the last inspection more focused activities had begun to take place. We saw that more was needed to support people on the dementia unit with meaningful activity and daily occupation. We spoke with the activity co-ordinater about this who showed awareness in this area and was keen to develop and focus on this area moving forward. Some investment had been made to the building to make it more dementia friendly and more work was planned. A dementia strategy had been developed and an action plan from an audit of the home provision had begun to be implemented. This work had not been as focused as the provider would have liked but the recruitment of a new registered manager was instrumental in moving this forward.

We found people’s care plans contained some good person centred information but were concerned others were inconsistent. Where actions were identified to reduce risks to people there were not any records to evidence the action had been taken. We also noted information in some plans did not reflect the individual's needs. Some care plans had not been reviewed for up to two months and there had clearly been changes in their needs. We found the home in continued breach of this regulation

The home had a comprehensive suite of quality audit and assurance. However the system was not being fully implemented. There were some gaps in recording that had led to two months in 2017 summary audit not being completed. We noted actions agreed, as required, to improve provision and delivery of service at the home had not been followed through. This meant that actions were not being monitored and signed off as completed. We found the home in continued breach of this regulation.

Steps had been taken to improve communication across the home; this included the introduction of daily flash meetings. We found the meeting we attended was not completely informed of the current picture on the day. We have recommended that systems are introduced to allow the different teams who fed into the flash meetings with a structure of the information they should bring to the meeting.

The home did accommodate emergency beds for the community emergency response team, but these had recently been decommissioned. The quality director had acknowledged the resource required to support these placements had impacted on the overall quality at the service and had taken steps to withdraw from the contract.

We were assured by our observations and what people living in the home and their families told us, that people were treated with respect and their autonomy and independence was promoted. People spoke positively of the staff and the staff spoke warmly of the people in the home.

The home continued to have a good understanding of the mental Capacity Act and how it should be used to support those people who were unable to give consent to their care and support. Assessments were completed for people’s capacity and where appropriate, applications for Deprivation of Liberty safeguards were completed or best interest decisions were made. The protection these procedures offered, gave us assurances that people were treated with respect and the least restrictive options were taken to support people with limited or fluctuating capacity.

The home continued to seek the views of people living in the home and their relatives by way of an annual questionnaire and results of the last questionnaire had been positive and were displayed in the home’s foyer.

The provider was displaying the ratings from the last CQC inspection.

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

The home was last inspected in September 2014 where we followed up on breaches identified at the previous inspection in June 2014. We found the home was meeting the regulations we inspected in September 2014.

The home is situated in Skelmersdale and is easily accessible by public transport. The home provides nursing or residential support for up to 66 people. Nursing care is provided on the top floor of the two story building with the ground floor area supporting people mostly living with dementia. At the time of our inspection there were 61 people living in the home.

Each floor has a lounge and dining room and a smaller quieter lounge used mostly for activities. The kitchen and laundry facilities are on the ground floor of the building and each floor is accessible by a lift and stairs.

The home had a registered manager who had returned from an extended period of leave on the second day 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.

At the time of the inspection all people living with dementia had an initial capacity assessment under the Mental Capacity Act 2008. In two files we also saw a number of decision specific assessments to support best interest decisions made to support people with specific support needs. We did find that some of this paperwork was inconsistent and contained some contradictions but steps had been taken to support people under the legal requirements of the Act. The provider assured us a monitoring exercise would be completed to ensure the paperwork was accurate and relevant to the individuals.

We found a significant reduction in formal staff support in the 12 months prior to the inspection. This included formal supervisions and appraisals, team meetings and the structured deployment of staff to support people living in the home. We found systems and procedures had not been followed or effectively monitored for some time which had led to concerns noted in the management of medicines and support for people who may be a risk of falls.

People living in the home had not been effectively supported with their nutrition and hydration with more people requiring support than those identified by the home. We also found some people who required regular eye tests had not had them and half of the people we noted to require glasses for watching television were not wearing them.

Not all the staff that had been recruited recently had all the information in their personnel files required under schedule 3. Schedule 3 identifies the requirements employers registered with the Care Quality commission need to take to safely recruit staff. This included assessments to determine if anyone required additional and suitable adjustments to better support them in their employment.

The home had two activity coordinators who worked to provide group and one to one activities for the people in the home. We saw two group activities taking place over the course of the inspection. Some people told us they would like more to do. We discussed the role of meaningful activity with people living with dementia and the manager told us they had recently completed the Kings fund dementia environment survey and had submitted improvement plans to the provider which considered meaningful activity. Once approved this would greatly increase the quality of people’s life in the home.

We found people’s care plans were written in a person centred way but they were not always reviewed regularly and changes at point of review or as needed had not be used to update care plans. This meant people were not always receiving the support they required to meet their needs.

The home had been contracted by the Community Emergency Response Team to provide 10 intermediate care beds. These beds were used to support people in a hope they would not need to go to hospital or to support people after hospital and before they returned home. The team told us the home managed the beds well and dedicated staff had been provided to ensure the success of the programme.

The home sought the views of people living in the home and their relatives by way of an annual questionnaire and results of the last questionnaire had been positive and were displayed in the home’s foyer.

We found staff treated people with dignity and respect and positive relationships had been formed between staff and people in the home. However due to a disorganised structure in the deployment of staff people did not always receive the support they needed in a timely way.

We also found concerns with the home’s system of audit and monitoring. The interim manager had not completed audits effectively or acted on the area manager audits to improve the service.

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

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the manager and from looking at records.

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

Is the service safe?

At the time of our visit to this location, we toured the premises and found the environment to be fit for purpose. It was safe, well maintained, clean and hygienic. The service was consistently monitored and the safety of those who lived at the home was constantly promoted. Therefore, people were not put at unnecessary risk.

People we spoke with told us they felt safe whilst care and support was being delivered and they, or their relatives had been involved in making decisions about the care and support provided.

Is the service effective?

The personal. health and social care needs of those who used the service had been assessed before a placement was arranged. A variety of external professionals were involved in their care and treatment and specialist dietary needs had been identified, where required. This helped to ensure people were receiving the health care support they required.

Policies, procedures and practices adopted by the home supported effective service delivery for those who lived at Aaron Crest. This helped to ensure the staff team delivered appropriate care and treatment in accordance with people's needs.

People's needs were taken into account enabling them to move around freely and safely. It was evident that visitors were able to see people in private and visiting times were flexible.

Is the service caring?

We asked those who lived at the home about the staff team. Feedback from them was very positive. They said staff were kind and caring and we observed members of staff speaking with people in a respectful and friendly manner. People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

Staff were seen to be responding to people well by anticipating their needs appropriately. The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

In discussion with the managers of the home it was clear the staff team had worked hard to improve the service since our last inspection. Records showed that areas for improvement had been identified by the monitoring processes in place and opportunities to change things for the better were promptly addressed. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service. People living at Aaron Crest and their relatives completed annual satisfaction surveys. Where shortfalls or

concerns were raised, these were taken on board and dealt with appropriately.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the Area Manager and from looking at records.

Some of those who used the service were unable to communicate with us verbally. However, we were able to speak with five of them and two relatives. The responses to the questions we asked were mixed.

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

Is the service safe?

People we spoke with told us they felt safe living at Aaron Crest. Safeguarding procedures were robust and staff had received training in this area. Systems were in place to help managers and the staff to learn from untoward incidents, such as safeguarding concerns.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications were in the process of being made. This helped to ensure people were not being unnecessarily deprived of their liberty. People (or their relatives) were involved in making decisions about the care and support provided.

At the time of our visit to this location, we toured the premises and found the environment to be fit for purpose. It was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore, people were not put at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant that people could access additional support, if they needed to. The health and personal care needs of those using the service had been assessed, with a range of people involved in their care and support.

Systems were in place to ensure the service was assessed, so the quality of service provided could be consistently monitored. Records showed and the majority of staff confirmed that a range of training modules were provided for staff, with regular mandatory updates. However, the training matrix displayed a mixture of dates in the future and in the past, which made it difficult to determine who had done which training course.

Is the service caring?

We asked those living at the home about the staff team. Feedback from them was, in general positive. They said staff were kind and caring towards them and helped them to meet their needs.

People's choices and preferences had, in general been recorded. However, although some good information had been documented, the plans of care seen varied in quality. Some were very brief, which failed to provide person centred information or clear guidance for staff about people's assessed needs, or how these were to be best met. One person staying at the home on respite care did not have a care plan in place and therefore staff had not been provided with clear instructions about the support this person needed. A relative commented, 'Most of Mum's needs are met.'

Is the service responsive?

It was not evident that activities within the home were provided in accordance with people's wishes and preferences. On the day of our visit most people were sitting in-front of the televisions. However, some were having their hair done and others were having manicures.

The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by senior personnel. People living at Aaron Crest and their relatives completed satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately. One relative commented, 'It ticks a lot of boxes here, but not all the boxes.'

We completed two SOFI (Short Observational Framework for Inspection) assessments. SOFI assessments were used to get short snapshots of information around the opportunities someone has to interact with their environment and people around them. The framework assesses the quality and type of interactions people were involved in.

The assessment observed people coughing, clearing their throat and drinking alone. Two people had a risk assessment in place stating they should be observed and supported when eating and drinking. This meant people who were potentially at a risk of chocking were left unsupported.

We looked at peoples care file information and saw that assessment and risk management strategies were sometimes difficult to follow. One person had two moving and handling assessments in their file but none were dated. Each assessment told of differing support needs. The assessments had not been reviewed for some months and as reviews simply stated no change it was difficult to ascertain this person's current support needs.

We spoke with a senior care worker and the Registered Nurse on duty about how medicines were managed on the two different units.

Nobody we spoke with expressed any concerns about their medicines; however we found errors and discrepancies in the records on the nursing unit that meant people had not always been given their medicines correctly.

Overall we found that people were not fully protected against the risks associated with the unsafe management of medicines.

We spoke with people living in the home about the level of support they required and whether they felt the appropriate level of support was given. One person told us, "The carers are first rate, can't fault them on anything they do for me. They are there whenever I need them and always have a smile on their face.'

We ate lunch with the people living in the home and asked them how their dietary preferences and needs were met. One person told us, 'I don't like onions and garlic and I'm never given any food that these are in. I'm not allergic to them or anything, I just don't like them, and it's never been a problem.'

We spoke to people living in the home about the staff that cared for them. One person told us, 'Every member of staff is pleasant and look after me well but (staff member) is something else, they make me feel like they really care for me as if I were a family member, now you don't get that everywhere.'

We spoke with people about their opportunities to feedback to the manager about how their support was provided.One person said, 'I can always get the support I need so don't ever have any reason to grumble.'