Rosehill House Residential Home

Rosehill House Residential Home is a residential care home providing personal care to up to 27 people. There were 14 people living at the home at the time of the inspection. Accommodation is provided over two floors in a detached period building with a large garden.

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

The providers governance systems did not always ensure effective oversight of the service. Quality assurance checks that were completed did not always identify improvements required to ensure people's safety

The provider was not promoting safety through the layout and hygiene practices of the premises. The service required renovation and modernisation.

There were not always sufficient numbers of staff to meet people's needs and ensure their safety. We found not all staff had completed refresher training in areas the provider had deemed mandatory, but the manager was in the process of planning and reviewing training. The provider had an appropriate procedure for the recruitment of staff.

Staff supported people 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. However, records relating to consent and capacity needed improving and we have made a recommendation about this.We issued a recommendation about this.

Staff supported people to eat a nutritionally balanced diet and to maintain their health. The registered manager assessed people's needs prior to them using the service. Staff treated people with kindness and respect and spent time getting to know them and their specific needs and wishes.

Staff told us they felt supported by the registered manager. People told us they felt safe living in the home, and they were happy with the service provided. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults' procedures.

We observed positive interactions between staff and people who lived in the home. However, people were provided with limited opportunities to express their views about the service.

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

Rating at last inspection and update

The last rating for this service was good (published 9 December 2021).

Why we inspected

We received concerns about the lack of robust infection prevention and control and ineffective governance and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, infection prevention and control, medicines and quality monitoring.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rosehill House Residential Home is a residential care home providing personal care to up to 27 people in one adapted building over two floors. There were 12 people living at the home at the time of the inspection.

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

People were safe living at Rosehill House. Systems and processes were in place to safeguard people and staff were knowledgeable about these. Risks to people were assessed and their safety managed and monitored. People’s needs were regularly reviewed and staffing levels supported people’s needs. Medicines were administered safely. Infection prevention and control was in place. Accidents and incidents were reviewed and lessons learnt shared with staff.

The home was well-led. People and staff told us they knew the registered manager and provider well. There was a scheduled system of checks and audits. The registered manager regularly communicated with people, relatives and staff to keep them informed. The registered manager had systems in place to keep updated with legislation and best practice. The registered manager regularly reviewed practices in the home to improve care quality. The home worked closely with the Local Authority.

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

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

Rating at last inspection and update

The last rating for this service was good (published 7 October 2020).

Why we inspected

We received concerns in relation to the management of risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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 found no evidence during this inspection that people were at risk of harm from these concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosehill House Residential 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.

We found the following examples of good practice.

The service had a dedicated unit to be used as a designated setting for people with a positive Covid-19 result. The unit has its own communal space and toilet and bathroom facilities and can accommodate up to ten people in single bedrooms.

Staff providing care and cleaning were designated to the unit and would not move between units to reduce the risk of transmission. Tests for Covid-19 were carried out weekly for staff.

Local policies had been developed to ensure staff understood how to work and deliver care safely. Staff had been trained in control of infection, use of PPE personal protective equipment and identification of people whose condition is deteriorating.

Systems were in place to fully sanitise each bedroom when a person moved out and before a new person moved in.

The home had closed to non-essential visitors due to local lockdown restrictions. People were supported to keep in touch with family and friends through regular telephone and video calls.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Rosehill Residential Care Home is a ‘care home’ providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

People told us they felt safe. Medicines were managed safely. However, we recommended the manager follows best practice guidance in relation to recording dates when medications are opened. Staff were recruited safely, and there were enough staff to take care of people. Support plans and risk assessments detailed what care and support people needed to reduce risk to them.

People spoke highly of the management team, commenting they were approachable and supportive. The manager understood the regulatory requirements. People told us they thought the service was well-led.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 10 September 2019), and there was a breach of regulation. 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 carried out an unannounced comprehensive inspection of this service on 5 August 2019. Breaches of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rosehill Residential 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.

Rosehill House residential home is a care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

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

Medicines were not always managed safely, systems were not in place to ensure people received medicines at specific times. As required medicines (PRN) were being administered on a frequent basis even though care notes demonstrated the person didn’t require the medicine. Staff were not always recruited safely, there were enough staff to take care of people. Care plans and risk assessments detailed what care and support people needed to reduce risk to them. People told us they felt safe.

Staff did not always receive appropriate training, however a plan was in place to ensure training was brought up to date. Staff were supported and felt supported by the management team. Staff received supervision. People’s needs were assessed, and outcomes recorded. People were offered a choice of food and drink. The service worked with other health care professionals.

People who used the service told us staff were kind and caring. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice. People told us staff treated them with dignity and respect, they were involved with the planning of their care and their views were listened to.

People’s end of life wishes had not been explored and documented. There were a complaints procedure and people knew how to complain. Peoples likes and dislikes were recorded in people’s care plan and staff knew people and their preferences well. People’s communication needs were in their plans. People had a good range of activities in place and people were happy with what was on offer.

People spoke highly of the manager and provider who they said was approachable and supportive. The provider and registered manager understood the regulatory requirements; however, there has been several months where monitoring the quality and safety of the service had not occurred. People told us they thought the service was well led.

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 inadequate (published February 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.

This service has been in Special Measures since December 2018. During this inspection the provider demonstrated that improvements have been made. The service 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.

Enforcement

We have identified two breaches at this inspection in relation to not doing all that is reasonably practicable to mitigate risks, this is a breach of Regulation 12: Safe care and treatment.

Not monitoring the quality and safety of the services provided in the carrying on of the regulated activity. This was a breach of Regulation 17: Good governance.

We have made a recommendation about the handling of disclosure and barring certificates.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.

We had previously inspected the home in December 2017 and rated it as requires improvement overall. Our key question of ‘caring’ was rated as good and other key questions were rated as requiring improvement. We found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 because the provider had failed to ensure they notified us of other incidents. At this inspection we found this had not improved.

Rosehill House Residential 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.

The home provides care and support for people with residential needs and has a maximum occupancy of 27 people over two floors. On day one of our inspection 23 people were living at the home, on day two there were 24 people living at the home, one of whom was receiving respite care and support on a temporary basis.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found failings in the oversight, monitoring and management of the service which meant people did not always receive safe care and support.

The management of risks was not cohesive or consistent. People did not always have individualised risk assessments in place and these had not always been reviewed regularly.

Medicines were not administered safely. We could not be assured these were always administered as prescribed or stored safely.

Mental capacity assessments and best interest decisions had not taken place for people living with dementia. Consent was not checked or recorded. DoLS applications had been made appropriately.

Staffing levels were sufficient, rotas were in place and gave consideration to staff skills. A dependency tool was used to asses staffing levels.

There was a regular programme of activities and people spoke positively about the activities co-ordinator however some people were left without social stimulation for long periods of time.

Staff received regular and appropriate training and supervision but had not received an appraisal within the last 12 months.

People's needs in relation to the protected characteristics of the Equalities Act 2010 were taken into account at pre-admission. People's communication needs were assessed.

There were safe recruitment policies and procedures were followed.

The service worked and developed links with local community groups and organisations.

Staff told us they felt supported by the management team and people spoke positively about staff.

We found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Where regulations have been breached information about these breaches is at the back of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is completed. Where providers are not meeting fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service.

When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action taken.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This is the first time the service has been 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, 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. 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.

Rosehill House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Rosehill House is registered to provide accommodation for persons who require nursing or personal care. The service can accommodate a maximum of 23 people. The service is a detached property within its own grounds. At the time of the inspection there were 22 people living at the home.

Our last inspection at Rosehill House took place on 6 and 7 September 2016. The service was rated Requires Improvement overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations. However, at this inspection we found the registered provider was not submitting notifications to the Care Quality Commission every time a significant incident has taken place, This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents. You can see what action we told the registered provider to take at the back of the full version of the report.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had the necessary skills and understanding to support people to evacuate safely in the event of a fire. We saw the registered manager was in the process of completing personal emergency evacuation plans (PEEPs) for everyone who lived at the service. PEEPs are a support plan for people who may need help and assistance to leave a building in the event of an emergency. We recommended the registered manager prioritise the completion of these assessments so associated risks are mitigated in the event of an evacuation.

The staffing numbers were worked out using a dependency tool. This identified the level of dependency for each person, such as low, medium and high dependency. We identified inconsistencies with the quality of people’s dependency assessments. Throughout the day we observed that people received timely care and staff did not appear rushed.

We found systems were in place to make sure people received their medicines safely so their health needs were met. We asked the registered manager to start recording room temperatures to ensure medicines are stored in appropriate conditions. If medicines are not stored properly they may not work in the way they were intended, and so pose a potential risk to the health and wellbeing of the person receiving the medicine.

The service employed a part-time activities coordinator and we saw a programme of activities was offered at the service. We received mixed feedback from people who used the service about the quality of activities provided.

We saw some people who used the service were living with dementia. We identified improvements to the adaptation and design of the service to make the environment more dementia friendly.

People’s care records contained detailed information and reflected the care and support being given. However, we found care records needed more detail about people’s social histories and preferences, such as likes and dislikes.

People spoken with were very positive about their experience of living at Rosehill House. They told us they were happy, felt safe and were respected.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role.

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

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Rosehill House Residential Home is situated on the outskirts of Dodworth village, near Barnsley. The home is a detached property within its own grounds, providing accommodation and personal care for up to 23 older people. To the front of the property is a large patio/terrace with garden furniture. Ramps are provided to the main entrance at the side of the building. At the time of the inspection there were 22 people living at the home.

Our records showed there was a registered manager registered for the location. However, the provider told us that this manager had not been at the home some time. He said he would take steps to remove this manager’s name from the registration. An acting manager was working at the home. She told us she had been in post approximately ten weeks and had commenced her application to formally register as the manager. Our records confirmed this process was ongoing. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People said they felt safe living at the home and said the staff treated them well. Staff had received training with regard to safeguarding issues and demonstrated an understanding of potential abuse. They told us they would report any concerns to the acting manager. We found some windows did not have restrictors or devices that met with current Health and Safety Executive guidance for care homes. No risk assessments were in place. There were odours in some rooms, although flooring and furniture was being replaced as part of an on-going programme of refurbishment. The laundry area was not suitable and walls in this area were damp and could not be cleaned effectively.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people living at the home. People said they felt more staff would be helpful and we observed that at meal times people did not always get consistent support. It was not clear how staffing levels were directly determined by dependency assessments. Medicines were handled safely and effectively and stored securely.

Most people told us they were happy with the standard and range of food and drink provided at the home and could request alternative dishes, if they wished. Kitchen staff had knowledge of specialist dietary requirements. Staff did not always support the social side of the meal time experience.

Staff confirmed they had access to a range of training. The provider had recently appointed an independent training company to support staff across all their homes. Staff told us, and records confirmed that regular supervision took place. The acting manager told us records she had reviewed suggested there had been no recent annual appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The acting manager had a full record of people who had been subject to a DoLS or for whom a DoLS application had been made. Some reference was made in care plans to taking decisions in people’s best interests, although details regarding the least restrictive option were not always clear. We have made a recommendation about this.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff.

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff demonstrated an understanding of people’s particular needs. People said they were treated with respect and their dignity maintained during the provision of personal care.

Care records were personal and contained good information about people as individuals. Assessments of people’s need had been undertaken. Care plans did not always contain sufficient detail for staff to follow or did not reflect advice from health professionals. The acting manager told us she was prioritising reviewing people’s care plans. People told us there were some events at the home but activities were limited at the current time. The acting manager told us she had just appointed a new activities co-ordinator, who was awaiting DBS clearance. People and relatives told us they had not made any recent formal complaints and would speak to the acting manager if they had any concerns.

The acting manager told us she carried out regular checks on people’s care and the environment of the home. These audits and checks had not always identified the short falls highlighted at the inspection. Staff were positive about the acting manager’s approach and said management were approachable and supportive. People living at the home knew who the manager was and said they could speak with her if necessary. A quality audit of people’s and relative’s views was generally positive about the care. Daily records were generally well kept, although shift handover records were not always personal and used frequent abbreviations.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Safe care and treatment, Staffing, Person centred care and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Rosehill House is a residential care home which was providing care and support to 22 people at the time of our inspection. A number of people living at the home had dementia. As part of the inspection we spoke with three people who lived at the home, four members of staff, one relative and the home manager.

This was a follow up inspection to check that improvements had been made in the management of medicines and assessing and monitoring the quality of the service since our previous inspection on 23 April 2014. At the previous inspection we found staff had not always signed the Medication Administration Record (MAR) when they had administered medication. The manager had audited the MAR sheets and identified that this was of concern but had not taken any action. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

The manager of Rosehill House submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At this inspection three people who used the service gave positive feedback about the care and support they received. They told us staff gave them their medication as prescribed and when they preferred.

We spoke with one visiting relative who told us, 'My [family member] is a thousand times better since coming here. The GP has carried out a review of their medicines and their health has improved to the extent that you wouldn't think they were the same person.'

We checked the MAR sheets for people living in the home. We found MAR sheets had been signed by the member of staff administering the medicines in all cases.

A senior staff member told us the manager carried out frequent medication audits so that any errors were identified promptly. We saw evidence of this. We also saw evidence that where staff had not signed MAR sheets they were formally supervised and informed that if they continued to not sign MAR sheets appropriately further disciplinary action would be taken.

Although improvements had been made, we identified with the manager other areas that needed monitoring such as the security of medicines at all times when medication was being administered to people and reviewing arrangements for the storage of medicines before their return to the pharmacy.

Staff training records evidenced staff received medication training to ensure they were competent in their role to safely manage medicines.

Is the service well-led?

At this inspection we found there were systems in place for auditing of the service. For example, medication, the environment, infection control, care plans and complaints. We saw the home manager had carried out regular audits and where appropriate taken action so that the quality of the service was improved.

People who used the service told us they were asked for their feedback on the service they received and that they had filled in a 'customer satisfaction survey'.

Rosehill House is a residential care home which was providing care and support to 19 people at the time of our inspection. A number of people living at the home had dementia. We spoke with five people who lived at the home, five members of staff, three relatives, the area manager and the home manager.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and staff understood their role in safeguarding the people they supported. Care and treatment was planned and delivered in a way that was intended to promote people's welfare. Staff used risk assessments. There were risk assessments in place with people's planned care. These gave details of how individual risks to a person could be removed or minimised.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

We looked at the system in place for the safe handling of medication. We found staff had not always signed the Medication Administration Record (MAR) when they had administered medication. The manager had audited the MAR sheets and identified that this was of concern but had not taken any action. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. We have asked the provider to tell us what they are going to do to ensure medication is handled safely, securely and appropriately.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet people's needs. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

In the main people were treated with respect and dignity by the staff. During our SOFI observation we did observe some staff speaking about people who used the service, in the dining room, where they could be heard by others. One member of staff asked another, "Has she been good this morning?" referring to a person who used the service. Another staff member was seen pointing at a person who used the service and saying loudly, "She has to see the nurse today for her injection". This meant that people's privacy and dignity were not maintained at all times.

People we spoke with told us staff were, "Very caring" and "Always willing to help me". A relative said, 'I visit my relative regularly and the staff are lovely to my relative. I think this home is Top of the Tree'.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We observed staff treating people with kindness and helping them with their daily activities such as personal care and social activities. We saw staff taking a person out to attend a dental appointment and taking a person for a walk to the shops.

People knew how to make a complaint if they were unhappy. One relative said, 'We always tell them if anything's not right and they listen and then put it right'.

Some people required specialised diets for health or personal reasons. We found the service provided food and drinks specifically requested by people. People told us, 'The food is good and I only have what I like and suits me' and 'If I ask for something they try their best to get it for me'.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service carried out a yearly 'Quality Assurance Survey'. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends and healthcare professionals. This showed people had the opportunity to share their views.

The service had a quality assurance system. Monthly and/or weekly audits were completed regarding such things as care plans, the environment, staffing and infection control. Records seen by us showed the shortfalls identified in the medication audits over a number of months, had not been addressed. We have asked the provider to tell us what they are going to do to ensure they identify, assess and manage risks relating to the health, welfare and safety of people who use the service.

Following the inspection the provider submitted an action plan detailing the actions they intended to take in order to achieve compliance in this area.

We visited the service on 12 August 2013 to check that improvements had been made to requirements relating to supporting workers. We found that staff received appropriate professional development and were able to obtain further relevant qualifications. We saw that relevant documentation relating to staff was now recorded.

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people in the communal areas of the home. This meant we were able to observe people's experiences of living in the home. We found that care and support was offered appropriately to people.

Each person living at the home had a care plan. We found that the information in these was detailed and up to date. This meant that the delivery of care to people was safe, effective and appropriate.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

We found that not all staff had received formal one to one supervision or a yearly appraisal. We also found that some 'newer' members of staff had no evidence that they had completed an induction, although staff told us they had worked alongside other more experienced members of staff before they started to work unsupervised.

The home had an effective complaints system available. We found that comments and complaints people made were responded to appropriately.