Thornton Lodge Care Home

Thornton Lodge is a residential care home located in Salford, Greater Manchester and is operated by GGS Care Home Limited. The home provides residential care to older people. The service can support up to 34 people, with 31 living at the home at the time of our inspection.

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

Since our last inspection of Thornton Lodge in October 2020, improvements had been made to governance systems to ensure legal requirements were being met.

People living at the home and their relatives told us the home was a safe place for people to live and staff demonstrated a good understanding about how to safeguard people from the risk of abuse. There were enough staff to care for people safely, although some staff reported to us more were required first thing in the morning at busier times. Staff wore PPE when delivering care and the home was clean and tidy throughout. We provided some feedback to the registered manager to ensure social distancing measures were followed whilst maintenance work was ongoing.

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. Staff told us they received enough training and supervision to support them in their roles. People received enough to eat and drink, with appropriate referrals made to other health professionals as needed.

The home had a registered manager in post who had worked at the home for many years. The feedback we received about management and leadership was positive. The current staff team spoke of a positive culture at the home. There were also good links within the local community.

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 December 2020) and there was a breach of the regulations. 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 looked at infection prevention and control measures under the Safe key question. We look at this at all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We carried out an announced focused inspection of this service in October 2020. A breach of legal requirements was found and a warning notice was issued to both the registered manager and provider regarding Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve the Safe, Effective and Well-led domains.

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, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (Caring and Responsive) 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 Thornton Lodge on our website at www.cqc.org.uk

Follow up

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

Thornton Lodge is a residential care home located in Salford, Greater Manchester and is operated by GGS Care Home Limited. The home is registered with the Care Quality Commission (CQC) to provide care for up to 34 people, some of whom are living with dementia.

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

Further improvements were required to ensure the building was safe and well maintained. We also identified some concerns regarding staff recruitment.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice.

Auditing and governance systems were in place at both provider and managerial level, however they had not always been effective in identifying the concerns found during this inspection and needed further improvement.

People living at the home and their relatives told us the home was a safe place for people to live. Staff demonstrated a good understanding about how to safeguard people from the risk of abuse, with allegations of abuse submitted to the local authority when needed. There were enough staff to care for people safely. Staff wore personal protective equipment (PPE) when delivering care and the home was seen to be clean and tidy throughout.

Staff told us they received enough training and supervision to support them in their roles. People received enough to eat and drink, with appropriate referrals made to other health professionals as needed.

The home had a registered manager in post who had worked at the home for many years. The feedback we received about management and leadership was positive. The current staff team spoke of a positive culture at the home, with good team work throughout.

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 July 2019). During this inspection in 2020, sufficient improvements had not been made to improve the overall rating.

Why we inspected

We carried out an unannounced inspection of this service in May 2019. Breaches of legal requirements were found regarding need for consent, safe care and treatment, good governance and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to ensure they were compliant with the regulations.

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, Effective and Well-led key questions which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (Caring and Responsive) were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same which is Requires Improvement. 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 Thornton Lodge on our website at www.cqc.org.uk.

Follow up

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

Thornton Lodge is situated in a residential area of Salford. The home provides personal care and support, nursing care as well as care for people living with dementia. The home is registered to accommodate a maximum of 34 people. At the time of the inspection there were 32 people living at the home.

People’s experience of using this service:

We found improvements were still required in key areas including safety of the premises and equipment, staff training, gaining and documenting consent to care and treatment and the homes auditing and quality monitoring processes. We found none of the regulatory breaches identified at the previous inspection had been fully addressed, with continued breaches noted in each of these areas.

People and their relatives were positive about the standard of care provided and spoke highly of the staff, who were described as ‘kind’, ‘polite’ and ‘effective’. People and relatives commented on Thornton Lodge being a ‘home from home’ and that care staff ‘Do their best to make us feel comfortable here’.

People told us they felt safe living at the home. Staff were knowledgeable about how to identify and report any safeguarding concerns, with these referred to the local authority as per the reporting procedure. Accidents, incidents and falls had been documented consistently, with monitoring completed to look for trends and help prevent a reoccurrence. We found the home to be clean, odour free with effective cleaning and infection control processes in place.

People received personalised care which met their needs. Care plans explained how people wanted to be cared for. These had been reviewed regularly to reflect people’s changing needs and wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People felt the staff were well trained and knew their likes, dislikes and interests. We saw lots of examples during the inspection which demonstrated this. People spoke positively about the choice and standard of meals provided and we found people requiring a modified diet received these in line with professional guidance.

Although people felt staff were competent, we found very few training sessions had been completed since February 2018. This meant staff had not had their skills and knowledge refreshed and, in some cases, completed training in key areas at all since commencing employment.

People told us staff were kind, caring and treated them with dignity. People’s independence was encouraged and promoted. We saw people had developed positive relationships with the staff, who had taken the time to get to know them. Where people required support at the end of their life, this was carried out respectfully, compassionately and with professionalism.

Medicines and care plans had been audited monthly with action points generated and completed. However, the rest of the home’s auditing and quality monitoring processes had not been utilised consistently for over 10 months. This had impacted on the action taken to address the issues noted at the previous inspection.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for the home was requires improvement (report published June 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. As the home was rated as ‘requires improvement’ following our last inspection, we returned within 12 months to check the necessary improvements had been made.

Enforcement:

We have identified breaches in relation to the need for consent, safe care and treatment, good governance and staffing. Please see the action we have told the provider to take at the end of this 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 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.

Thornton Lodge 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 is registered with CQC for 34 older people, including care for people living with dementia.

Thornton Lodge is situated in Salford, Manchester and close to local amenities with good access to public transport and motorway networks. At the time of our inspection there were 30 people living at the home.

At the previous inspection in July 2017 we identified six breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance and staffing. We served a warning notice for regulation 12; safe care and treatment and regulation 17; good governance. The home was rated inadequate overall and in the key question safe and well-led. The home was also rated as requires improvement in effective, caring and responsive.

As a result of the findings at our inspection in July 2017, the home was placed in special measures and kept under review. Following the inspection and enforcement action taken, the provider sent an action plan to show what they would do and by when to meet the regulatory requirements and improve the overall rating.

The inspection in March 2018 was undertaken to determine the improvements that were needed had been made. Although we found the provider had made significant improvements in several areas, we did find continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; Regulation 12; safe care and treatment, Regulation 17; good governance and Regulation 18; staffing. We also identified a breach of Regulation 11; need for consent. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection, there was a manager in post who had not yet been registered with the CQC, however we saw evidence that this application had been submitted and their application was on going. 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.

Although people and their relatives were positive about the management of safety concerns, we identified continued concerns with the management of risks. We found discrepancies in the care records and the documentation could not be relied upon to determine people’s needs were being met in line with their requirements.

There was a system in place to manage people that had specialist dietary needs but records needed strengthening to determine the foods provided were in line with their assessment.

The home had a system in place to determine the required staffing levels and although we observed staffing levels had increased since our last visit. We noted staffing levels were still not consistently maintained at weekends to the same ratio as within the weekdays.

The home had suitable safeguarding procedures in place and staff demonstrated they knew how to safeguard people and follow the alert process.

The environment had improved since our last inspection and there was an identified action plan for works required. Funding had been secured but there was no identified timeframe for completion. The home was clean and had recently been awarded 96% on the infection control audit.

We found people’s food preferences were catered for and people were provided sufficient quantities of quality food to eat. We observed the meal time experience which was relaxed and staff took the time to sit and chat with people.

Staff told us they felt supported but we found gaps in staff training which meant they had not been appropriately equipped to meet the needs of the role and people they supported.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Decision specific Mental Capacity assessments had not been completed and there was limited information contained in people’s records to determine their needs.

We observed appropriate displays of affection between staff and people and staff comforting people timely when they showed distress. People were treated with dignity, respect and were given privacy at the times they needed it.

People’s independence was promoted and people were encouraged by staff to do as much for themselves as possible. Activities were provided and opportunities for social inclusion.

The home was engaged in the 'Six Steps' End of Life Care Programme. This meant that for people who we were nearing the end of their life, they could choose to remain at the home to be cared for in familiar surroundings by people they know and could trust.

Systems and process for audit, quality assurance and acting on feedback from people who used the service were not operated effectively.

At our last inspection on 13 March 2017, the home was rated as requires improvement in the key questions of effective, responsive and well-led. The home was rated as ‘good’ in safe and caring. This meant the overall rating was ‘Requires Improvement.’ We brought the inspection forward due to concerns received regarding the standard of care provided to people at Thornton Lodge.

During this inspection, we found six breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance and staffing. We served a warning notice for regulation 12; safe care and treatment and regulation 17; good governance. You can see what other action we took at the end of the full version of this report.

Thornton Lodge Care Home provides 24 hour nursing and /or personal care for up to 34 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.

At the time of the inspection there was no registered manager in post. The previous registered manager left on 11th July 2017 and the new manager took up post on 25th July 2017 and intended to register with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that there was not enough suitably trained and experienced staff on duty to meet people’s social, emotional and physical needs. Staffing levels were not calculated using a formal calculation based on the needs of people using the service. During the inspection, we observed staff were ineffectively deployed which resulted in people being left for prolonged periods of time and their care needs not being met timely. Following the inspection, the provider contacted us to inform us that a formal dependency tool had been implemented to calculate staffing requirements. This will be followed up at our next inspection to determine that staffing has been provided in line with people’s assessed needs.

We identified serious concerns regarding risk management that we immediately fed back to the provider. We found risk assessments were not in people’s care files but stored electronically with only nursing staff and senior care staff having access to the electronic system. This meant care staff did not have access to the identified risk in order to mitigate the risks and provide safe care.

People were not protected from the risk of aspiration and were given foods by staff which could cause them to choke. We observed the food provided to one person had been identified as a food the person was to avoid when they had been assessed by SALT (Speech and Language Therapy). We saw this person had also been given food not consistent with their assessed needs on days prior to the inspection indicating that this was not an isolated occurrence. We saw ‘Resource’ which is a thickening agent left accessible to people on the nursing floor which presented the risk of people consuming this accidently and placing themselves at risk.

Staff recruitment was robust, with appropriate checks carried out before staff began working at the home.

The environment did not meet good practice guidance for supporting people living with dementia. The upper floor was small and could not accommodate the number of people living on the nursing floor in the dining room or lounge area. The residential floor had a large and spacious lounge, dining area and an additional large quiet room. However, only two people were supported from the nursing unit downstairs to the residential unit to access these areas. The provider told us this would be addressed following the inspection and that everybody would be offered to go downstairs if this was their preference.

Upstairs, we found lighting was poor on the corridor with a number of light bulbs needing replacing which led to dimly lit corridors making visibility difficult for people with visual and memory impairment.

We identified issues with the overall décor and maintenance of the home. Paintwork and furnishings were dirty and although we saw the domestic cleaning during the inspection, there was no oversight or clinical infection control measures or audit undertaken by the management or provider at the home.

We saw broken and damaged fixtures and fittings, including the bathroom and a number of bedroom ceilings which had water damage caused by a leak. We saw there was a note on the bathroom door indicating that the light was not to be turned on. We asked a member of staff why the light was not to be turned on and was informed it was due to a leak that had come through the light fitting. We requested the door was locked as a matter of precaution and safety to people living at the home.

The people we spoke with during the inspection lived on the residential floor as the people on the nursing floor were living with advanced dementia and were unable to verbalise their experiences. The people we spoke with during the inspection spoke highly of the staff and the care provided. However, although we don’t dispute the experiences of the people we spoke with, we observed differences during the inspection on how the nursing and residential floor operated. Our observations of care staff interactions on the residential floor were positive. The majority of care staff interactions on the nursing floor were good but we observed one care staff member did not communicate with people or ask for people’s consent before doing care tasks and we noted people’s distress at having a tabard put over their head or taken off without reassurance or explanation.

We noted two people on the nursing unit that should have been wearing hearing aids and glasses. However, neither person had these throughout the inspection.

People and their relatives had not been formally involved in initial assessments or reviews. However, we received mixed feedback from relatives regarding this. One relative told us they felt communication was good and that they were frequently consulted and involved in decisions about their family members care. Whilst a second relative didn’t feel the staff were responsive to their family member’s needs and didn’t feel their family member was receiving safe care. They told us they had raised a number of concerns with the management but nothing had changed.

We found people’s biographical information; likes and dislikes, were not consistently captured to support person-centred care planning. The provider told us this information was captured in the activities file but when we looked at this, we found that none of the booklets had been completed.

People were not supported to live full and active lives. There was no stimulation or attempts made to engage people in meaningful activity. We observed people sat in the lounge on the nursing floor for long periods of time with no staff presence. The television remained on one channel with no consideration as to whether the programmes were appropriate or of interest to the people sat in the lounge. Our observations of staff engagement on the residential floor were more positive and we noted that there was a continued staff presence in the lounge which meant people were not left without staff support.

Accurate and contemporaneous records were not maintained. This included food and fluid records, weight monitoring, oral hygiene, nail care, fluid consistency and life history information about people living at the home.

We identified significant shortfalls in the quality of the care provided to people living at the home. The provider did not have a system in place to assess the quality of the service. There were no governance systems to monitor people’s dietary needs, risk assessments and care plans, the environment, staffing or observations of the quality of care provided. These were areas of concern that we identified during the inspection. This meant the provider was not meeting their regulatory requirements.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it 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.

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.

The inspection took place on 13 March 2017 and was unannounced. An inspection was carried out in December 2015 when the home was rating Requires Improvement in three areas and overall. There was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to poor record keeping. A further focused inspection was undertaken in March 2016 when only the domain of responsive was looked at. At the focused inspection the service was found to have improved in regard to record keeping, but we were unable to evidence sustainability at this time. At this inspection records were seen to be complete and up to date.

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

People who used the service told us they felt safe. Staffing levels were sufficient to meet the needs of the people who used the service and were based on a dependency tool.

There was a safe system of recruitment in place. This helped ensure staff employed were suitable to work with people who were vulnerable.

Safeguarding policies and procedures were in place at the service. Medicines were managed safely and health and appropriate safety measures were in place.

The induction programme was robust and on-going training was comprehensive and included relevant areas of learning.

Most of the people who used the service were living with dementia. The environment required improvement so that people would be better able to orientate themselves around the premises, to their own rooms and communal spaces and to time, day and date.

Nutritional and hydration requirements were documented and addressed, special diets were catered for and a kosher diet could be sourced for those who wished to have this. The dining experience could have been improved with better presentation of tables and the addition of condiments and napkins.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring and we observed friendly and polite interactions throughout the day. Staff respected people’s privacy and dignity.

Relevant information about the service was given to people who used the service and their families. Where people had expressed them, their wishes for when they were nearing the end of their lives had been documented. The service endeavoured to care for people in the home if that was their wish.

People’s choices, wishes and preferences were documented within the care files. However, some preferences, such as times of rising and retiring were not always adhered to.

There were a number of activities on offer for people and special occasions were celebrated at the home.

Complaints were documented and responded to appropriately and we saw a number of compliments received by the service.

People told us the management at the home were very approachable and helpful.

We saw evidence of a number of audits and checks within the service. Monitoring and analysis of the audits helped identify themes and drive improvement.

The service was involved in a number of local initiatives to help improve the health and well-being of people in the home.

Thornton Lodge Care Home provides 24 hour nursing and or personal care for up to 36 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.

At the time of our visit, there was no registered manager in place, though the current manager had been in post since April 2015. Their application to register with Care Quality Commission (CQC) was currently being processed. 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.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thornton Lodge Care Home on our website at www.cqc.org.uk.

During our last inspection, we found the service had failed to maintain accurate, complete and contemporaneous records for people who used the service. This was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance.

During this inspection we found the service was able to demonstrate they were meeting the requirements of regulations. We looked at a sample of five care files and found that on the whole, records were accurate and complete. We found care plans accurately reflected people’s current needs.

We found issues that had been recorded in the daily diary such as referrals to other health care professionals were suitably transferred and recorded in people’s individual care files, together with the reason for the referral. During our visit we found where challenging behaviour had been assessed, suitable care plans, risk assessments and monitoring records were now in place. Where checks such as weight monitoring was required, records we looked at were accurate and up to date.

The manager explained the service was in the process of introducing a new electronic records system and that records were currently being transferred and updated. It was anticipated that the process would be completed within the next four week. We were shown how the service intended to fully utilise the system throughout the home by the manager, who told us that computer terminals would be located in both the nursing and residential unit for staff to use.

A new provider had recently acquired the home in August 2014 and the manager had just been appointed having been in post since 18 August 2014. The Manager identified the home as being work in progress and advised that they were working closely with the provider to agree a manageable and sustainable way forward to improve the quality of the home and service provided to people.

We were told a major improvement programme of refurbishment and decoration had been agreed to improve all bedrooms, bathrooms and communal areas both within and outside the building. Care plans, training, policies and procedures together with documentation was also being reviewed by the new manager.

During our visit we spoke to four people who used the service, nine relatives and friends and six members of staff.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission together with a specialist advisor in nursing. They addressed our five standard questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

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

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; 'I've been elsewhere so I can compare. I have no concerns about the staff or place. Any issues and they put it right straight away.'

Systems were in place to make sure that the service and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager was able to demonstrate a good understanding of the legislation though most staff had a limited understanding of the legislation and no recent training had been undertaken.

Equipment was well maintained and serviced regularly therefore people were not put at any unnecessary risk.

The registered manager set the staff rotas and ensured suitable numbers of trained staff were available to meet the needs of people who used the service. We were informed staffing levels and rotas were currently being reviewed by the service.

We found the service had some policies and procedures in place to make sure that unsafe practice was identified and people were protected. We were told that the service was currently reviewing all policies.

During our inspection we had concerns regarding the personal hygiene of some people and cleanliness of the home.

We found that medication was not managed safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to hygiene and cleanliness and the safe administration of medication.

Is the service effective?

We found people's health and care needs were assessed with them, and that they or their representatives had been involved in determining what care and support they needed, though this was not always clearly demonstrated in care files.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed they were always made to feel welcome and that visiting times were flexible.

During our inspection we had concerns that the service was not always effectively meeting the needs of people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to effectively meeting peoples' needs.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff supporting people in a kind and caring manner.

People commented; 'Individual care is excellent.' 'I'm really grateful for this place, they really look after her and me.' 'The new manager is really helpful and the girls are really good.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and had been provided in accordance with people's wishes.

Is the service responsive?

There were a very limited range of activities available at the home to stimulate people mentally and physically. We were told that availability of activities were currently being reviewed by the new manager.

People knew how to make a complaint if they were unhappy. The service had procedures in place to deal with complaints.

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.

On the whole, the service had some quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service continuingly improved.

Staff told us they were clear about their roles and responsibilities within the home.