Sahara Parkside

People’s experience of using this service

Improvements had been made in the home following our last inspection. The management team had developed robust quality assurance systems to monitor the safety and quality of the home. Improvements in how people’s medicines were stored had been made to ensure they were kept at recommended temperature levels.

The home was safe. People were protected from the risk of abuse through the provider’s safeguarding procedures. People were supported to understand the safeguarding process. Staff were trained in how to identify abuse and report it. There were systems to ensure risks to people were assessed and mitigated against. The provider assessed the required staffing numbers to support people. Staff were recruited in a safe way and checks were carried out to ensure they were suitable to work with people. Accidents and incidents in the home were reviewed and analysed to learn lessons to help prevent their re-occurrence. There were effective procedures to prevent and control the spread of infections.

We expect health and social care providers to guarantee people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right care, Right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The physical setting did not meet the principles because it was a large apartment building for up to 30 people, with offices for staff located on the ground floor, and thus a campus style environment. There were obvious signs it was a care home from the outside. However, people were supported to have choice and control of how their care and support was delivered to them. People were supported to integrate into the local community and be as independent as possible.

Right care:

• Care was person-centred and staff people’s dignity, privacy and human rights were respected.

Right culture:

• The values and attitudes of staff and managers in the home encouraged people to be as independent as possible and feel empowered in their daily lives.

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 were supported by the provider and managers. They received training and ongoing supervision to maintain their skills and development. People were able to choose their food and drink preferences and were supported to attend healthcare appointments.

People had developed positive relationships with staff. They were supported by staff to maintain relationships with family and friends to help avoid social isolation. The provider had designed a day centre to support people in the home to engage in meaningful activities that interested them.

Care plans were personalised to meet the needs and preferences of people. There was a complaints process for people and their relatives to use. People’s communication needs were understood and met. Feedback was sought from people and relatives to help make continuous improvements to the home.

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

Rating at last inspection

At the last inspection, the service was rated Requires Improvement (report published 10 October 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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

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. If we receive any concerning information we may inspect sooner.

Sahara Parkside is a care home for up to 30 adults with learning disabilities, acquired brain injuries and autistic spectrum conditions. It is arranged as ten three-bedroom flats. At the time of our inspection, nine people were living there.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The home was larger than most domestic style properties. The home was situated in a residential area close to the town centre. There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home.

People’s experience of using this service

People received their medicines as prescribed. However, there were no effective systems in place for medicine temperature control in people's apartments. We made a recommendation in this area.

Most risk assessments were in place to ensure people received safe care. However, for people that may demonstrate behaviours that challenge, we found risk assessments were inconsistent and did not include robust de-escalation techniques. We made a recommendation in this area.

People’s apartments required work to ensure cleanliness and infection control was sustained.

Although regular audits were being carried out since the last inspection, audit processes needed to be more robust to continuously identify shortfalls and take action to minimise risk of re-occurrence.

Since the last inspection, we found improvements had been made in some areas. People had healthy food and appetisers in their apartments. People had choices with meals and were involved with menu planning. Care plans were person centred and included details of people’s support needs and preferences. Regular supervisions had been carried out and staff felt supported. Care plans had been reviewed regularly to ensure they were accurate. People had been included in key worker meetings and their goals and preferences were discussed. However, some recordings required details on what was discussed.

Pre-employment checks were carried out to ensure staff were suitable to care for people safely. Safeguarding procedures were in place and staff were aware of these procedures. Staffing levels were appropriate to support people safely.

Staff had completed essential training to perform their roles effectively. 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. People had access to a number of health services.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them. People were encouraged to be independent and to carry out tasks without support.

People participated in a number of activities both inside and outside the home. The management team and staff gave us a number of examples of how people had developed and progressed since the last inspection.

Systems were in place for quality monitoring to ensure people’s feedback was sought to improve the service. People and staff were positive about the management of the service.

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 home was requires improvement (published 18 September 2018). The home remains rated requires improvement. The home has been rated requires improvement for two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will speak with the provider prior to 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 any concerning information is received, we may inspect sooner.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home was last inspected on 6 and 7 November 2017 when it was found to be in breach of five health and social care regulations. These breaches related to risk assessments, medicines, staffing, training, access to healthcare, good governance and record keeping. The home was rated Inadequate overall and therefore this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the provider demonstrated to us that improvements have been made in the service and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found some areas that required further improvement and therefore the home has been rated ‘Requires Improvement’.

The home did not have a registered manager. The previous manager had left the home after our last inspection and a new manager was in the process of being recruited. The home was managed by external care consultants and two deputy managers with the support of the Chief Executive Officer. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Concerns we found at the last inspection with one particular person’s risk assessments had been addressed. Risk assessments for most people who lived in the home included information on how to mitigate identified risks. However, we found risk assessments for people that may demonstrate behaviours that challenged were inconsistent and did not include robust de-escalation techniques.

People received their prescribed medicines and Medicine Administration Records (MAR) evidenced that medicines were given on time. However, where people refused medicines that were to be taken as needed, known as PRN medicine, this was not recorded on their MAR. Medicines were not being administered as instructed by the pharmacist. Immediate action was taken to remedy this.

Care plans were inconsistent. We found care plans were personalised and included information on how to support people. However, assessments carried out on falls and skin integrity using a scoring methodology was incorrect.

Quality assurance systems were in place. Although the audits which the home carried out had identified and addressed most shortfalls, further work was required to ensure all issues were captured within people’s care plans and risk assessments. We made a recommendation in this area.

Staff we spoke with were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally. Pre-employment checks had been carried out for new staff to ensure they were suitable to provide care and support to people safely.

There were sufficient staffing levels to support people. Staff received regular breaks. Dependency assessments were carried out to calculate the number of staff needed according to people’s needs. Premises safety checks had been carried out to ensure the premises was safe.

Incident records were reviewed and these showed the provider took appropriate action following incidents that had been recorded. Systems were in place to analyse incidents for patterns and trends to ensure lessons were learnt and incidents were minimised.

Staff had received mandatory training to perform their roles effectively. Supervisions had not been carried out regularly and there were no records of annual appraisals of staff. The provider was in the process of taking action to ensure staff supervisions took place regularly. Staff told us that they were supported by the management team.

People had access to healthcare services. Systems were in place to ensure people received annual health checks.

People and staff told us that they had choices during meal times and had enough to eat. We found the kitchen in three apartments did not contain sufficient amount of food such as snacks and healthy appetisers. Food was kept in the main kitchen outside of people's apartments. This was being addressed by the management team.

Some people who lived at the home were deprived of their liberty under the Mental Capacity Act 2005. Records and staff told us the home complied with the conditions imposed on deprivation of liberty safeguard (DoLS) authorisations for two people.

Reviews with key workers were held monthly. Records showed that not all people’s goals were being monitored and assessed. This was currently being actioned by the management team. We made a recommendation in this area.

At our last inspection, we made a recommendation about supporting people with relationships. We found care plans contained information about friendships or other relationships or if people wished to be supported to form new relationships.

People’s privacy and dignity were respected by staff. People told us that staff were caring and they had positive relationships with staff.

People participated in regular activities and most people had a weekly activities plan. The activities people carried out were not always recorded accurately in daily records and weekly activity logs. We made a recommendation in this area.

We found complaints were being investigated and staff were aware of how to manage complaints.

Staff were positive about the management of the home and told us the home was well-led and it had improved since our last inspection. People and relatives were positive about the management team.

The home was last inspected on 12 and 13 April 2017 when it was found to be in breach of three regulations relating to training, need for consent and good governance. An action plan was submitted by the provider after the inspection that included how the breaches would be addressed. During this inspection we found the home continued to be in breach of these three regulations. In addition to the aforementioned breaches, the home was in breach of two more regulations. These breaches related to risk assessments, medicines, staffing, access to healthcare and record keeping.

We carried out this inspection due to the high number of safeguarding concerns we had received about the home.

The home did not have a registered manager. The previous registered manager had left the home in August 2017 and a new manager had been appointed and intended to apply to become registered with us. We were informed that the change of managers had an impact on the running of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Risk assessments for most people who lived in the home included information on how to mitigate identified risks. However, risks were not always robustly managed for one person to ensure they were safe at all times.

Medicines were not being managed safely. We found that people’s Medicine Administration Records (MAR) were not always completed in full or accurately. Medicines were not being administered as instructed on people’s MAR, or in accordance with the provider’s policy.

Staff we spoke to were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally. However, we were informed that some staff had not received refresher safeguarding training therefore may not be up to date with safeguarding procedures. We also found incidents with medicines that had not been recorded as an incident and relevant authorities had not been notified of this.

Incident records were reviewed and these showed the provider took appropriate action following incidents that had been recorded. However, systems were not in place to analyse incidents for patterns and trends to ensure lessons were learnt and incidents were minimised.

At our last inspection, we made a recommendation that the home seek and follow best practice guidance from a reputable source about staff deployment. During this inspection, people, relatives and staff continued to raise concerns with staffing levels. Records showed there were enough staff on duty to meet people’s needs. However, the way staff were deployed across the building meant there were sometimes delays for people who required support.

Not all staff had received core and specialist training they needed to do their jobs effectively. Supervisions had not been carried out regularly and there were no records of appraisals that had been carried out since 2016. Staff told us that they were supported by the manager.

People did not have access to all the healthcare services. Systems were not in place to ensure people received annual health checks.

People and staff told us that people had choices during meal times. We found the kitchen in two apartments did not contain sufficient amounts of food on both days of the inspection.

Some people who lived at the home were deprived of their liberty under the Mental Capacity Act 2005. Records showed the home continued to not always comply with the conditions imposed on deprivation of liberty safeguard (DoLS) authorisations for one person. Although the majority of recommendations of DoLS were complied with for the person, we found one condition had not been complied with.

Care plans were inconsistent. We found a care plan did not include information about the support people would require in relation to their current circumstances. Pre-assessment forms had been completed in full to assess people’s needs and their background. Reviews with key workers were held monthly.

People’s needs and choices were not being assessed effectively to achieve robust outcomes. Records showed that a person's goals were not being monitored and reviewed and one person's concerns had not always been followed up.

At our last inspection, we made a recommendation about supporting people with relationships. We found care plans still did not contain information about friendships or other relationships or if people wished to be supported to form new relationships.

Quality assurance systems were in place but were not always effective. The audits, which the service carried out, had not identified the widespread shortfalls we found during the inspection to ensure people were safe at all times. Accurate and complete records had not been kept to ensure people received high quality care and support.

At our last inspection, we recommended the home seeks and follows best practice guidance from a reputable source about recruitment practice. Improvements had been made in this area and pre-employment checks had been carried out for new staff to ensure they were suitable to provide care and support to people safely.

People’s privacy and dignity were respected by staff. People told us that staff were caring and they had positive relationships with staff.

At our last inspection, we recommended the home seeks and follows best practice guidance from a reputable source about resolving complaints. We found complaints were being investigated and staff were aware of how to manage complaints.

Staff told us the culture within the home had improved since the new manager had come in post. People, relatives and staff were positive about the manager.

We identified five breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this home is ‘Inadequate’ and the home is therefore in 'Special Measures'. The home will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the home, the home will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

The service was last inspected in February 2016 when it was found to be in breach of two regulations. The service had taken action to address the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and risk assessments and behaviour care plans were now more robust. However, the actions taken to address the breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had not been effective as the number of staff who had received the specialist training required to meet people’s needs remained low.

Sahara Parkside is a service for up to 30 adults with learning disabilities and autistic spectrum conditions. It is arranged as ten three-bedroom flats. At the time of our inspection 15 people were living there permanently and an additional six people used the service occasionally as a respite service.

The service did not have a registered manager. The previous registered manager had left the service in February 2017 and a new manager had been appointed and intended to apply to become registered with us. 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.

Care plans and risk assessments for people who lived in the home permanently contained a high level of detail and personalisation. This included details of peoples dietary preferences, health needs and care preferences. Care plans and goals were reviewed and updated on a monthly basis, although some people did not feel they were involved in this process. The quality of documentation and risk management for people who used the service on a respite basis varied. The provider produced a plan to address these variations during the inspections.

The service supported people to take their medicines. This was not always managed in a safe way and errors in the records were identified during the inspection which the provider took immediate action to address.

People and staff told us they did not think the service had enough staff. Records showed there were enough staff on duty to meet people’s needs, but the way staff were deployed across the building meant there were sometimes delays for people who wanted to receive support. We have made a recommendation about staff deployment.

The service had had a high turnover of staff and had completed recruitment of new support workers. The service completed checks on people’s identity and criminal records to ensure they were suitable to work in care. However, records showed the service did not consistently follow its recruitment policy regarding interview recording and references. We have made a recommendation about recruitment.

Staff were knowledgeable about safeguarding adults from avoidable harm and abuse. Records showed that concerns were appropriately escalated and investigated.

At the last inspection we found that records of care were not completed fully and made a recommendation about record keeping. The service had followed this recommendation and records of care were now clear and contained the information required.

People who lived at the home were deprived of their liberty under the Mental Capacity Act 2005. Records showed the service was not complying with the conditions imposed on people’s deprivation of liberty safeguard authorisations.

Feedback from people and their relatives about the quality of the relationships with the staff varied. Some people told us staff were kind and caring but others told us they did not find staff friendly or caring. Some people did not feel they were treated with respect. Records showed some staff did not understand the importance of respecting people’s preferences.

People and staff told us they did not always participate in activities as much as they wished to. Records showed that people were not supported to be involved in activities as detailed in their care plans.

Care plans contained information about people’s religious beliefs and cultural background. They also contained details about people’s family relationships. However, they did not contain information about friendships or other relationships or if people wished to be supported to form new relationships. We have made a recommendation about supporting people with relationships.

The service had a robust complaints policy. Records showed that complaints were investigated and responded to, however, it was not always clear what actions were in place to prevent future incidents.

Feedback from staff, people and relatives about the management of the service varied. Some people told us they found the management team open and approachable but others told us they found management unapproachable.

The service completed various quality assurance checks and audits. These were not always effective as a number of issues were identified during the inspection which had not been identified by the provider’s systems.

We found breaches of three regulations. You can see what action we told the provider to take at the back of the full version of this report.

The service is a registered care home for people with learning disabilities. The building is divided into 10 three bedroom flats. At the time of our inspection 13 people were living in the home.

The service was last inspected in June 2014 when it met the outcomes that were inspected.

The service did not have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The manager of the service had been in post for two weeks and had submitted an application to register with CQC.

Risk assessments and support plans relating to behaviour that challenged the service and health conditions lacked detail and did not provide staff with the information they needed to provide good support. We have made a recommendation about supporting people with complex health conditions.

Permanent staff received a thorough induction, but this was not the case for agency workers who were not always provided with all the information they needed to provide people with good support. Staff had not received the specialist training they required to meet people's needs.

The management of the service had changed and there were concerns that information had been lost in the transition. Although the new management team had plans in place to assess and improve the quality of the service, these were not in place. We have made a recommendation about quality assurance systems.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, records of consent and capacity assessments were not always clear. The management team were taking action to address this.

People and relatives told us they thought the service was safe. There were safeguarding policies and procedures and staff had received training regarding abuse and knew how to report any concerns.

The service had robust recruitment procedures in place which ensured staff in post were suitable to work in a care environment. There were sufficient staff on duty to meet people's needs.

People had support plans in place in relation to their nutritional needs. Where people followed specialist diets for religious reasons this was supported. People were supported to maintain a balanced diet.

People, their relatives and staff told us they had time to build up positive caring relationships.

People were involved in making day to day decisions about their care. People told us they could speak up easily in the home. Relatives told us it was easy to talk to staff at the home.

People's privacy and dignity was respected and promoted. People were supported to practice their religious beliefs.

The service had a robust complaints policy which was available in an accessible format for people who lived in the home. The service responded to complaints in line with the policy. People and relatives told us it was easy to raise concerns.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

During the inspection we spoke with five of the eleven people that used the service, two relatives of people that used the service and eight members of staff. This included the area manager, the manager of the home and six senior support workers or support workers.

This is a summary of what we found-

Is the service safe?

We found that the home had a safeguarding vulnerable adult's procedure in place and that staff had a good understanding of their roles and responsibility for reporting any allegations of abuse. Risk assessments were in place which included information about how to manage and reduce risks people faced. Clear guidelines were in place about supporting people who exhibited challenging behaviours. Arrangements were in place for the safe storage, administration and recording of medication. The service had robust staff recruitment procedures in place. These included seeking references and carrying out criminal records checks on prospective staff. People and relatives we spoke with told us they felt the home was safe. One relative told us 'I feel my sister is safe and happy with the place.'

Is the service effective?

We found that care plans and risk assessments were in place which set out how to meet people's assessed needs, for example in relation to communication and personal hygiene. Some people we spoke with were aware of their care plan, one told us "my folder is in my flat, I can look at it when I like." We found that there was enough staff on duty to meet people's assessed needs. Staff we spoke with said staffing levels were sufficient to enable them to carry out all their duties. Records showed people had access to health care professionals and people we spoke with confirmed this. One person said "they (opticians) come here to test my eyes" and they also told us the service arranged for them to see a doctor if they felt unwell.

Is the service caring?

People we spoke with told us that staff treated them with respect. We observed staff interacting with people in a polite and caring manner. We saw that when people wished to be on their own staff respected this which promoted people's privacy. Staff we spoke with told us how they promoted peoples dignity for example by encouraging people to be as independent as possible.

Is the service responsive?

We found that care plans had been signed by people or their relatives where appropriate to show people were happy with the content of their care plans. The service supported people to make choices for themselves. Where people lacked capacity to make choices we saw that mental capacity assessments had been carried out. If a person lacked capacity to make a decision we saw that a 'best interest' decision had been made on their behalf. This involved relevant persons including staff from the home, relatives and health and social care professionals.

Is the service well-led?

At the time of our inspection the service did not have a registered manager in place. A manager had been appointed to manage the home approximately one month prior to our inspection. They told us that they were in the process of applying for registration with the Care Quality Commission at the time of our inspection. The service had various quality assurance and monitoring systems in place including health and safety audits, surveys of relevant people and quality monitoring visits carried out by senior managers. We found that confidential records were stored securely and records we looked at were accurate and up to date. The service notified the Care Quality Commission of significant events as appropriate.

We spoke with four people using the service. They were all positive about the home. One person said they 'enjoyed' living there. Another person said, 'it's OK, yes it's alright. They are good.' People told us they had support from staff when they needed it and could choose what they wanted to do.

The provider assessed people's needs on admission. However, people's progress was not regularly reviewed and people's needs were not always being met. For example, some people had not received one-to-one support from a member of staff although they had been assessed as needing this. We also found that the home's procedures for recording and administering medicines were not being followed by staff. We could not be sure that people were taking their medicines as prescribed.

Some people using the service experienced profound learning disabilities affecting their capacity to consent to care. The provider had not documented people's consent and could not demonstrate that people's mental capacity had been formally assessed when appropriate.

We found that the staff were not always clear about safeguarding arrangements and when to raise an alert. Some of the home's procedures and checks, for example around managing people's money, did not adequately safeguard people from the risk of abuse.

The managers had identified a number of key risks and were taking action to address these. However the provider's systems to recruit staff and monitor the quality of care in the home were not robust and placed people using the service and staff at risk.

People who use the service and their relatives were satisfied with the care and support provided at the service. One family member said "staff know how to support him and he has settled down there." Another person told us staff were friendly and knew what they were doing. We found staff to be caring and supportive to people.

People who use the service and their families told us they were involved in making decisions around their care and support planning. We found that where people did not have the capacity to consent, the provider had not acted in accordance with appropriate guidance on consent.

We found that procedures were in place to protect people who use the service from abuse. People told us that they felt safe with the staff and they would raise any concerns with the staff or their relative or friend. The staff were aware of the signs and symptoms of abuse.

Staff told us that they received appropriate training and support from the management team.

We found that the recording of essential information was inconsistent and incomplete making it difficult to assess whether people were receiving the level of care that they required.