Our current view of the service
Updated
21 May 2025
Date of inspection 5 June 2025 to 2 July 2025. The service is a nursing home providing care and support to older people, including people with dementia. At the time of this inspection 33 people were living at the service.
The inspection was carried out in response to safety concerns received about the service. We found 4 breaches of regulations relating to safe care and treatment, staffing, consent and governance.
Risks to people were identified but not always mitigated. The service was not working to the principles of the Mental Capacity Act 2005 which failed to safeguard people. Sufficient staff were not provided to meet people’s needs and promote their safety, well-being and independence. Records were contradictory, incomplete and terminology used was not always in line with best practice.
Staff were suitably recruited, and systems were in place to increase the supervision and monitoring of staff. Staff felt suitably trained and had their competencies assessed for tasks they were involved with. Safe medicine practices were promoted with safe systems in place to safeguard people.
Governance systems were being developed, and they had started to identify shortfalls in the service.
The provider and manager were proactive in response to our feedback, and they took immediate actions to address the findings, to safeguard people.
We have asked the provider for an action plan in response to the findings and to enable us to monitor progress within the service.
People's experience of the service
Updated
21 May 2025
We received mixed feedback from people and their relatives about their experience of care. People told us they felt safe and gave examples of how this was promoted. For example, the building was secure, and people had access to moving and handling equipment, call bells and sensor mats.
People and relatives told us the staffing levels were not sufficient, and this impacted on the quality of care they received. They told us their care was rushed, there was a delay in getting the required support with personal care, medicines and in being supervised and supported to go to the communal areas of the service. This impacted on people’s health and well-being.
Whilst people and their relatives told us communication and engagement with them had improved, there was dissatisfaction around the lack of consultation and choice on the recent enforced bedroom moves. Some people and relatives told us the bedroom moves had a detrimental effect on their independence and had led to an increase in isolation for others.
People and their relatives mainly described staff as kind and caring. They had confidence that staff were suitably trained. They informed us there was a lack of variety of activities and no community activities taking place. The provider had recently appointed a second activity co- ordinator which it was hoped would enable them to increase the range of activities on offer to people.
People and relatives gave mixed feedback on the provider and manager changes. Some people felt the provider and manager had started to make a difference and they were more involved in their care. Others told us that issues were not always handled to their satisfaction, there had been a high turnover of staff and this impacted continuity of care for people.