Archived: Chaseside Care Home

Chaseside Care Home is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

We found breaches of legal requirements in relation to the safe and proper management of medicines and the management of risk. We made a recommendation about ensuring staff recruitment records were complete. We found some shortfalls in relation to infection prevention and control. There were sufficient numbers of staff deployed to meet people’s needs. People felt safe and were protected against the risk of abuse.

We found breaches of legal requirements in relation to quality assurance and records. The provider’s systems to assess, monitor and improve the service had not identified the shortfalls highlighted in this report. We received good feedback about the culture of the service and the management team. We received mixed feedback from relatives about communication with the service during the pandemic.

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 23 September 2020).

Why we inspected

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 inspection was prompted due to concerns at the provider’s other location. We carried out this inspection to make sure people were safe.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

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 found the following examples of good practice.

¿ The provider implemented a very good protected visiting system. All visitors followed an external route and before entering they were temperature and symptom-checked. Staff obtained their contact details to enable effective track and tracing.

¿ The provider communicated well with relatives and posters displayed information about safe visiting. This included the supply and donning of personal protective equipment (PPE) and social distancing rules. Staff supported people throughout the pandemic to maintain their family relationships via computer and telephone technology.

¿ Staff and the management team demonstrated a very good understanding of effective procedures. Staff said they felt safe because they were given the knowledge and guidance to maintain their duties.

¿ The management team introduced a number of other procedures to strengthen their management and mitigation of risk. For example, staff were required to travel to and from the home in their own clothes and then change into a clean uniform on arrival.

¿ Staff confirmed they had sufficient stock and supply of PPE. People told us the management team explained the current situation and their response to mitigate risk. They said they observed staff consistently wearing equipment, which reassured them they were safe and comfortable.

¿ Staff and people had their temperatures checked daily and were tested in line with current practice. The provider implemented enhanced risk and infection control policies and procedures. This included isolation and, if necessary, managing an outbreak. The provider followed national guidance on the safe admission of people to Chaseside.

¿ The environment was very clean, tidy and bright. Enhanced cleaning schedules included the use of antiviral disinfectant. People commented they found the home was frequently cleaned and they lived in a safe environment. Hand hygiene and washing facilities were spread throughout the home, along with information about effective handwashing methods.

¿ Posters were displayed throughout the home to guide staff. The manager set up a new file containing checks and tests results, quality oversight audits and the latest guidance to familiarise staff. The workforce received enhanced infection control and PPE training. It was clear when we discussed this with them, they had a good understanding and felt well-supported by the manager and provider.

Further information is in the detailed findings below.

Consequently, we undertook a comprehensive inspection to review these concerns. We did this because there were multiple areas raised in relation to the five key questions we look at – is the service safe, effective, caring, responsive and well led?

Chaseside provides personal care and support for a maximum of 22 older people who may be living with dementia. The home is situated in a residential area of Lytham St Annes close to the local park and the promenade. There are two double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of two lounges, a separate dining room and an area designated as the ‘sensory room.’

A registered manager was not in place. 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.

At the last inspection on 02 and 03 February 2017, we rated the service as Requires Improvement. This was because the home was in the process of making ongoing improvements, which required time to embed in service management, care delivery, staff understanding and Chaseside’s environment.

We additionally made recommendations for the provider to further improve people’s safety and welfare. These concerned systems to enhance recordkeeping associated with medication and infection control.

During this inspection, people we spoke with told us they felt comfortable living at Chaseside. One person said, “I feel safe.” Staff received medicines training and competency testing to demonstrate they were safe to administer medication. The provider developed with each person an individual medication care plan and risk assessment to guide staff to manage their medicines safely.

We received positive comments from people about the cleanliness of the environment. The provider had assigned a staff member the role of ‘infection control champion’ who was responsible for disseminating good practice at Chaseside.

The provider had systems to assess, monitor and alleviate potential risks to people who lived at the home. Staff demonstrated a good awareness of safeguarding and reporting procedures. They received training to underpin their skills and understanding.

We reviewed rotas and found staffing levels and skill mixes were sufficient to meet people’s support requirements. We checked staff records and noted employees received, or were in the process of completing, training. The provider had reviewed each applicant’s full employment history, qualifications and abilities to work at the home before they were recruited.

We observed staff were knowledgeable and effective in supporting people who lived with dementia or displayed behaviours that challenged the service. This helped to identify triggers and methods of supporting people that had a positive impact on them and everyone else at the home.

Records we looked at confirmed all staff who prepared food completed food safety and hygiene training. People commented they enjoyed their meals and were encouraged to have them where they chose.

We found staff followed the Mental Capacity Act 2005 because where people were deprived of their liberty to safeguard them correct records were in place. We observed people were able to move about the home without restriction. Care records contained evidence of consent to care.

We observed people who lived at the home were clean, smart and well dressed. Assessments and care records were developed with the person and relatives at the forefront of their support. Everyone we spoke with commented staff had a caring, kind and patient attitude.

All documentation we reviewed was personalised and kept updated to guide staff to people’s changing requirements. Those who lived at Chaseside told us they were fully occupied whilst living there. We found the provider was implementing a number of new methods to improve their lives.

The provider was working very closely with local authorities as part of their improvement requirements following recent complaints. They had introduced new systems and procedures to enhance the management of people’s concerns.

We found the provider had developed its quality assurance systems and introduced a variety of new audits. Where they identified issues, the staff and provider acted to improve the quality of people’s care. Additionally, people were supported to give feedback about their experiences of living at Chaseside.

Chaseside provides personal care and support for a maximum of 22 older people who may be living with dementia. At the time of our inspection there were 13 people living at the home. Chaseside is situated in a residential area of Lytham St Annes close to the local park and the promenade. There are two double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of two lounges, a separate dining room and an area designated as the ‘sensory room.’

At the last inspection on 29 June 2016, we rated the service as Inadequate and placed it in ‘Special Measures.’ This was because breaches of legal requirements were found. The provider failed to ensure care was planned around people’s personal needs and wishes, in ways that promoted their dignity and privacy. We saw legal consent to care and treatment was not always obtained from each person or their representative. People were not always protected from the risk of being unlawfully deprived of their liberty. The provider failed to safeguard each person’s health and safety by not consistently assessing risks and planning support to mitigate them. They had not ensured staff had the skills to care for individuals in a safe manner. Additionally, staff were not properly recruited to protect them against unsuitable employees.

We additionally made a recommendation for the provider to care plan people's individual preferences in relation to activities. This included information about the support they required to engage in them.

During this inspection, we found the provider had made a number of improvements following our last inspection. Training records we looked at confirmed staff had completed training related to safeguarding principles. When we checked their understanding of protecting people from potential abuse or poor practice, we found they had a good level of awareness. The provider was implementing new risk assessments and related procedures to protect people from an unsafe environment and inappropriate care. In the meantime, we saw current records had been updated and reviewed. People told us they felt safe whilst living at the home. One person said, “Yes, I keep myself safe, but the staff are there to help.”

We looked at rotas from the previous four weeks and saw levels and skill mixes of staff were sufficient. Ancillary personnel enabled care staff to focus on their own roles and responsibilities. We reviewed staff files and found they consistently held the required information to protect people from the recruitment of unsuitable employees. Staff, including new personnel, had training and supervision, underpinned by competency checks, to support them in their responsibilities.

The home was clean and tidy throughout. However, we identified a strong, unpleasant odour within the ground floor hall and attached communal areas throughout our inspection. We saw further issues with the staff toilet, the lack of bin lids and kitchen cleaning recordkeeping. We discussed this with the provider, who assured us they would address the issues as a priority.

We have made a recommendation the provider seeks guidance about safe practice and recordkeeping in relation to infection control.

People we spoke with said they received their medicines on time and when required. We saw staff were trained to administer medication and had regular competency testing to check they were safe practitioners. However, we noted handwritten entries were not consistently countersigned to evidence accuracy and there were gaps in related monitoring charts. The provider told us they address these issues as a matter of urgency.

We have made a recommendation about the provider seeking guidance related to medicines recordkeeping.

The provider had improved how they obtained consent to care and worked within the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had training to develop their awareness and we saw they did not take control, but worked hard to support people to make decisions. People told us they felt there were no unnecessary restrictions whilst they lived at Chaseside. One person said, “I like a bit of freedom and I’ve got that now, so I’m happy.”

People and their representatives told us staff offered choice at mealtimes and they enjoyed the food. One person said, “I eat everything put in front of me and there’s more than enough.” We saw documentation was in place and up-to-date to monitor people against the risk of malnutrition.

Staff were kind, respectful and patient when they assisted people. One staff member told us, “A resident said the other day, ‘I love you,’ after I had helped her. It made me cry.” Throughout our inspection, we found their approach helped individuals to maintain their dignity. A relative said, “I find them very respectful and welcoming.” People and their representatives worked together with staff to help them understand their needs and preferences.

We found the provider had protected people from potential failed placements because they had been assessed before their admission. Records were detailed and guided staff about how best to respond to each person’s individualised needs. Furthermore, care planning covered people’s requirements in relation to social activities. A programme of events offered those who lived at the home social stimulation.

The local authority told us the provider was working closely with them as part of their improvement requirements. They confirmed the management team had developed stronger management of the home. Staff added they had opportunities to raise any issues or ideas to improve Chaseside. They felt a part of the changes and witnessed the positive results of the home’s ongoing improvements.

We observed the provider promoted a calm atmosphere and was visible around the home. We saw evidence they worked with and acted upon suggestions from people and their relatives to improve the quality of their care.

They provider had introduced suitable arrangements to monitor people’s safety and their wellbeing. For example, they completed a variety of new audits, which assessed the level of any concern, action required and action taken.

Chaseside Care Home is located in Lytham St. Annes, Lancashire. The home is registered to provide accommodation and care for up to 22 older people. The majority of people accommodated are living with dementia. At the time of our inspection there were 12 people who used the service.

At the time of this inspection there was no registered manager in place at the service. The previous registered manager left the service in November 2015. Since this date the provider had taken control of the day to day running of the home but had not applied to the Commission for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection of this service took place on 18 November 2015. At this time the service was found to be in breach of regulations relating to good governance and person centred care and was awarded a rating of ‘Requires Improvement.’

During this inspection we had ongoing concerns relating to the previous breaches. We also identified further breaches of regulations.

Risks to the health, safety and wellbeing of people who used the service were not always assessed or managed in an effective way. Some examples were found of risk assessments not being completed and other examples were found of risk assessments which did not contain current or accurate information. Where risks were identified, these were not always addressed through robust care planning.

We found that suitable arrangements were not in place to ensure that all staff had the necessary skills and knowledge to meet people’s needs safely.

There were significant shortfalls in the service’s recruitment procedures. We found several examples of staff being recruited and allowed to work shifts in the home without the appropriate background checks being carried out. This meant the safety and wellbeing of people who used the service was not protected.

The rights of people who were not able to consent to their care were not consistently protected as the service did not always work in accordance with the Mental Capacity Act and associated legislation.

People’s privacy and dignity was not consistently promoted due to inadequate arrangements to protect their personal information.

The arrangements for monitoring the safety and quality of the service were found to be in ineffective. Audits viewed had not identified some significant shortfalls and had failed to assist in identifying areas for improvement.

Evidence showed that potential learning from adverse incidents was not always identified or acted upon.

When viewing rotas it was not always clear who was in charge at the home on particular dates. Rotas were not always properly completed to reflect this information.

We requested the provider’s training records during and after the inspection to enable them to demonstrate their competence to carry out the role of registered manager. However, these were not provided.

Complaints were not always properly recorded. We did however, find evidence that the provider took action to resolve concerns raised.

Procedures for managing people’s medicines were found to be generally satisfactory. Although some minor shortfalls in records were identified.

People we talked with spoke highly of staff and felt they were treated in a kind and caring manner. People expressed satisfaction with the standard of accommodation and the quality and variety of meals provided.

The provider and staff worked in partnership with community professionals to help ensure people’s health care needs were met.

Meetings for people who used the service were held on a periodic basis. The provider attempted to gain people’s views through processes such as satisfaction surveys.

During this inspection we found evidence of ongoing breaches of regulations in relation to governance and person centred care. We also found evidence of new breaches of regulations relating to consent, dignity and respect, safe care and treatment, safeguarding, staffing and recruitment.

Following this inspection the overall rating for this service is ‘Inadequate’ and the service has been placed 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, 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.

You can see what action we have taken at the end of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, two relatives, the staff supporting them and from looking at records. We also spoke with two community professionals and the local authority commissioning team.

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

Is the service safe?

The registered manager had improved processes for identifying risk to people who used the service in areas such as falling or developing pressure ulcers. Risk assessments were now an integral part of each person's care plan and where risk was identified, there was a clear management plan in place to provide them with safe support.

Recruitment processes were significantly improved and there was evidence that all new staff members were required to undergo a variety of background checks prior to being offered employment. This meant that people were better protected from the risk of receiving their care from a person of unsuitable character.

There were improved processes for the monitoring and analysis of incidents and accidents. This meant the registered manager was able to identify any themes or patterns and take prompt action to address them.

Some improvements were found in the management of medicines, but we found evidence that medicines were still not always managed safely.

Safeguarding procedures had been reviewed and further training had been arranged to help ensure all staff were fully aware that any safeguarding concerns must be reported without delay. Further improvements to the risk assessment and care planning for people with complex behaviours would safeguard them and those around them more effectively.

Is the service effective?

People's health care needs and the support they required in this area was well detailed in their care plan. Care records demonstrated that the registered manager and care workers identified changes in people's health care needs and took prompt action to ensure health care support was provided when necessary.

A process for the induction of new staff was in place. This helped ensure that new starters received the necessary support and guidance to carry out their roles effectively.

A full training audit had been completed by the registered manager and the core training programme for staff had been improved. Arrangements had been made to ensure all staff were provided with training in accordance with the core programme. In addition, all staff employed at the home had been enrolled on national vocational training.

Is the service caring?

We spoke with four people who used the service and two relatives. The feedback we received was very positive. One person commented, 'We could not have asked for better people to look after Mum' and told us they 'couldn't have been happier with the care provided.'

Another person we spoke with told us they were very happy with all aspects of the care their loved one received. They told us they visited the home on a daily basis and saw everything that happened. They said, 'They are not just lovely with (name removed), they are the same with everyone ' they are so nice with the residents.' She went on to say she felt she also received a good level of support from the registered manager and staff. 'I am always welcome. They invite me for meals and help me with transport as well. Those little things make a really big difference.'

We spoke with a person who used the service who was supervising the setting up of the dining room for lunch. She told us she did this task every day and was clearly enjoying it. She said of the staff, 'We have a right laugh here. They are good people. I get on with them all.'

Other comments we received from people who used the service included: 'It's nice here. In fact it's not nice ' it's very nice.' 'We have no problems here. You can give them the seal of approval.'

Is the service responsive?

We spoke with one person who described their experience when their loved one had started to use the service. They told us the registered manager had taken time to understand their relative's needs and that a detailed care plan had been put in place that reflected their needs. They said they had found the process very reassuring.

We found the standard of people's care plans was improved. Information about their needs, wishes and preferences was included in a clearer way, so staff had some understanding of how people wanted their care to be provided.

We found evidence that the provider and registered manager had sought the views of people who used the service and their relatives, and acted on them. Arrangements were in place to hold regular meetings with people and a number of changes had been made as a result of feedback they had given.

Is the service well led?

There was a new registered manager in place. The registered manager was fully aware of previous concerns identified about the service and was able to provide evidence of action taken to address them, as well as plans for further improvement.

The provider of the service now worked in the home on a daily basis, maintaining contact with people who used the service, their relatives and staff and ensuring the registered manager received sufficient support.

Formal systems to assess the quality and safety of the service were now in place and included regular monitoring of all aspects of the service provided. We also found evidence that the registered manager took appropriate action when any areas for improvement were identified.

We spoke with two community professionals who felt the service had improved significantly and who were satisfied with the service provided.

During this inspection we were assisted by the newly appointed manager who was going through the process of registration with the Commission. The manager was aware of the concerns and with the provider's support, had taken a number of steps to address them.

The manager was able to give us a number of examples of significant improvements and also described improved quality monitoring processes, which would help ensure the improvements were maintained.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported 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?

Staff were not always fully aware of people's care needs or risks to their health and wellbeing.

Risks to individual people's safety were not always assessed thoroughly or well managed. Staff did not always follow individual care plan guidance, which meant people were at unnecessary risk.

People were not protected against the risks associated with the use and management of medicines.

People did not receive their medicines at the times they needed them or in a safe way. Medicines were not stored, administered and recorded properly.

Recruitment procedures were ineffective, which meant people were at risk of receiving their care from staff who did not have the correct skills or were not of suitable character.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to identifying risk, managing medicines, and recruiting staff.

We are working together with other agencies including the local authority, to ensure the safety and wellbeing of people who use the service is safeguarded.

Is the service effective?

Care plans were in place for all residents, which covered their assessed needs but staff were not always fully aware of the information within them.

Staff did not always follow individual risk assessment guidance, which meant residents were at risk of not receiving safe or effective care.

The induction, training and supervision of staff was not always carried out effectively to ensure care workers had the skills to carry out their roles effectively.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the provision of safe and effective care for people who use the service.

Is the service caring?

People we spoke with generally felt that care workers treated them with kindness and respect. Throughout our visit we observed care workers supporting people in a patient and caring manner. Staff were seen to respond to people's requests for assistance in a timely manner.

People's care plans contained information about their personal wishes and preferred daily routines. This helped staff to support them in a personalised manner.

The feedback we received about standards of care from staff at the service was variable. Some staff felt that standards of care could be improved because some workers did not have the correct skills or attitude to carry out their roles.

Is the service responsive?

People that used the service, who we spoke with told us they felt able to raise concerns with staff and the manager of the home. One person described how the manager of the home had responded to their changing needs by involving community professionals in their care, which they were very pleased with.

We saw some examples of effective joint working with community health care professionals to help ensure that people received safe and effective care. However, we also found an example of advice from a mental health specialist not being followed.

We found some examples of adverse incidents and complaints not being responded to effectively. For example, audits demonstrated that the manager had identified a number of errors in relation to the recording and administration of people's medicines. However, these had not been addressed.

We also found two complaints, which had not been responded to appropriately. One complaint was from a staff member and the other was from the relative of a person who used the service. This meant that opportunities to improve the service had been missed and the complainants had not had their concerns properly investigated.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to responding to risk and learning from incidents and events that affect people's safety.

Is the service well led?

We identified a number of concerns during the inspection. Some of our concerns had been previously identified by the manager but no action had been taken to address them.

No formal quality assurance process was being carried out by the provider of the home. We were advised that management meetings did not take place.

Concerns raised by people had not been properly investigated, which meant they had not received an appropriate response. It also meant that opportunities to improve the safety and quality of the service had been missed.

The home was busy with various activities going on. A visiting musician was entertaining some residents whilst others had a walk to the park. Residents were seen moving around the home freely, some choosing to sit out in the sun. There were a variety of visitors throughout the day.

We noted that staff supported people in a kind, respectful manner. Staff were seen to attend to residents' requests promptly and in a pleasant way. The interaction between the staff and residents was very positive with lots of friendly discussion and joking.

We spoke with residents and in some cases, their relatives. In general, the feedback we received was very positive and most people expressed satisfaction with their care and spoke highly of staff.

One person commented, 'This is a place where the staff and managers really do care about the residents. I think the standard of care is brilliant.' A resident told us about the recent refurbishment that had taken place. He said he had felt involved throughout. 'It was marvellous. They came to me and asked me where I wanted my shelves and plug sockets. It was all done to my request!'

Other comments included:

'I have always been very happy here. The care is very good.'

'We have been more than satisfied with the whole package! No complaints whatsoever.'

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, staff and from looking at records.

We asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

Staff knew what care people needed to keep safe and understood the risks to individual resident's safety and wellbeing. Staff knew what measures they needed to take to protect people from harm.

Where people's rights were restricted in their best interests, the manager had gained the appropriate authorisation and worked in accordance with the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff had clear guidance about supporting people with complex behavioural needs and had received training in areas such as de-escalation and physical intervention.

Staff were aware of their duty to report any suspected abuse or poor practice and felt confident to do so. Staff had received training in recognising abuse.

Staffing levels were adequate to safely meet the needs of people who used the service. People received their care from a consistent staff team who they were familiar with.

Staff were trained in important health and safety areas such as fire safety, infection control and moving and handling.

The manager and staff learned from events such as accidents, complaints and safeguarding investigations. However, records did not always reflect this. Records of audits, and the monitoring and analysis of adverse incidents would help ensure risks to people were quickly recognised and addressed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service effective?

People we spoke with expressed satisfaction with their care and felt their needs were well met.

Residents appeared content in their surroundings and got along well with staff.

We saw some residents had experienced good outcomes due to the care they had received. For example, improvement in mental and physical health since their admission to the home.

People were supported to access support from community professionals such as District Nurses and GPs. The home had systems in place to ensure that any advice given by external professionals was incorporated in people's care plans.

There were ample numbers of staff on duty to provide effective care and respond to people's individual requests.

Staff had training in a number of areas to help them provide safe and effective care.

People's care plans and risk assessment information did not always reflect all of their needs or was not fully up to date. This meant that people could be at risk of not receiving the right care. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service caring?

People we talked with spoke very highly of staff describing them in ways such as 'kind', 'caring' and 'helpful.'

We observed people receiving support and saw that this was provided in a pleasant and respectful manner. Staff addressed residents with kindness and patience. Staff responded to resident's requests straight away and appeared happy to do so.

People's privacy and dignity was respected and promoted by the manner in which staff supported them.

The manager had introduced a new care planning tool called 'This is me.' This helped carers to understand the things that really mattered to people and made a difference to their daily lives. For example, their preferred daily routines, hobbies and important relationships.

Is the service responsive?

We saw that feedback from residents and their families was encouraged. The manager was able to give us examples of changes that had been made as a result of people's feedback.

People that we spoke with told us they were able to raise concerns and felt that the manager was approachable. One person we talked with had recently had cause to raise a concern, which she felt had been responded to appropriately.

We saw examples of improvements made within the service as a result of feedback from other professionals. For example, the home had implemented a detailed improvement plan as a result of a recent local authority quality inspection.

There was evidence that changes in people's care needs were identified by staff and responded to appropriately. For example, we looked at the care plan of one person whose general health had deteriorated. We saw that staff had been quick to seek medical advice and adapt the resident's care plan in line with their new needs.

We were able to confirm that staffing levels were developed in line with the needs of residents. There were processes in place to ensure that additional staff could be brought onto duty if any residents required additional care.

The manager and staff learned from events such as accidents, complaints and safeguarding investigations. However, records did not always reflect this. Records of audits, and the monitoring and analysis of adverse incidents would help ensure people received an effective service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service well led?

People told us the manager and provider were approachable and supportive.

The manager maintained a strong and regular presence in the home and was constantly available to residents, relatives and staff.

The manager listened to feedback from people who used the service and other professionals and took action in response to it.

Staff had good understanding of their roles and duties. Staff understood how to raise concerns and felt confident in their manager to deal with concerns appropriately.

There was a quality assurance system in place, which included the use of audits and the monitoring of adverse incidents and complaints. However, these were not always well recorded. Records of audits, and the monitoring and analysis of adverse incidents would help ensure any shortfalls in the quality of the service were quickly recognised and addressed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us the staff prompted them when they needed to take their medicines and they were always given their medicines on time. We found there were arrangements in place to manage medicines safely. People were cared for by staff that had been through the appropriate recruitment checks.

The people we spoke with told us they had no concerns about the care they received and they would speak to the registered manager if they had any concerns. We found that there was an effective complaints system available, in case anyone wished to raise a complaint.

A more in-depth discussion took place with the third person who confirmed he was encouraged to made positive decisions for himself on a day to day basis. This person told us, 'I feel very content here, almost too content. They all support me very well. I am very well looked after. They cater for all people here really well, they care for people. I feel safe here'

We observed that people were comfortable and relaxed in their surroundings. It was also clear that there was a positive relationship between the staff team and the people they supported.

In order to try to understand what it was like for people living at the home we also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed that people who used the service were supported to remain as independent as possible. We also saw that people were consistently treated with dignity and respect. For example, we saw staff offer assistance with personal care needs in a discreet and dignified manner and called the person by the name they preferred.