Abbeyfield House - Alnwick

Abbeyfield House – Alnwick is a residential care home providing accommodation and personal care for up to 25 people, some of whom are living with a dementia related condition. At the time of our inspection there were 24 people living at the home.

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

Medicines were not always managed safely. Records for ‘as and when required’ medicines were not always in place. Other aspects of medicines were managed safely. Improvements had been made in the management of topical medicines.

People and their relatives were subject to restrictions on visiting which is contrary to current government guidance. There was no consultation with people about visiting restrictions.

Quality assurance checks were taking place, lessons had been learnt in a number of areas. However, checks had failed to identify issues relating to medicine records.

There had been a history of non-compliance with the regulations. The provider had been in breach of the regulations at 7 of their 8 inspections since 2015.

People were safe from the risk of abuse. Risks to people were assessed and regularly reviewed when people's needs changed. The building was well maintained, and health and safety risks were assessed.

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.

There was a positive and happy culture. People felt they received good quality care.

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 22 July 22). This service has been rated requires improvement for the last two consecutive inspections.

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 some improvements had been made and the provider was no longer in breach of regulations in relation to topical medicines, duty of candour and risk assessments. However, at this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that safeguarding procedures were reviewed. At this inspection we found that improvements were still required.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement

We have identified breaches in relation to visiting restrictions and medicines record management.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

Abbeyfield House – Alnwick is a residential care home providing accommodation and personal care for up to 25 people some of whom are living with a dementia related condition. At the time of our inspection there were 22 people living at the home.

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

A system to manage accidents and incidents was in place. However, records did not always evidence that people’s risk assessments were reviewed after every incident to help identify if the risk assessment remained relevant or whether any actions were needed to mitigate future risk.

Records relating to prescribed topical medicines/creams and ointments did not always document that these were administered as prescribed. The registered manager explained there had been stock issues with their pharmacy. They also stated they had made topical medicines administration records more visible by placing them on a clip board in people’s rooms to help promote staff completion.

Records were not fully available to demonstrate how the provider was meeting their responsibilities under the duty of candour.

There had been a history of non-compliance with the regulations. The provider had been in breach of the regulations at six of the seven inspections since 2015.

A safeguarding system was in place. We spoke with the registered manager about ensuring the correct agencies were involved and notified regarding one safeguarding allegation. We have made a recommendation about this. People told us they felt safe. One person told us, “I've been here two years and I've never had anyone be nasty to me.”

People and relatives spoke positively about the staff and the care provided. Comments included, “They love her and she really loves them” and “The staff are amazing - really lovely.” Staff enjoyed working at the home and there was a positive atmosphere. One staff member said, “It’s a happier place now.” This was confirmed by relatives. One relative stated, “There’s a very friendly atmosphere - not clinical, very friendly and the staff are approachable.”

There were sufficient staff deployed to meet people’s needs. One person told us, “There’s a lot of staff to look after me.” Safe recruitment procedures were followed.

Improvements had been made in relation to infection control since our last inspection. Staff now followed government guidance relating to infection control and the safe use of PPE. One person told us, “They are always good with wearing their masks.” Relatives told us they could visit when they wished and raised no concerns about any restrictions.

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 15 June 2021). There were breaches of regulation in relation to safe care and treatment and good governance regarding infection control. We issued a warning notice and told the provider they needed to improve. At this inspection, whilst the provider had met the requirements of the warning notice and improvements had been made in relation to infection control; shortfalls were identified regarding the maintenance of records and the provider remained in breach of the regulation relating to good governance.

Why we inspected

We undertook this focused inspection to check they had met the requirements of the warning notice, followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions, safe and well-led, which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. Please see the safe and well-led sections of this report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified one continuing breach of Regulation 17 (Good governance). 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 and meet with the registered manager and provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbeyfield House – Alnwick provides personal care and accommodation for up to 25 people. Accommodation was provided on one level. There were 23 people living at the home at the time of the inspection, some of whom had a dementia related condition.

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

Risks relating to IPC had not been fully assessed, monitored and managed. Government guidance relating to safe working practices regarding infection control, including the use of PPE was not always followed by staff.

Checks to monitor the quality and safety of the service were carried out. However, an effective system to assess and monitor infection control was not fully in place.

People’s needs were met by the number of staff on duty. Medicines were managed safely.

Staff spoke positively about working at the home and the people thy supported. They explained they had worked as a team to help promote people’s wellbeing throughout the pandemic. People were actively engaged in a range of activities throughout the day. The provider was facilitating visits for people living in 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

The last rating for this service was Good (published 14 October 2019).

Why we inspected

We undertook this targeted inspection to look at infection control processes at the home. 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 coronavirus and other infection outbreaks effectively.

When we inspected, we found there was a concern with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to 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 on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so

We have identified breaches relating to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will 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.

Abbeyfield House – Alnwick provides personal care and accommodation for up to 25 people. Accommodation was provided on one level. There were 22 people living at the home at the time of the inspection, some of whom had a dementia related condition.

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

At our previous inspection, some people told us that improvements were required with the attitude and manner of certain staff to ensure they demonstrated high quality compassionate care. At this inspection, action had been taken to improve and people spoke positively about the caring nature of staff.

There were systems in place to protect people from the risk of abuse. People told us they felt safe. Staff were knowledgeable about the action they would take if abuse were suspected. No safeguarding concerns were raised. There were enough staff deployed to meet people’s needs. Safe recruitment procedures were followed.

Medicines management had improved since our last inspection. Risks were assessed and monitored. There was an ongoing refurbishment plan in place. New flooring was being laid at the time of our inspection. The design and décor of the home met people’s needs.

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 a choice and access to sufficient food and drink. A person-centred approach was followed at meal times. There was an emphasis on home baking and people spoke positively about the meals. People were supported to access a range of healthcare professionals to ensure they remained healthy.

People were treated with kindness and staff respected people’s differences. Care plans now contained information about people’s life histories and their likes and dislikes to help staff deliver person-centred care.

People’s social needs were met. Staff recognised the importance that animals had on people’s wellbeing. The provider had adopted a rescue dog called Flash who had come to live at the home.

A complaints procedure was in place. Surveys and meetings were carried out to obtain feedback from people, relatives and staff.

The atmosphere within the home had improved. The culture was open, person-centred and positive. People spoke positively about living there. One person told us, “It’s very good - the best home in Alnwick.” A range of audits and checks were carried out to monitor the quality and safety of the service. Action was taken if any issues or concerns were identified.

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 13 September 2018). We identified a breach of the regulation relating to good governance. 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 this regulation.

Why we inspected

This was a planned inspection based on our inspection programme.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced comprehensive inspection of Abbeyfield House – Alnwick in December 2017. We identified two breaches of the regulations relating to dignity and respect and good governance. We rated the key question ‘is the service well-led?’ inadequate and rated the service as requires improvement overall.

Following the inspection, we met with the registered manager and nominated individual to discuss our concerns, improvements needed and support that may be available. The provider also sent us an action plan stating what action they were going to take to improve.

We carried out a comprehensive inspection on 19 and 24 July and 3 August 2018 to check that they had followed their plan and to confirm that they met legal requirements.

At this inspection we found that improvements had been made, however, further action was required.

The provider was a charitable organisation. A committee of volunteers oversaw the home. A registered manager was in post. 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 deputy manager had stepped down from their post. As a result, there was no deputy manager in place at the time of the inspection. Following our visits to the home, the registered manager told us that a new deputy manager had been appointed.

There were safeguarding procedures in place. The local authority safeguarding team were working with the home following the concerns that were raised at our last inspection. A safeguarding meeting had been held and an action plan formulated which the home were working towards. The provider had commissioned an external human resources consultant to speak with staff and write a report detailing any recommendations that needed to be made. The consultant was speaking with staff at the time of our inspection and was in the process of writing their report.

We received mixed feedback about the caring nature of staff. People and most staff told us there had been an improvement in staff attitude but further changes were still needed with regards to the attitude of a certain few. We observed positive interactions between staff and people. Staff promoted people’s dignity and ensured they promoted people’s privacy and dignity during moving and handling procedures.

Some people, staff and relatives told us that more staff would be appreciated. Staff were more visible than at our last inspection. We observed however, that there was a lack of interaction at certain times of the day especially in the afternoon. We have recommended that staff deployment is kept under review due to the mixed feedback we received.

We identified issues with the maintenance of records. There were shortfalls in the recording of certain medicines. Care plans for two people who were staying at the home for respite care had not been fully completed and some of the assessment tools we viewed were outdated.

There was limited information about people’s personal histories and backgrounds in the care files we viewed. This information can help staff provide care and support that respects the individual’s wishes, needs and preferences. We have made a recommendation about this. The registered manager told us that she was visiting another Abbeyfield care home to view their care documentation.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found omissions in the maintenance of records relating to the Mental Capacity Act 2005. The registered manager was addressing this issue.

The service was clean and there were no malodours. Checks and tests had been carried out on equipment to ensure this was safe. Temperatures within the home were monitored and were within acceptable and comfortable limits. We found that not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. We have made a recommendation about this.

Most people told us they were satisfied with the meals at the home. We observed the lunchtime experience. Staff sat and ate with people at lunch time to make the meal a more social experience.

Staff worked with various agencies and accessed other services when people's needs had changed, for example, consultants, GPs, dietitians, the chiropodist and dentist.

An activities coordinator was employed. There was a varied activities programme in place. People told us there was enough going on to occupy their attention. There was a complaints procedure in place. No complaints had been received.

There was a quality monitoring system in place. However, this had not always identified the issues which we had found with the maintenance of records relating to medicines, the MCA and care records. In addition, further improvements were required to ensure that all staff demonstrated high quality compassionate care.

The omissions and shortfalls we identified did not appear to have a major impact upon people themselves. People and relatives told us they were happy with the service. One person told us, “It’s the best here in Alnwick.”

We found one continuing breach of the Health and Social Care Act 2008. This related to good governance.

Due to the continuing breach of the regulation relating to good governance and the continued rating of requires improvement; we have organised a meeting with the registered manager and provider to discuss our concerns and the improvements required for this service to become compliant with the regulations.

Abbeyfield House – Alnwick is a ‘care home’. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 25 people. There were 24 people living at the home at the time of the inspection.

A registered manager was in post. 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 provider was a charitable organisation. A committee of volunteers oversaw the home. Most staff told us that more support from the registered manager and the Committee would be appreciated. They told us morale was low and several staff were leaving.

Most staff and several people raised concerns about the manner of a small number of staff who could be abrupt at times towards people and the other staff. Several staff informed us they were unable to use the provider’s whistle-blowing procedure because they felt it was ineffective. This was the third inspection in which comments had been made about the behaviour of a minority of staff.

We received mixed feedback regarding staffing levels. Some people, staff and relatives told us that more staff would be appreciated. We have recommended that staff deployment is kept under review due to the mixed feedback we received.

The service was clean and there were no malodours. Checks and tests had been carried out on equipment to ensure this was safe. Risk assessments had been completed regarding roller blind cords. Blind cord pulls were attached to the wall to reduce the risk of injury. We found however, that the temperature in the home dropped to 19 degrees at certain times of the day. In addition, one person told us that her hot water tap sometimes ran cold. The registered manager told us that this was being addressed. Records were not available to evidence that water temperatures were within safe limits.

We checked the management of medicines. The treatment room had been refurbished and was clean and orderly. Medicines administration records were accurately completed. However, we identified shortfalls in relation to the monitoring of one person who self-administered their medicines and the storage of those medicines.

Staff said there was sufficient training. Most told us there was too much training. We noticed there were some gaps in the provision of training such as ‘challenging behaviour’. The registered manager told us that staff were currently completing this training.

We found omissions in the maintenance of records relating to the Mental Capacity Act 2005.

People told us they were generally satisfied with the meals at the home. We observed the lunchtime experience. Staff sat and ate their meal with people which they told us added to the social experience.

Staff worked with various agencies and accessed other services when people's needs had changed, for example, consultants, GPs, speech and language therapist, dietitians, the chiropodist and dentist.

We found that not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. We have made a recommendation about this.

We received mixed feedback from people and relatives about the caring nature of staff. We did not witness any inappropriate care during the inspection. People and relatives said that staff promoted people’s dignity. We observed that certain staff procedures such as moving and handling did not always promote people’s dignity.

Care plans were extensive and not always relevant or necessary. Some of the assessment tools we viewed were outdated. We have recommended that the provider reviews their care documentation and assessment tools to ensure they are person centred, up to date and based on best practice guidelines.

An activities coordinator was employed. There was an activities programme in place. People told us there was enough going on to occupy their attention.

There was a complaints procedure in place. However, the registered manager had not recorded full details of the complaints which had been received.

At our previous two inspections, we found that the provider had not informed CQC of certain notifiable events in line with legal requirements. At this inspection, we identified that the provider had not notified CQC of a safeguarding investigation and the outcome of a DoLS application. This meant an effective system was not in place to ensure that all notifiable incidents were reported to ensure CQC had oversight of all notifiable events to ensure the correct actions were taken.

The omissions and shortfalls we identified did not appear to have a major impact upon people themselves. People and most relatives told us they were happy with the service. One relative told us, “This [home] has definitely got the nicest feel.”

Since 2015, we have rated the service as requires improvement at our last three inspections. At this inspection, we found that improvements had not been fully made. This meant that systems were not fully in place to ensure compliance with the regulations and achieve good outcomes for people.

We held a meeting following the inspection with the registered manager and nominated individual to discuss our concerns, improvements needed and support that may be available. The registered manager wrote to us following this meeting and informed us what action they had taken to address the concerns we had raised.

We found two breaches of the Health and Social Care Act 2008. These related to dignity and respect and good governance.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. The inspection was also prompted in part by the receipt of a notification of an incident following which a person using the service sustained a serious injury. This report only covers our findings in relation to those requirements and this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeyfield House – Alnwick on our website at www.cqc.org.uk.

At our previous inspection we identified a repeated breach of regulation 17, good governance. We found shortfalls in the maintenance of records which had not been identified through routine audits of the service. At this inspection, we found further shortfalls and omissions.

There was a registered manager in post she had commenced employment at the end of September 2016. She had become registered with the Care Quality Commission in January 2017. 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 identified omissions and shortfalls relating to one person’s care following an accident. The registered manager told us that she had arranged further training for the staff involved.

Risk assessments had been completed following an assessment of people’s care. We noted that roller blinds with pull cords were fitted in some people’s rooms. This risk had not been fully assessed, monitored and mitigated to ensure the health and safety of people.

There were safeguarding policies and procedures in place. However, some staff raised concerns of a safeguarding nature. We found that one specific allegation had not been fully investigated.

A monthly accident analysis had been completed to ascertain whether any trends or themes were identified. It was not always clear whether the actions taken to minimise accidents or incidents were effective.

We found shortfalls in the maintenance of records. Observation charts were not completed following one person’s accident. There were two falls risk assessments in people’s care files. These sometimes assessed people’s risk of falls differently. One person’s falls risk assessment rated them at medium risk of falls, the other rated them as high risk. We considered that this could lead to confusion.

Deprivation of Liberty Safeguards [DoLS] assessments had been completed. However, these had not been updated following the Supreme Court judgement in March 2014. This meant that DoLS assessments may not accurately assess whether people’s plan of care amounted to a deprivation of liberty.

A quality assurance system was in place. We noted however, that this had not highlighted the areas of concern which we had found.

We checked whether the provider was meeting the conditions of their registration and notifying us of all changes and events at the service in line with legal requirements. The submission of notifications is a requirement of the law. They enable us to monitor any trends or concerns within the service.

At our previous inspection we found that the provider had not notified the Commission of two events at the home in line with legal requirements. At this inspection we identified that the provider had not notified the Commission of four safeguarding incidents. These omissions meant an effective system was not in place to ensure that all notifiable incidents were reported to ensure the Commission had oversight of all safeguarding allegations to make sure that appropriate action had been taken to safeguard people.

We have carried out three inspections including this inspection since the provider registered with CQC in 2015. We rated the service as requires improvement at our inspections in 2015 and 2016 and identified two breaches in 2015 relating to safe care and treatment and good governance and one breach in 2016 which related to good governance. At this inspection we identified further concerns and shortfalls and breaches of regulations. This meant that compliance with the regulations was not sustained and consistency of good practice was not demonstrated.

Despite our findings and identified shortfalls, people and relatives were positive about the care home.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, safeguarding people from abuse and improper treatment and good governance. We also identified a breach of the Registration Regulations 2009 which related to the notification of other incidents.

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 inspection took place on 1, 10 and 12 November 2016 and was unannounced. It was carried out by one inspector.

We inspected the service on 27 and 29 October 2015. At that time we found that people were not protected against the risk of unsafe or inappropriate care because accurate risk assessments had not been maintained. We also found that governance arrangements in place at that time had failed to pick up the shortfalls we identified during our inspection.

There was no registered manager in post. A new manager had been appointed at the end of September 2016 following a period of absence and then resignation of the registered manager. The new manager was in the process of registering with CQC.

Safeguarding policies and procedures were in place and staff had received training in the safeguarding of vulnerable adults and were able to tell us the process to follow if neglect or abuse was suspected. Suitable procedures were following when recruiting staff which also helped to protect people from abuse.

There were some gaps in staffing, and new staff had been recruited. Agency staff were being used at times to fill these gaps, but we were told by the manager and staff that the use of regular agency staff helped with consistency of the care provided. Staffing had been reviewed, and there were plans to increase the numbers of staff on duty, particularly at night.

Individual risks to people were identified, and risk assessments had been evaluated on a monthly basis. We found that one risk assessment had not been updated following an incident and we told the manager about this who addressed this immediately. Health and safety checks on the premises and equipment were carried out although records of these checks were not held centrally and were difficult to locate.

The home was clean and regular infection control and cleanliness audits were carried out. The premises were generally well maintained and there were plans in place to address issues with the building and maintenance following an inspection of the premises form which an action plan was produced. Visitors commented that the service was homely and had a lovely atmosphere.

Staff received regular training and where there were gaps in training, this was planned. The manager had reviewed training and planned to increase the frequency of some mandatory training to ensure that staff remained up to date with changes in legislation and current best practice. Staff supervision had not been taking place due to the absence of the previous manager. These had recommenced however and appraisals were planned. Staff told us they felt well supported.

People were supported with eating and drinking and told us they enjoyed the food. Special diets were catered for and alternative choices were offered. Nutritional assessments were carried out and where people were at risk of malnutrition appropriate medical and dietary advice was sought. There were gaps in food and fluid and weights records.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The manager had submitted DoLS applications to the local authority for authorisation. Care records related to capacity and consent contained conflicting information, and were unclear.

People had access to a range of health professionals, and named preferred providers were recorded such as optician or GP. Health records were easy to access in an emergency and contained up to date information.

Most people told us they felt well care for and that staff were very caring. A number of people told us, however, that there was a small number of staff who could be abrupt and impatient at times, towards them or others. We passed this information to the management committee and local authority safeguarding team. The committee were very keen to address this issue and to monitor staff attitude and ensure all staff knew the conduct expected of them.

The privacy and dignity of people was maintained. End of life wishes were being recorded in updated care plans to ensure that staff were aware of people's wishes where they wished to share these.

Person centred care plans were in place which were reviewed monthly. Audits had been carried out on care files by the manager who planned to update and streamline these. We found that documentation was in need up updating and streamlining.

A complaints procedure was in place, and a complaints book was used to record complaints. Records of complaints varied in style and content and were not maintained in a format which could be audited.

People and relatives complimented the range of activities available and said that there was always something happening in the home. People were supported to maintain contact with the community and had access to regular trips, and visitors to the home.

There had been a period without a registered manager due to absence and their subsequent resignation. A new manager had been appointed and an executive committee were very involved in the running of the service. We found that there were a number of shortfalls, particularly in relation to record keeping which had not been picked up during quality audits. There was some evidence that some issues had been picked up by the executive committee and new manager, and they were in the process of addressing these, however governance processes were not sufficiently robust to identify all issues, particularly in the absence of a manager.

The executive committee were closely involved with the service and visited on a regular basis. They knew staff and people well.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. You can see what action we told the provider to take at the back of the report.