Haresbrook Park Care Home

Haresbrook Park Care Home is a residential care home providing personal and nursing care up to 57 people. At the time of the inspection no one was receiving nursing care. The service is registered to support younger adults, older adults, people living with dementia and mental health. The home is purpose built with all accommodation and facilities on ground floor level over two units. There were 37 people living at the home at the time of our inspection.

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

The providers systems and processes to monitor oversight had not always been effective in identifying some of the concerns we found during inspection, including, medicine management and environmental risks.

Medicine audits had not identified areas of concern we highlighted during our inspection. When we raised these concerns, action was taken immediately which included carrying out medication competency checks which ensured all staff assessments were now in date.

Some environmental risks required a more robust oversight to ensure people were not at risk from avoidable harm due to radiator covers being loose.

People were supported by staff that had been recruited safely and had received relevant training to enable them to carry out their roles effectively. Staff understood the different types of abuse and knew how to report and record any concerns.

Accidents and incidents were reviewed by the registered manager to identify any potential themes and trends to prevent the risk of incidents from happening again.

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, relatives and staff views were gained through meetings and surveys to help drive through improvements.

Managers and staff were clear about their roles. Staff spoke positively about the management team and working at 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 16 November 2021).

Why we inspected

The inspection was prompted in part due to concerns which included the management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

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 changed from good to requires improvement based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Haresbrook Park Care Home is a residential care home providing personal and nursing care to 27 people. At the time of the inspection no one was receiving nursing care. The service can support up to 57 people. The service is registered to support younger adults, older adults, people living with dementia and mental health. The home is purpose built with all accommodation and facilities on ground floor level over two units.

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

Improvements of the governance systems ensured better oversight of performance and quality.

Systems to assess, monitor and mitigate risks to people’s safety and well-being had improved. For example, potential risks to people's health and wellbeing had been identified and were managed safely.

Staff had now received access to training and support to meet the needs of people they cared for.

The provider and management team were checking staff’s knowledge and practices to assure themselves people were provided with effective care and improvements were ongoing.

People received their medicines as prescribed from staff who were trained and competent to do so.

Infection, control and prevention procedures had improved and helped to protect people from the risk of infection.

Staff were confident in recognising and reporting abuse. The management team had made improvements to the processes in place to record incidents and accidents so these were analysed and lessons could be learnt.

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.

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 18 December 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 August 2020, 01 September 2020 and 10 November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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

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 in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s safety. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Haresbrook Park Care Home provides accommodation and personal care for up to 75 people. At the start of this inspection 25 people were living at the home. This number reduced to 20 people at the time of our final visit. The home is purpose built with all accommodation and facilities on ground floor level over two units.

Most people living at Haresbrook Park live with an advanced dementia related illness or mental health illness. County House unit has previously supported people with more complex health care needs and advanced dementia. Glen View unit has supported people who were more independent and live with a dementia illness or mental health need. At the time of the inspection everyone was living within Glen View.

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

The service was not well- led. The providers did not have effective governance systems in place to maintain continuous improvement. The service has not been well-led for six consecutive inspections.

This resulted in some people not receiving safe care. Risks to people were not always identified and managed in relation to ensuring the environment was safe. Medicines were not always managed safely. There, were areas where staff were not following infection control guidance and procedures in relation to the Covid-19 pandemic.

Accidents and incidents were not effectively recorded and therefore were not suitably monitored to consider lessons learnt and reduce the risk to people. It was not possible to establish whether incidents should have been notified to Care Quality Commission (CQC) and the local safeguarding authority.

Care plans were not always up to date and did not therefore always contain accurate information about people’s care and support needs.

The care and support provided to people was not always person-centred and did not always people’s individual needs.

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

Quality assurance systems were not effective and failed to ensure compliance with regulations. Where issues had been identified, the provider did not act in a timely manner to address these.

A high use of agency staff was in place. Areas of training needed to be improved.

The provider was working with local agencies due to the concerns raised by professionals who had visited the location.

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 requires improvement (published 30 January 2020).

Why we inspected

This inspection was prompted in part due to a specific incident following which a person, using the service, died. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident. In addition, we had received concerns regarding staffing and the management of the service including the maintaining of up to date records regarding people’s care and support.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We did not review the remaining key questions. Ratings from the previous comprehensive inspection for those questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements.

Please see the safe, effective and well-led sections of this full report.

The overall rating for the service has remained as requires improvement.

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 Haresbrook Park 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 in relation to the safe care and support of people, systems to recognise safeguarding, person-centred care and areas relating to leadership and the management of the service at this inspection.

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 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.

Haresbrook Park Care Home provides personal care and accommodation for up to 57 older people. At the time of this inspection there were 34 people living at the home.

The majority of people who live at Haresbrook Park live with an advanced dementia related illness or mental health illness. The home was split into two separate units, Country House, which supports people who have more complex health care needs and advance dementia related illnesses. Also Glen View which supports people who were more independent and have a dementia related illness or mental health support need.

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

People had their risks assessed and further improvement was needed to ensure staff had detailed guidance to manage these consistently safely. People had their medicines as prescribed and the systems in place continued to be improved to monitor this. Staff demonstrated they understood and followed infection control and prevention procedures. People were cared for by knowledgeable staff who knew how to keep them safe and protect them from avoidable harm

Systems were being established to investigate and monitor incidents and accidents to ensure actions were taken to mitigate risks. The management team were reviewing the numbers and deployment of staff to ensure people’s needs were met. Systems in place to monitor the safety of the environment continued to need improvement to ensure risks were identified and actioned consistently.

People were supported by staff who were on a program to update their skills to ensure people’s needs were met. People's needs were assessed, and care was planned to meet legislation and good practice guidance. 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 were in place to support this practice. People’s meal-time experience had improved, and the management team were working with staff to ensure this was consistent.

People received support from kind and caring staff, who were building friendships with the people they supported. The management team were establishing new ways to gather people’s views and acted on people’s ideas for improvements. People's privacy was respected, and their dignity maintained.

Further improvement was needed to ensure people’s needs were consistently met and establishing interesting things for people to do and connections with the community. The information staff needed to provide personalised support and understood people’s health needs was in the process of being updated. People's concerns were listened to and changes made to improve the service. When people needed support at the end of their life the service had skilled staff and systems in place to meet people’s needs.

The management team were open, approachable and were improving the culture for people and staff at the home. The management team had clear ideas to improve the quality of the care and establish systems to consistently ensure this was provided. People and relatives knew the management team and had confidence improvements would be maintained. The management team and staff established good relationships with other professionals and were developing links in the community.

Rating at last inspection and update

The last rating for this service was Inadequate (published 5 November 2019) there were multiple breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Haresbrook Park Care Home, is a ‘care home’ providing personal and nursing care for up to 57 people across two units on the ground floor in one large adapted building. Haresbrook Park Care Home specialises in the care of people living with dementia and older people. At the time of our inspection, there were 41 people living at the home.

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

The quality of care had deteriorated since the last inspection. People were at risk because safeguarding policies and procedures were not being followed. The provider had not assessed and managed risk, which placed people at risk of harm.

People did not consistently receive their medicines as prescribed.

There were concerns with staff practices regarding infection prevention and control and lack of knowledge regarding supporting people to safely eat and drink. The provider failed to ensure that the nutrition and hydration needs of people were regularly reviewed during the course of their care. People were at risk of choking due to staff not being fully aware of their eating and drinking needs.

There continued to be insufficient staff with the correct skill mix to meet people’s needs. Some people’s relatives, professionals and staff continued to raise concerns about the limited insight staff had into people’s needs, due to high staff turnover and high levels of agency staffing.

The provider failed to ensure people were not at risk of harm. The risks to people’s health, safety and welfare were not always assessed, recorded and kept under review. Incident and accident records had not always been completed to confirm all necessary actions had been taken.

The provider’s quality assurance systems and processes failed to address issues with documentation not being completed appropriately. We found unexplained gaps in recording on people’s medicines application records and repositioning records. Professionals continued to express mixed views about and varying confidence in the management team. The majority of staff did not speak positively about the support they received from the management team.

The service was not well led. The provider failed to have sufficient oversight of the home and five breaches of regulations were identified.

Rating at last inspection

The last rating for this service was Inadequate (report published 15 July 2019 ).

Why we inspected

We received concerns in relation to moving and handling practices, staffing, risk management and medicines. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. 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 remained the same.

We have found evidence that the provider needs to make urgent improvement. Please see Safe and Well-led sections of this full report.

Enforcement

The service met the characteristics of Inadequate in two key questions of safe and well-led. At this inspection, we identified breaches of regulation 9, 12, 14, 17 and 18. Full information about CQC's regulatory response to any breaches of regulation found during inspections is added to reports after any representations and appeals by the provider have been concluded.

Following the inspection we referred our concerns to the local authority. In addition, we requested an action plan from the provider, and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

Follow up

We will continue to monitor the service closely and discuss ongoing concerns with the local authority. 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.

Special Measures

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

personal care for up to 57 people. There were 54 people living at the home all of whom received residential care.

People’s experience of using this service:

The service was not safe. People continued to be at risk of harm through the lack of competent staff. We saw staff put people at risk through their poor practice. The provider failed to meet regulations to ensure people were safe and had their needs met. Systems to ensure people were safeguarded from abuse were not always effective. Accidents and incidents were not always reviewed to ensure lessons were learnt. People were at risk of harm, systems to protect people were not always completed and were ineffective at identifying and managing these risks. People did not always have their prescribed creams when they should do, they were at risk of sore skin.

People did not always have their needs met because of the lack of competent, knowledgeable staff who knew them. Staff continued to support people despite concerns about their practice identified by the management team.

The service was not always effective. Care was delivered by staff who were not always trained, skilled and knowledgeable about people's care and support needs. People's needs were assessed however people’s needs were not consistently met. People had a nutritious diet, and they enjoyed the food offered. The management overview needed to be improved to ensure the principles of Mental Capacity Act (2005) were complied with, and staff knowledge and understanding improved. People were supported to access the health care they needed.

People and their relatives had some positive comments about the care provided. However, some relatives were concerned about staffing levels, and we found people were cared for by staff who were sometimes task focussed because they were rushed or lacked the competency to support people. Staff were kind to people, however sometimes they were not available to meet people’s needs when they were upset. People’s privacy was not always upheld because people wandered in and out of other people’s rooms.

People did not always have access to interesting things to do. The management team were recruiting for extra staff to improve people’s well-being. Relatives did not always feel their complaints had been actioned.

The service was not well led. The provider continued to not have effective governance systems in place to identify shortfalls in the quality and safety of the service for the third inspection in three years. The providers governance systems had failed to ensure people were protected from the risk of harm, and that there were sufficient suitably skilled staff to meet people’s needs. Systems to provide an overview of accidents, incidents and safe guarding’s were ineffective therefore there was a lack of continuous learning and improving people’s safety and outcomes.

Rating at last inspection: Comprehensive inspection completed June 2018. The overall rating was requires improvement. There were breaches in regulation that continue not to be met and sufficient progress to improve people’s care had not been made.

Why we inspected: This was a responsive inspection bought forward because of concerns raised by other Authorities and whistle blowers about people’s safety.

Enforcement: We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulation 12 safe care and treatment, regulation 18 insufficient competent staff to meet people’s needs and regulation 17 there was continuous systemic failure in the effectiveness of governance systems. This was the third inspection in three years where there was a continuous breach in this regulation.

Please see the end of the full report for what action we took.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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

Haresbrook Park Care Home provides personal care and accommodation for up to 57 older people. There were 56 people living at the home on the day of our visit. The majority of people who live at Haresbrook Park live with an advanced dementia related illness or mental health illness. The home was split into two separate units, Country House, which supports people who have more complex health care needs and advance dementia related illnesses and Glen View which supports people who are more independent and have a dementia related illness or mental health support need.

Haresbrook Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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

People told us they felt safe with the care they received from the staff who supported them. Staff demonstrated good knowledge in how they were to protect people from harm, they recognised the signs of abuse and knew how to report most of this. However we found incidents between people who lived in the home had not been reported to the registered manager to ensure appropriate action was being taken to protect people. Where potential risks to people had been identified, staff did not consistently follow these to ensure the risk of harm was mitigated. There were enough staff to support people’s physical care needs, however the provider had not recognised that consideration was needed to allow staff time to support people’s emotional needs. People were supported with their medicines in a safe way. Staff understood the importance of reducing the risk of infection to keep people safe.

People’s care was assessed and reviewed with external healthcare professionals involved from the start. Improvements had been made to ensure people had enough food and fluid to keep them healthy. Where people required additional support with their eating and drinking staff knew who required this support. The registered manager had recognised where people were being restricted of their liberty and had sought the authorisations to do this. However where people had conditions within the authorisations these had not always been met to ensure people had maximum choice and control of their lives. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people.

Staff continued to be task focused in their approach and continued to not always recognise when people who lived with advanced dementia related illness required re-assurance and support. Where people were able to communicate their views and the decisions they had made about their care these were respected by staff who supported them. People and relatives felt the staff team were kind, friendly and respectful.

People received healthcare support which met their needs in a timely way. People had access to information about how they could complain about the service. The registered manager kept records of the complaints received. Where the registered manager had received complaints, these had been responded to, with a satisfactory outcome and learning shared.

The provider had maintained a senior level of management structure, which ensured the monitoring, identifying and improving the service, was maintained. The provider was introducing new systems and processes into the service, these were being introduced and not fully in place to enable the provider to test these new methods to understand if they were effective. The provider had not always ensured all levels of staff understood their responsibilities and accountabilities to ensure the systems they had in place were being effectively followed. The registered manager had not followed the provider’s recruitment policy to ensure they were employing staff which were inline with the provider’s values. People told us they had the opportunity to raise their suggestions and ideas about how the service was run. People felt they could speak with the registered manager when they wanted to and they would listen to them. Staff were involved in the service and said they felt able to share their ideas about the way in which the service was run. People, relatives and staff felt the registered manager was approachable and listened to them.

Haresbrook Park Care Home provides personal care and accommodation for up to 54 older people. There were 52 people living at the home on the day of our visit. The majority of people who live at Haresbrook live with an advanced dementia related illness or mental health illness. The home was split into two separate units, country house, which supports people who have more complex health care needs and advance dementia related illnesses and Glen View which supports people who are more independent and have a dementia related illness or mental health support need.

There was a registered manager working at the home at the time of our inspection. 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 had responded to external healthcare professionals concerns around pressure area care. We found that while records did not always demonstrate staff were providing care in the instructed way, external healthcare professionals told us there had been an improvement to people’s pressure area care. People felt safe living in the home and staff recognised signs of abuse and knew how to report this. Staff did not always have time to spend with people; however staff worked as a team to ensure people were kept safe for harm. People’s medicines were administered and managed in a safe way.

We found that while the registered manager had identified that some people had their freedom restricted; this was not always done so in a legal way. This was because where people’s DoL authorisations had expired the registered manager had not submitted further applications to the supervisory body in order to gain the correct permission.

We found that where people lacked capacity to make decisions around their care and treatment, meetings with external healthcare professionals and the involvement of the person’s family had not been held to discuss what was in the person’s best interest.

Staff had received enhanced training around continence and pressure area care following concerns investigated by the local authority. Staff told us they needed training for dementia related illness so they could understand and support people in the right way that was individual to the person. People had access to their doctor or district nurse when they became ill or had an accident.

Where risks had been identified and monitored, staff had not always taken timely action with the information they had. We found that where identified weight loss, or low out-put of fluids had been recorded staff were unclear what next steps they would take. People told us and we saw that snacks and fresh fruit was not readily available to them.

People told us that staff did not have time to spend with them. Staff told us they felt frustrated they did not have the time to spend with people and support their emotional needs. People and relatives told us the staff were kind and caring. People spoke of the affection shown by staff and that they enjoyed this. We saw staff spoke to people respectfully and supported them in a dignified way.

There were assessments in place to ensure the provider could meet people’s needs when they came to live in the home. We found that when people’s care needs changed these were not always consistently responded to. We received mixed responses from people and relatives about their involvement in the planning of their care.

People we spoke with had not raised a complaint about the service provision. We looked at the providers complaints over the last 12 months and saw that no complaints had been recorded. The registered manager told us they had not recorded any verbal concerns they had received. The operations director told us that better recording would be put in place to understand what learning could be taken from these to improve practice.

There were not effective systems in place to ensure the service was delivering good quality care. Staff told us that morale was low within the staff team. Staff felt they were not always supported to carry out their roles and responsibilities effectively, which meant that people’s care was sometimes compromised. There was not always the right skill mix of staff on each shift, to ensure there was the right skills, knowledge and experience to support people in the right way. Some staff worked long hours without rest days, the provider agreed that long working hours was not safe practice.

The provider had recognised that their homes required more support from senior management staff and had employed a director of operations two months prior to our inspection who had previously worked for the provider, along with an area manager who begun work one week prior to our inspection. We found that the senior management staff had a good understanding of what good care looked like and were putting plans in place to address this.