Archived: Harry Sotnick House

However, the information shared with CQC about the incident indicated potential concerns about the management of risks associated with; a failure to follow professional guidance adequately, the safe monitoring of people’s hydration and nutrition needs, the administration of medicines and the changing needs of people as they move towards end of life care. A second incident reported to CQC did not involve a person who lived at the home; however this raised serious concerns about the risks associated with the management of medicines in the home. All of these identified risks have been examined in this inspection.

The registered provider has an extensive history of non-compliance with the required regulations in this home. You can see the reports which have been published about our inspection program at this home on www.cqc.org.uk .

In December 2016 the home was rated as Inadequate and placed into special measures by the Commission. Two separate conditions were imposed on the registered provider’s registration for this home which required the registered provider to provide information to the commission on a fortnightly basis showing the actions they were taking to comply with all the required Regulations and provide information on the number of agency staff working in the home.

This home was last inspected in May 2017 where we found the home to be compliant with all the Regulations and was fulfilling the requirements of these conditions. However, further work was required to embed good practices in the home. The home was moved out of special measures although the two conditions imposed on the registered provider’s registration of this home remained in place. The registered provider applied to have these conditions removed from their registration on 14 July 2017; however they remained in place at the time of this inspection.

At this inspection we have identified four breaches of the Health and Social Act 2008 (regulated Activities) Regulations 2014.

The overall rating for this 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.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The home provides accommodation, nursing and personal care for up to 92 older people, most of whom live with dementia. Accommodation is arranged over two floors with stair and lift access to all areas. A third floor provides staff facilities. At the time of our inspection 70 people lived at 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.

Medicines were not always managed in a safe and effective manner to ensure the safety and welfare of people. Medicines errors had not always been identified or investigated and learned from.

We identified a number of incidents in the home during our inspection relating to the poor clinical knowledge and understanding of registered nurses.

There was a lack of good clinical leadership in the home. Nursing staff did not always demonstrate a good understanding of their roles and responsibilities. Where clinical errors had been made learning from these was not always recognised and shared in the service.

Whilst there were safe recruitment practices in the home, there were not always sufficient staff with suitable skills, knowledge and experience deployed to meet the needs of people. There was a high dependency on the use of agency registered nurses in the home.

The risks associate with people’s changing clinical needs were not always assessed and actions taken to mitigate these in a timely way.

We saw there was confusion and misunderstanding about what constituted end of life care in the home; care plans in place and actions taken by staff were not always consistent and appropriate to ensure people received care which was in line with their needs and preferences at the end of their life.

People were cared for in a kind and compassionate way. Their plans of care were mostly person centred.

People were encouraged to interact with each other and participate in a wide variety of stimulating activities and events.

There was a system in place to allow people to express any concerns or complaints they may have, and people had the opportunity to express their views on the quality and effectiveness of the service provided at the home.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

People received nutritious food in line with their needs and preferences. Food and fluid records were well maintained and people enjoyed the food they received.

We undertook this unannounced comprehensive inspection on the 30, 31 May and 1 June 2017 to check the registered provider had met all the legal requirements. We found they had taken steps to address all of the breaches in Regulation which we had identified in our previous inspection, although further work was required to embed working practices in the home. The registered provider was complying with both of the conditions placed on the registration of this location. The service had demonstrated sufficient improvement to be taken out of special measures.

Harry Sotnick House provides accommodation, nursing and personal care for up to 92 older people, most of whom live with dementia. Accommodation is arranged over two floors with stair and lift access to all areas. A third floor of the home accommodated office space for staff. At the time of our inspection 64 people lived at the home.

There was a registered manager in post at the home. They had been a registered manager in another of the registered provider's homes and transferred their registration to Harry Sotnick House to provide strong and effective leadership. 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.

There were sufficient staff deployed to meet the needs of people and staff felt supported by the new management team in the home. There was a clear staffing structure in the home and training, supervision and staff meetings provided an effective support network for staff. The registered manager promoted open and honest communications with staff which was reflected in the way staff had responded to changes and new ways of working since our last inspection.

Risk assessments had been completed to support staff in mitigating the risks associated with people’s care. Plans of care were informed by these assessments.

Whilst medicines were managed in a safe and effective manner, improvements were required in the safe administration and record keeping of some medicines.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes were in place to check the suitability of staff to work with people.

Health and social care professionals were involved in the care of people and care plans reflected this.

Staff ensured people who were able to consent to their care were involved in making decisions about their care. Where people could not consent to their care staff were guided by the principles of the Mental Capacity Act 2005 (MCA). The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered provider was meeting the requirements of these safeguards.

People’s nutritional needs were met in line with their preferences. The risks associated with malnutrition and dehydration had been assessed for people and actions were taken to reduce these risks.

Care plans in place for people were person centred and gave clear information for staff on how to meet the needs of people. People and their relatives told us they were involved in the planning of their care and work was on-going to involve people further in regular reviews and updates of their care plans.

There was a wide range of activities available for people and the home provided a stimulating and homely environment for people, particularly those who lived with dementia and mental health conditions.

Complaints were recorded and responded to in line with the registered provider’s policy.

Systems and processes were in place to assess, monitor and improve the quality and safety of the services being provided in the home.

The home had a history of non-compliance with the required Regulations of the Health and Social Care Act 2008 between the dates of February 2013 and September 2015.Reports from these inspections can be found at www.cqc.org.uk. We served Warning Notices on the registered provider in February 2015 for breaches in five Regulations. We inspected the home in May 2015 and found it was not compliant with all the Regulations. We placed the home into special measures and placed a condition on the home to prevent any admissions without the express permission of the Commission. This condition was lifted by the Commission following an inspection of the service in September 2015 when we found the registered provider was compliant with all the Regulations although practices needed embedding in the home. At this inspection we found the registered provider was again not compliant with all the Regulations.

It is a requirement of the registered provider’s registration to have a registered manager in post at the home. 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.

There was no registered manager in post. The service had been without a manager registered with the Commission between May 2014 and February 2016. A registered manager worked in the home between February 2016 and June 2016. An interim manager was appointed to the home in September 2016 however they had not registered with the Commission. At the time of this inspection the interim manager had been in post for six weeks. The registered provider advised the Commission a new manager was due to start working at the home and would be making an application to the Commission to become registered as the manager as soon as they arrived. They could not confirm the date this person would start employment. Following our inspection the registered provider advised us this person was no longer going to be joining the home and they were interviewing further suitable candidates for the role.

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. 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.

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 time frame 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The 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.

There were insufficient staff available to meet the needs of people. Staff were not always available to support people to mobilise safely and so some people remained in bed. There were a high number of unwitnessed falls and a high number of agency staff used who did not always understand or have sufficient information to ensure they knew how to meet the needs and preferences of people. Staff did not feel supported to complete their roles efficiently and effectively due to the lack of staff. The interim manager told us this was under review.

Whilst medicines were stored safely they were not always managed in a safe and effective manner.

The risks associated with people’s care needs had not always been accurately assessed and plans of care were not always informed by these. For people who were at risk of falling from their bed, assessments for the use of bed rails and floor mats had not been completed and plans of care were not informed by these risks.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes were in place to check the suitability of staff to work with people. Staff received training to develop the skills to meet the needs of people.

Health and social care professionals were involved in the care of people and care plans reflected this. They told us staff knew people well at the home and understood how to meet their needs.

Staff ensured people who were able to consent to their care were involved in making decisions about their care. Staff were guided by the Mental Capacity Act 2005, however where Deprivation of Liberty Safeguards were in place for people, conditions attached to these safeguards were not always met and records did not reflect the reason these were in place.

People’s nutritional needs were met in line with their preferences and needs although records did not always reflect this. People who required specific dietary requirements for a health need were supported to manage these. Records of people’s weights and dietary and fluid intake were not always accurately recorded however this was being addressed.

Care plans in place for people did not always reflect their identified needs and the risks associated with these. People and their relatives told us they were involved in the planning of their care.

Complaints were recorded and responded to in line with the registered provider’s policy.

There was a lack of strong and consistent management in the home to provide guidance and stability for staff and safe governance of the home. Staffing structures had not been effective in ensuring all staff received supervision and support to maintain their roles. This was being addressed by the interim manager.

Care records were not always up to date and in some instances were inconsistent or conflicting. There was a lack of consistency in the application of quality assurance systems and processes which the registered provider had in place to ensure the home was compliant with all the Regulations. Not all actions identified by the provider through their quality assurance processes had been completed in a thorough or timely manner.

The inspection team consisted of a lead inspector, a pharmacy inspector, two other inspectors and an Expert by Experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. We also spoke to two health and social care professionals who have involvement with the care of people at the home. These included a social worker and a member of the continuing health care nursing team.

We spoke to 12 staff and to the Regional Director. Relatives of four people who lived at the home were asked for their views of home and we spoke to six people who lived at the home. We used also used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. The SOFI tool allows us to spend time observing what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. The SOFI was carried out during the lunch time meal in three of the six units where people lived. We saw people had positive experiences but noted in one unit the lunch was hurried and was late being served. We also observed in a fourth unit that the lunch was not well organised and the dignity of people was not always promoted.

Relatives of people who lived at the home made positive comments about the service provided by the staff. Personal care was said to be of a good standard, although we received information prior to our inspection that one person was not bathed frequently. People were seen to be clean and well groomed.

Relatives said the atmosphere in the home had changed for the better. Comments included, 'The staff are much happier,' and, 'The atmosphere is nicer.'

The home has a new manager who has not yet registered with the Commission. Staff told us the manager provided better support than they previously had. In particular, staff commented how the manager was frequently present in the living areas of the home so staff could ask for any advice about the care of people.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

The provider reported any incidents regarding the safety of people to the local authority safeguarding team and to the Care Quality Commission. Care plans showed where accidents and incidents occurred there was a review of the person's care and amendments made to the care plan so staff had guidance to prevent a reoccurrence. Where people had behaviour needs there was a care plan so that people were safe.

Staffing levels had been reviewed since the last inspection and were found to be sufficient to meet people's needs.

Medicines procedures were not safe as records of medicines were incomplete and medicines were not always administered at the prescribed times. Medicines were also not always securely stored.

Is the service effective?

People's needs were assessed and recorded. Each person had a care plan which reflected their choices and preferences. There was one care plan which did not contain all the information needed for staff to provide effective care.

Staff said the support they received had improved since the new manager started work at the home. They said induction and training was provided so they had the skills to effectively care for people. Staff were observed to be skilled in communicating with people with dementia.

Care plans included guidance on supporting people who were subject to restrictions under the Deprivation of Liberty Safeguards authorisations.

A choice of food was provided. People were supported to eat. Drinks were offered to people and records were maintained to show people had sufficient fluids.

Is the service caring?

Relatives told us people were treated with kindness, dignity and respect. Staff were observed to treat people well and showed warmth in the way they spoke to people. Relatives also told us they felt able to raise any issues they had, that the staff listened to them and acted on what they said.

Is the service responsive?

People's individual care needs were detailed in care plans which were updated to reflect people's changing needs. Activities were provided and there was an activities coordinator to facilitate these. These included trips out from the home. Individual activities were provided as part of the requirement of DoLS authorisations.

Relatives told us they felt able to raise any concerns, however, relatives of two people contacted us prior to the inspection to say their complaints were not always responded to in a timely way.

Is the service well led?

The home has a new manager and staff said there has been an improvement in the way they were supported. Staffing and management had been adjusted so there were lead nurses for mental and physical health. Admission procedures for those with mental health needs had improved so the needs of people are fully known before being admitted to the home.

Care records showed incidents and accidents were reviewed and action plans devised to reduce the likelihood of any reoccurrence.

People's views were sought by the use of a survey questionnaire.

Monitoring and auditing of medicines procedures had not taken place as the provider said they would be in their action plan we last inspected the medicines procedures.

The inspection team consisted of a lead inspector and an inspector who specialised in the Mental Capacity Act 2005. We spoke to eight staff plus members of the home's management team. Following the inspection we spoke to four health and social care professional about the care provided by the home.

We spoke to three people and to four relatives of people who lived at the home. Due to people's mental health needs we had limited communication with people and used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. The SOFI was carried out during the lunch time meal in one of the units where people with more complex needs lived. We saw people had positive experiences. People were offered choices from a wide range of foods. Staff supported people to eat where people needed assistance. Staff were observed to be patient and calm with people and were skilled in working with the behaviour needs of people living with dementia.

We received mixed feedback from people and relatives about the standard of care. Relatives told us the staff were kind and attentive. Staff were said by relatives and people to treat people with respect and dignity. One relative told us the service had improved. Relatives told us the provision of activities was of a high standard. One relative told us communication with the home had been problematic. One relative said there had been a high turnover of staff and frequent use of agency staff which sometimes impacted negatively on the continuity of care for people. Another relative described the home was going through a period of change and improvement steered by a new management team.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

Staff told us they received training in the safeguarding of vulnerable adults and that they knew what to do if they had any concerns about people's safety or welfare. Staff also told us how the care and safety of people was paramount to their role.

Relatives told us staff treated people with respect and with dignity.

We saw the service reviewed any accidents and incidents so that people were safe. However, we noted these were not always carried out so that staff had sufficient guidance about how to deal with people's behaviour where there was a risk to people's safety.

The service reported any incidents regarding the safety of people to the local authority safeguarding team and to the Commission.

The service understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Mental Capacity Act 2005 assessments were well recorded and identified when people needed to be referred for a Deprivation of Liberty Safeguards (DoLS) authorisation.

The service had made arrangements to provide staffing at levels assessed as being safe for people. However, we identified specific times when staffing levels needed to be reviewed.

The service took action where staff had not followed safe care practices so that safe care was promoted in the home.

Is the service effective?

We saw that people and their relatives had opportunities to express their views about people's health and quality of life outcomes. These included people and their relatives being consulted about arrangements for meeting care needs and relatives' meetings where relatives could raise any issues they had about care in the home. One relative told us there had been communication problems with the home; that calls were not returned as instructed. Another relative said how good the home was at keeping in touch regarding any changing circumstances.

We saw people's needs were assessed and recorded. Each person had a care plan which reflected people's choices and preferences. We noted there was a lack of clarity regarding the status of one person regarding the Mental Health Act 1983 which the home's management said could have affected the support the person received. Care plans needed to be updated to reflect people's current needs.

Newly appointed staff told us they received an induction which prepared them for their role and said they felt supported in their work. We saw the home had introduced a programme of supervision for staff and that there was a training matrix to monitor that staff attended the required training courses.

We noted seat cushions on a number of armchairs in communal lounges were missing, which would make it difficult for people with mobility needs to get up.

Is the service caring?

Relatives and people told us the staff treated people with kindness and compassion. One relative said some staff were more caring than others. Another relative said, 'The staff are brilliant. Some have a magical touch.' Comment was made by a relative that the staff were now more caring and had moved away from providing care based on completing tasks to a more personalised approach.

Is the service responsive?

We saw care was arranged to meet people's individual needs. This included the service liaising with health and social care commissioners so that people were provided with additional staff supervision to meet their needs. We observed one person taking part in activities with a designated staff member. However, we also saw that one person's care plan regarding a daily activity was not always being followed.

We saw care plans and assessments were updated as people's needs changed but also examples where care plans did not give sufficient information to staff following a review of care needs.

The service was responsive as a range of activities were provided to people. The home had a team of activities coordinators who arranged an activities programme.

We saw records were maintained of how the home dealt with complaints. These showed the home responded to each complaint although not all the information regarding specific complaints was available for us to see. Relatives told us they knew how to raise any concerns.

Is the service well led?

At the time of the inspection the home did not have a registered manager. The management role was jointly being undertaken by the Regional Director and the Operational Support Manager. We found the home's management were committed to making improvements at the home and recognised areas of the home's performance needed to change.

Staff gave mixed opinions of the support and management of the home. This ranged from staff feeling supported and feeling able to raise concerns to one staff member citing a lack of support from the management as well as frequent management changes.

Health and social care professionals told us the service worked in conjunction with them to meet people's needs.

On the day of our visit there were 85 people living at the home. We were given information about the number of nursing and care staff the provider required to support these people on each of the three shifts which were completed through any 24 hour period. We looked at the rotas of staff duties to cover the three weeks prior to our visit. We also looked at the records the home held which showed where staff had been allocated to work throughout the home. We saw that staffing levels fluctuated throughout this period of time and that there were not always the required levels of staffing working.

We had been told that the registered manager for this service was no longer working at this home. The operational service manager and regional director were present at the home when we visited. They told us that a new registered manager was being employed but that there was not yet a confirmed date for them to start.

We were told by the regional director that the provider used a dependency tool to assess the level of care needed for people who lived at the home. We saw that this tool was completed by the registered nurses. However we were unable to see how this tool informed the levels of staff which were required to provide a safe and effective service for people who lived at this home.

We spoke with 17 members of staff, two people who live at the home and two relatives. Staff we spoke with told us of their dedication to the service and their passion about delivering high quality care. However, staff told us that they often felt there were not enough staff to meet the needs of people. They told us that the management structure of the home had changed frequently over the past year and they were unclear on the support network available to them. Staff we spoke with told us that they had not received supervision or appraisals in the past six months.

The provider sent us an action plan to say the home was compliant by 15 December 2013.

We spoke to six people who lived at the home and to six relatives of people who lived at the home. Relatives reported the home generally provided a good standard of care. One relative said, 'I can't fault the place,' and another said, 'It's a lovely home. The staff are wonderful. I can't fault them.' Relatives also raised issues about staffing levels and communication which they felt could be improved.

We also spoke to a number of staff about their work. Staff had a good knowledge of people's needs and how to provide care.

During the lunch time meal we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. These were carried out by two inspectors in two of the home's six units. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. People were offered choices from a wide range of foods. Staff interacted well with people and were observed to be patient and courteous. People were supported with eating according to their level of need.

We found the home had reviewed and updated people's assessments and care plans. Sufficient information was now recorded so that staff had guidance on how to provide safe and effective care. We saw that staff supported people with their mobility needs as set out in care plans. Guidance was provided for staff on how to deal with behaviour needs of individual people. Where people were identified as being at risk from pressure injuries or had wounds, there were care plans in place of how these were monitored, treated and managed.

Since the last inspection we found the home has reviewed and increased its staffing levels in two of the units.

At the last inspection we found the home's computerised system for recording care plans and assessments did not work properly and that some paper records were not readily available. This has now been rectified.

We spoke to six people who lived at the home and to a number of relatives of people who lived at the home. We also spoke to two health and social care professionals about the care provided by the home. We also spoke to staff about their work.

During the lunch time meal we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. These were carried out by two inspectors in two of the home's six units. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. People were offered choices from a wide range of foods.

We looked at the care people received at the service. This included looking at people's care records. Each person's needs were assessed and there were care plans but we noted these did not address many of the needs for people including areas where there were identified risks, such as pressure area care and the moving and handling.

The home's care records were held on two computerised systems. The home had a new computerised system and care records had been transferred from the previous system to the new one. We noted the new system was defective and frequently gave information on two clients when looking at one person's records. Not all relevant information had been transferred to the new system so staff had to access these records via the previous system. Only one staff member in the home had a password to access these records. Consequently care records were not available to nursing and care staff at all times.

We saw that people had a varied and nutritious diet. We noted that food and fluid charts were not always completed when they needed to be.

Nursing and care staff were assigned to each of the six units in the home. Health and social care professionals as well as care and nursing staff told us the home needed more staff so that people's needs could be effectively met.

The home has introduced a system of staff supervision. We saw records that staff performance was addressed with staff. Records of these meetings did not reflect the contents as described by the manager and appropriate action had not been taken regarding an allegation about a staff member.

Relatives and staff reported the new management team at the home had made a number of improvements particularly regarding communication and responding to any issues.

We looked at care plans and assessments of need for people. These showed how people needed to be supported by staff. We noted there was a lack of information regarding specific needs and observed the support provided by one staff member was not safe. Medication procedures did not give staff sufficient guidance regarding the use of 'as required' medication.

We saw that the home had increased its staffing levels. Staff have had access to a variety of training courses. Staff said they felt supported but reported a lack of supervision, which was reflected in a lack of supervision records.

The home used a number of audits to check its performance, but we found the home had not completed all the actions as highlighted in its own audit.

People who live at the home and their relatives told us staff treated people with respect and kindness. Two relatives commented that there had been problems with personal property going missing.

People and their relatives told us they considered the home to be a safe place for people to live. We found that the majority of care staff had not completed training in safeguarding vulnerable adults and that the service did not always respond adequately to issues regarding the safety of people.

The home had a complaints procedure but we found people were not always provided with this and that complaints were not always adequately responded to.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 45 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. The meal time was calm and well organised.

We visited the home at 10pm and there were two RGNs on duty as well as seven care staff. Staff told us there were enough staff on duty to meet people’s needs and for carrying out tasks such as administering medication.

We spoke briefly to one person and observed people in the home’s communal areas. We did not speak to people about their experiences at the home due to the time of night. We observed people had made a choice about the time they went to bed. Some people were in their rooms and others were seated in communal areas. Staff told us people were able to choose the time they went to bed. We observed staff interacting with people. Staff spoke to people in a calm and reassuring manner.

At the time of our inspection staff were administering medication to people. We carried out a sample check on this and found medication was given to people as prescribed. The staff member had signed a record to say the medication was given.