Archived: Old Vicarage

The Old Vicarage is a care home for 22 adults with acquired or traumatic brain injury, or other

neurological conditions. At the time of our inspection there were 15 people accommodated. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement.

The Old Vicarage is one of six adult social care locations at Glenside which also has a hospital that is registered separately with CQC. Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

The hospital was closed at the time of our inspection due to flood caused by a major water leak in January 2019. Patients from the hospital were transferred at short notice to some of the adult social care locations and at the time of our inspection, three patients were accommodated. We reviewed aspects of these patients care and support in line with the expectations of their inpatient status, with assistance of CQC colleagues from the hospital’s directorate.

The provider notified us of the temporary arrangements for hospital patients while refurbishments were taking place. We informed the provider at the time and at inspections that to continue offering accommodation to hospital patient’s they must submit applications to CQC. This is to ensure the regulated activity for hospital patients was provided at Old Vicarage. However, the provider failed to do this which meant the Old Vicarage continues to be incorrectly registered.

People’s experience of using this service:

People were not safeguarded from abuse and were placed at some risk of harm.

Medicines were not well managed. Medicines Administration Records (MAR) were confusing. This increased the risk of errors.

There were concerns about the competencies of some staff to manage the complex care needs of people living at Old Vicarage. There were concerns about the medical cover provided to people who should have been accommodated in the hospital.

The service was not well led. The management had not taken action in response to events that had or could cause harm to people. There have been persistent changes of senior managers. There was a lack of regulatory response from the provider.

Rating at last inspection: The overall rating was changed to Inadequate at the focused inspection dated March 2019.

Why we inspected: This inspection was brought forward due to information of risk or concern following the last inspection, in March 2019. After the inspections in August & November 2018 and March 2019 CQC requested assurances from the provider about the action they would take to improve the service. The responses provided by the provider did not give assurances that the service would improve.

Enforcement: Following the last inspection we imposed a condition on the providers registration to submit monthly improvement action plans to CQC. The action plans provided did not give assurances that the service would improve.

Section 31 of the Health and Social Act 2008 allows the Commission to serve a Notice of Decision upon providers if it has reasonable cause to believe that, unless it acts any person will or may be exposed to the risk of harm.

The Commission used its powers pursuant to the urgent procedure (for suspension, or imposition or variation or removal of conditions of registration) under Section 31 of the Health and Social Act 2008. Although the provider told us they intended to close the service we continued to urgently remove the regulated activity from the registration.”

Follow up: This service has been placed 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.

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.

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

The Old Vicarage is a ‘care home for 22 male adults with acquired or traumatic brain injury, or other neurological conditions. 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.

The Old Vicarage is one of six adult social care locations at Glenside which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Speech and Language, psychology physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

One adult social care location (Pembroke Lodge) is currently closed as there were ongoing and continual issue with the provision of heating and hot water.

The hospital is also currently closed due to flood caused by a major water leak. People from the hospital were transferred at short notice to some of the adult Social care locations. Works to repair the fabric of the hospital building are currently underway. The Old Vicarage was temporarily accommodating four people from the hospital. We reviewed aspects of these peoples care and support in line with the expectations of their inpatient status.

The provider notified us of the temporary arrangements for hospital patients while refurbishments take place. However, The Old Vicarage will not be correctly registered with CQC if these arrangements become long term. The provider will need to submit applications to CQC to register appropriately if the closure of the hospital continues.

People’s experience of using this service:

The service was rated Requires Improvement at the comprehensive inspection dated June 2018. The rating for the focus inspection undertaken on the 7 November 2019 remained the same.

• People were placed at risk from poor management. We found systemic overarching poor management systems and improvements were not prioritised. Quality assurance systems were in place but the improvement plans were not adequate. There had been sudden and persistent changes of senior managers. A lack of regulatory response from the provider. Poor recruitment procedures, lack of investment with equipment and maintenance of the property. The morale of the staff was low and they were reluctant to give feedback because of fear of reprisals.

• Areas of the home were not clean and there were repairs outstanding. The staff told us the response from the maintenance team was not prompt.

• Care plans and risk assessments were in place on how to manage risk. The staff knew people’s individual risks and the action needed to minimise the risk. There were people whose brain injury had triggered changes in their behaviour. Care plans gave detailed guidance on how staff were to manage situations when people used extreme behaviours to express their emotions.

• Protocols on the administration of medicines prescribed to be taken “when required” were not detailed on how staff were to identify signs of anxiety. Risk assessments did not give staff guidance on the preventative measures to take for people that smoked.

• Medicine records were signed by staff to show they had administered medicines. A record of medicines no longer required was maintained which the supplying pharmacist signed to evidence receipt of the medicines for disposal.

• The staff we spoke with knew the types of abuse and to report their concerns. People said they felt safe living at the home.

• There were adequate staff available to support people. People told us the staff responded to their request for support and assistance. Staffing levels were maintained with agency staff.

• The staff told us the home manager was approachable. These staff expressed concerns about the changes at senior manager level.

• Patients were not receiving safe coordinated clinical care from health professionals.

The service did not have a registered manager in post. The service was being managed by an interim manager

Whilst we saw that some improvements had been made these were not sufficient to improve the ratings.

Rating at last inspection: This service was rated Requires Improvement at the inspection dated 30 August 2018.

Why we inspected:

This inspection was brought forward due to information of risk or concern; following the last inspection, in October 2018, we have received on going whistleblowing concerns. After the last inspection we requested assurances from the provider about the action they would take to improve the service. To date these assurances have not been forthcoming. We did not inspect the key questions Effective, Caring and Responsive because ongoing monitoring did not raise any information about risks or concerns in these areas.

Enforcement:

Following the focus inspection in November 2018 we imposed a condition on the providers registration. The provider was required to submit monthly improvement action plans to CQC from February 2019. We also issued four warning notices following the focus inspection at Glenside Hospital in November 2018.

Follow up: The overall rating for this service has changed to Inadequate. We are placing the service in 'special measures'. 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 and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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

The team inspected the service against two of the five questions we ask about services: is the service well led and safe. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Effective, Caring and Responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The Old Vicarage is a care home for 22 male adult’s with acquired or traumatic brain injury, or other neurological conditions. 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.

The Old Vicarage is one of six adult social care locations at Glenside Manor which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain. Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

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.

At the previous inspection dated June 2018 we found a breach of Regulation 12 – safe care and treatment. We asked the provider following the inspection to tell us how they were going to meet this regulation. The provider failed to report on the actions to meet Health and Social Care Act 2008, its associated regulations, or any other relevant legislation. At this focus inspection we found other parts of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were not being met.

The CQC formally requested under Section 64 of the Health and Social Care Act 2008 to be provided with specified information and documentation by 16 November 2018. We received some of the information requested but not all.

Quality assurance systems were inadequate. Audits were not robust and did not provide an accurate assessment of the quality of care delivered. Action plans were not developed to drive improvements. The CQC was not notified of accidents and incidents reportable under the Care Quality Commission (Registration) Regulations 2009: Regulation 18.

People were not safe from the risk of potential harm. There were people whose behaviours had changed due to their brain injury or neurological conditions. This meant some people presented with difficult behaviours when they expressed their frustrations and anxiety. The training matrix indicated that 90% of staff had attended MAPA training. MAPA (Management of Actual or Potential Aggression) programme teaches management and intervention techniques to help staff manage escalating behaviour in safe manner. However, the names of staff listed in the staff list were not included in the training matrix. The names of 18 staff in the staff list were not included in the training matrix. This meant all staff working at the home had attended training.

Recruitment procedures did not ensure the staff employed at the home were suitable to work with adults at risk. There were staff employed through a recruitment agency and referred to as “agency staff” because of their terms and conditions. The HR assistant was not able to show that agency staff recruited were suitable to work with adults at risk.

New staff did not always have an induction to prepare them for the role they were employed to carry out. The personnel files of five staff did not provide any evidence of the induction completed or in progress. We were not able to verify that these staff had an appropriate induction before starting work. We were informed that not all staff had received an induction or mandatory training due to the level of the English they spoke and understood. It was said that these staff were unable to sign the training completed because their English was so poor.

Whistleblowers told us senior managers were unaware of staff working and accommodated within Glenside Manor. We received concerns about staff known as “agency staff” as they were not directly employed by the provider but introduced to the provider by recruitment agencies. There were a number of staff on site whose identity could not be confirmed by the most senior staff on duty. The list of agency staff provided on the first day of the inspection was not up to date as we met another 11 staff not included in the list and covering a variety of roles.

The documents provided to us under Section 64 of the Health and Social Care Act 2008 did not provide confidence that staff working at the home were trained for their role. The staffing list provided included the names of 15 staff with the role of delivering direct care for up to 12 people. The training matrix listed the names of nine staff as having attended training. However the names of six staff were missing from the training matrix. This meant there was no evidence that the six staff had attended any training. .

People were not provided with their personal care in a timely manner. There was insufficient equipment across sites. For example, hoists for transfers were shared with another location.

The CQC received whistleblowing concerns about the competency of the staff undertaking maintenance checks of systems and equipment. The CQC following the inspection requested proof of the competency of these staff from the provider. The documentation provided under Section 64 of the Health and Social Care Act 2008 did not give CQC reassurances that staff undertaking maintenance checks were skilled or competent.

The information received from relatives about raising concerns was not consistent with the complaints log.

Staff morale was poor and staff told us they feared about their jobs as they had witnessed other staff being dismissed almost daily. The staff survey provided under Section 64 of the Health and Social Care Act 2008 indicated that 13 of the 38 staff responding would recommend the home.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. 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.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. 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.

This inspection took place on the 6 and 7 June 2018 and was unannounced on the 6 June 2018. The operations director and staff were aware of the visit that took place on the 7 June 2018.

The Old Vicarage is a ‘care home for 22 male adult’s with acquired or traumatic brain injury, or other neurological conditions. 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.

A manager was in post and was in the process of applying to register as manager with CQC. ‘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 raised concerns with the operations director about the number of locations the proposed manager will have and how a management presence will be maintained. The operations director told us a deputy manager’s post was introduced and they will provide day to day presence at the home. The deputy manager told us the current manager maintains good lines of communication between the home and the operations director.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people who used the service. Documents were developed from the audits undertaken which showed how the provider was meeting their own targets. While audits were undertaken to assess how standards of care were being met the findings from this inspection had identified other areas for improvement. However, there were areas identified at this inspection that had not been prioritised for improving. For example, risk assessments action plans, care plans lacked guidance to staff and following incidents and accidents a review of needs was not triggered

Some risks were assessed but lacked action plans on how to minimise the risk. Individual risks included people with a history of falls, mobility needs, and malnutrition. Moving and handling risk assessments were detailed on each movement, the aids and equipment used and the number of staff needed. The staff we spoke with had attended training in moving and handling.

There were people who at times placed themselves and other at risk of harm. The management of behaviours policies were not always followed. The appendices attached on developing behaviour plans were not used. Members of staff described how they managed these situations but guidance was not detailed on how staff they were to manage these levels of anxiety. Information of aggression was reported in the daily notes but senior staff were not always aware of incidents. Analysis of behaviour charts have no impact on devising behaviour management plans

Incidents of aggression were not analysed for those people that expressed their anxiety through behaviours that were difficult to manage. A review of the risk assessment was not triggered following incidents. There was little evidence of learning from incidents and staff may take aggression towards them as usual during the working day instead of devising plans to prevent situations from escalating. Without specific guidance for reference the actions of the staff were open to their interpretations as the same staff were not on duty each day. This meant without detailed guidance a consistent approach was not always possible.

The rota showed there were 11 staff on duty during the day and included registered nurses and one to one support. The staffing levels were maintained mainly by agency staff.

Housekeeping vacancies meant all areas of the home were not clean and people were at risk from the spread of infection. The rota was not meaningful for the whole site. For example, a member of housekeeping staff employed to work seven and a half hours per day was rostered to work at the home for six hours as well as 11 hours in four other locations within the site. Cleaning schedules showed from 3 June until 6 June one bedroom was cleaned. We showed the clinical lead the areas of the home that were dirty and in need of repair. The clinical lead took immediate action.

Some care plans had aspects of person centred care in relation to tasks. However, care plans lacked clear guidance on how to deliver care. Guidance was inconsistent and not clearly written. There was a lack of continuous assessment of needs to ensure people’s changing needs were met. Communications care plans needed to be clearer. Staff were not given guidance on how to communicate with people. Handovers were from the registered nurse to registered nurse arriving on duty and then to rehabilitation care assistants. This meant that information relayed was prioritised by staff.

There was a medical model approach to people and for recording information. For example, people were referred to as "patients" and registered nurses as "ward staff". A hospital model for all locations was used despite this home and five other locations having an Adult Social Care (ASC) registration. People in ASC services have an equal right to expect support in a manner and in circumstances which correspond with their preferences as well as being enabled to be as independent as possible. Whereas staff using a medical model approach have a view of what is 'wrong' with the person and may create low expectations and leads to people losing independence, choice and control over lives.

The arrangements for medicines were mainly safe. However, “when required” (PRN) procedures were not clear on when these medicines were to be administered. PRN protocols for paraffin based emollients did not include safety precautions for people that smoke.

Repairs were outstanding and were not carried out in a timely manner or adequately to keep people safe.

New staff had an induction to ensure they were confident to perform their role. Staff told us they had attended the training provided by the organisation and there were opportunities for staff to gain professional qualifications. Staff felt supported and able to discuss issues with a line manager. Group supervision was recently introduced e.g. safeguarding week to look all areas related to specific topics.

The people we spoke with told us they made their own decisions in relation to activities, meals and times to rise and retire. Mental capacity assessments were in place for complex decisions. Where people lacked capacity to make decisions clear documentation was in place on who made the best interest decisions. However, overarching capacity assessments for care and treatment need to include administration of medicines and photographs.

There were weekly routine visits from the GP and as needed for urgent visits. People at the service had access to on site Speech and language therapists, Occupational therapists and psychologists through a referral system.

The people we spoke with said they felt safe. The staff we spoke with said they had attended safeguarding of abuse training. They knew the types of abuse and who to report their concerns of abuse. We saw the staff manage incidents calmly and quietly and resolved issues quickly before they escalated. People knew who to approach with concerns and the complaints procedure was on display in the home.

People told us the staff were caring and felt able to express their views about their care. The staff respected their rights. We saw good interaction between staff and people. We saw the staff were fund raising for therapeutic care intended to bring “one person out of himself.”

Staff told us there had been many management changes and changes of owners. They said the team worked well together and were supported by the deputy manager on a day to day basis.

We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in post and had been recently employed. ‘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 people we spoke with made positive comments about the care delivered by the staff. They said they felt safe living at the home, the food was good and there were choices of meals at mealtimes. People attended residents meetings where their views about the service were gained. They told us their healthcare needs were met and they had access to internal healthcare professionals. People told us how verbal and aggressive behaviours were managed by the staff.

The staff said they attended training that ensured they had the skills and knowledge needed to meet people’s needs. However, staff showed a lack of insight into people’s needs and how to develop relationships with people living with dementia. We noted staff used outdated language when they discussed people and in the recording of people’s needs. Comments from staff about the importance of developing relationships were not always person centred. Staff did not have an understanding of the person and what was individual about them. While training was available to staff on person centred care and to meet the needs of people living with dementia not all staff had taken the opportunity to develop their skills and knowledge in this area.

Care plans were variable and were not always person centred. People were not involved in the development of their care plans and did not participate in their review meetings. Behaviour management plans were in place and the quality of the information was variable. Staff recorded incidents of aggression on Patient Observation (OS) charts which showed behaviour management plans were not consistently followed. There was no evidence that the charts had been analysed and the care plan reviewed following an incident. We were shown the charts to be introduced and will provide more detailed information for staff to identify triggers. We were told the new formats will allow for analysis of frequent behaviours.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people who used the service. Documents were developed from the audits undertaken which showed how the provider were meeting their own targets and identified business development plans with areas for improvements. While audits were undertaken to assess how standards of care were being met the findings from this inspection had identified other areas for improvement. We found the care plan audit had not identified the terminology used by staff to document events and that care plans were not person centred.

We found there were areas of the home that were not maintained to an acceptable hygiene standard. We found there were repairs needed in bedroom and lift. Link infection control staff had identified shortfalls in hygiene standards. However the Health and Safety audit had not identified the same areas of poor hygiene and in need for improvement.

Members of staff attended training in safeguarding of vulnerable adults from abuse. The staff we spoke with knew the types of abuse and the actions they must take for allegations of abuse.

Some risks were assessed and staff knew the actions they must take to minimise the risk to the person. Risk assessments were in place for people who at times resisted personal care and staff were given guidance on how staff to respond and reduce anxiety. Risk assessments were not in place for people who smoked and where staff restricted their access to lighters and cigarettes and for people at risk of over hydration.

Staff said the staffing levels were decreasing and the needs of people were not recognised which meant sufficient staff were not on duty to meet people’s needs. The registered manger and operations manager said this was staff perception and initiatives such as task lists were introduced to show to staff they had sufficient time for task and for one to one time with people.

Safe recruitments processes were in place. Candidates were able to use their preferred method of application form which included CV to apply for vacant posts. Disclosure and Barring Services (DBS) must be approved before the staff start working at the service. A Disclosure and Barring Services (DBS) check allows employers to check whether the applicant has any convictions or whether they have been barred from working with vulnerable people. Where staff had disclosed convictions or cautions they were investigated and risk assessments completed to ensure staff were safe to work with people.

People's medicines were administered from standard packaging and Medication administration charts (MAR) were signed to show the medicines administered. Application charts were not used by rehabilitation assistants (RA) to document the application of topical creams. The procedure was for RA to confirm to the nurse who will then sign the MAR. The operations manager said the method of recording topical cream will be reviewed. The number of medicine errors has reduced since changes of the supplying pharmacy for medicines.

Induction of new staff was detailed and there was ongoing reviewing of the process. Staff on induction said the induction was good. There was mandatory training set by the provider which staff attended to ensure they had the skills needed to meet people’s needs. There was a re-validation programme for nurses. Staff can apply for nursing degree and during their training these staff must work at the service one shift per week.

Appraisals of staff with the registered manager were annual. Part of the appraisal system was for staff to appraise themselves. The appraisals we viewed did not include the discussion with the registered manager and the action plan on goals for the year was not included in the appraisal records. This will ensure staff were confident and skilled to perform their role Appraisals of staff with the registered manager were annual.”

People were subject to continuous assessments. Staff's awareness of Deprivation of Liberty Safeguards (DoLS) procedures was variable and their knowledge depended on their role in this area. Staff's understanding on the principles of the Mental Health Act was based on how to support people with making day to day decisions.

People’s ongoing healthcare needs were met and referrals to specialist healthcare professionals were made for further investigations. We saw that following visits healthcare professionals documented the outcome of their visits. People had access to internal support e.g. Speech and Language therapists and Occupational therapists.

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We saw staff had supported people to personalise their bedrooms. A member of staff said the when people arrive maintenance staff support people personalise bedroom. For example, to hang pictures where people wanted. We saw staff spending time with people participating in activities such as games and quizzes.

The management team took inspection feedback seriously and acted upon some of our findings promptly to enhanced the quality of care

“You can see what action we told the provider to take at the back of the full version of the report.”

We made a recommendation the service review procedures in line with the Mental Capacity Act Code of Practice and to ensure a person centred approach is embedded into day to day practice.