Gresley House Residential Home

About the service

Gresley House Residential Home is a residential care home providing personal care to up to 37 people. The service provides support to older people, younger adults, people living with dementia and people with physical disabilities. At the time of this inspection there were 25 people using the service. Accommodation is provided in one adapted building. There are a range of communal facilities including space to eat and socialise both inside and outdoors.

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

The inspection identified refurbishments in the home had been completed to a good standard. The home was clean throughout and had a homely atmosphere.

Staff were available to support people to meet their needs, including in activities of their choosing. Areas of risk in people's lives were identified and managed effectively. People's care records contained up to date and consistent information.

People received care that was person centred to meet their needs. Staff knew people well and how best to support them in line with their individual preferences.

People and their relatives were very complimentary about the home. One relative told us, “When I’m walking through the home everyone looks happy, I feel the staff are there for their love of the residents, it’s not just a job to them.”

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.

Staff were engaged and involved in the service and supported by the registered manager. People, their relatives and staff gave consistently positive feedback about the registered manager. Staff told us they were proud to work at the home.

The provider had implemented systems and processes to improve the oversight at the service. More time was required to provide assurance that recent changes to systems were effective and fully embedded.

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 inadequate, published 18 January 2023. Another inspection took place on 6 February 2023, published 21 April 2023. This inspection was not rated.

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 the inspection in November 2022, report published 18 January 2023. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to good based on the findings of 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 COVID-19 and other infection outbreaks effectively.

Follow up

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

Gresley House is a residential care home providing personal care for up to 37 people. The service provides support to older and younger adults, including people who have dementia. At the time of our inspection there were 28 people using the service. The accommodation is split over 2 floors with a purpose-built extension.

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

Care records did not always contain accurate, consistent or up to date information. Risks to people were not always identified or effectively managed.

There was a lack of provider oversight of the service. Systems and processes were ineffective and failed to identify or address some issues and concerns.

Infection control measures and practices had been implemented and improvements had been made to the environment.

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 inadequate (published 22 November 2022) and there were 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 the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about safeguarding incidents, whistleblowing allegations and unwitnessed falls. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review.

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.

Gresley House is a residential care home providing personal care for up to 37 people. The service provides support to older and younger adults, including people who have dementia. At the time of our inspection there were 30 people using the service. The accommodation is split over two floors in a purpose-built building.

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

The provider lacked oversight of the service and did not ensure sufficient and effective management. This resulted in a lack of effective audits which meant issues and concerns were not being picked up or addressed.

People were not protected from risks associated with their individual needs and wider environment. The provider did not effectively implement measures to reduce risks. People’s medicines were not always managed in a safe way.

People did not always receive care in a personalised way. People were not supported to continue taking part in hobbies that interested them and activities were not developed to support people with specific needs. People’s care plans contained incomplete and inconsistent information.

People were not 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; the care plans and systems in the service did not support this practice.

The service relied heavily on agency staff, some of whom we could not be certain had been checked for suitability prior to supporting people. People told us they sometimes had to wait for support. Staff said they were very rushed and felt they could not spend quality time with people.

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 2 November 2022) and there were 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 the provider remained in breach of regulations.

Why we inspected

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

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 requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to managerial oversight, personalised care, safeguarding and risk management 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Gresley House is a residential care home providing personal care for up to 37 people. The service provides support to older and younger adults, including people who have dementia. At the time of our inspection there were 36 people using the service.

People's experience of this service and what we found

Risks to people's health and safety were not always identified or managed effectively. These included environmental risks and risks associated with people's care and support. People were not consistently protected from the risk of infections.

People did not always receive their medicines as prescribed. Improvements were needed to ensure people's medicine records were an accurate reflection of their needs and prescriptions.

Oversight arrangements for the quality and safety of people’s care were not effectively operated. Not all concerns found on inspection had been identified. Systems to monitor the running of the service were not always effective in identifying and ensuring improvements were made and sustained. The provider remained unable to demonstrate sufficient improvements to the service had been made or sustained since our last inspection to achieve a good rating.

People were supported by enough staff to meet their needs. Staff, including agency staff, were safely recruited, inducted into the service and received on-going training and support. Staff were aware of people's needs and provided personalised care and support. People were supported to maintain their health and well-being. 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 were supported to interact, participate in in-house activities, and maintain links with family and friends. We have made a recommendation around the activity provision for people who have dementia to ensure all activities are inclusive.

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

Rating and update

The last rating for this service was requires improvement (published 28 November 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to people's health and safety, including the prevention and control of the risk of infections, the safe management of medicines and leadership and governance of the service at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gresley House Residential Home is a residential care home registered to provide care for up to 37 older people, some of whom are living with dementia. At the time of the inspection 32 people were living in the home.

Gresley House Residential Home accommodates up to 37 people across two floors.

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

The home appeared clean, however, the registered manager needed to implement systems to record when cleaning of shared equipment and bathrooms was taking place.

The registered manager needed to implement twice daily temperatures in line with current guidance.

People, staff and visitors were protected against the spread of COVID-19. The provider carried out regular testing and screening procedures to ensure visitors could safely visit. The registered manager maintained contact with relatives and kept them updated on any changes.

Staff wore appropriate PPE and PPE stations including hand sanitiser were placed throughout the home. The disposal of Personal Protective equipment (PPE) followed government guidance and best practice.

Risk assessments were in place for people and staff regarding individual risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations.

The registered manager completed regular audits to ensure oversight of IPC practices.

The provider had a number of staffing vacancies. They used regular agency staff to ensure there were enough staff to meet peoples' needs. The provider had a recruitment drive to employ more care staff.

People's risks were assessed regularly or as their needs changed. Staff referred people to health professionals for skin conditions and followed their advice.

Staff assessed and monitored people after they had a fall. The registered manager reviewed the incidents of falls for trends so they could implement changes to improve the service.

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 the service was Requires Improvement, published on 21 October 2019.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received relating to the management of falls, staffing, skin integrity, record keeping and cleanliness of the service. The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

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

We found the following examples of good practice.

¿ The registered manager was knowledgeable about best practice guidelines in relation to infection prevention and control. They had reviewed procedures to ensure staff were adhering to this guidance.

¿ There was Personal Protective Equipment (PPE) around the home. Staff had received infection control training and their knowledge and competencies had been reviewed to ensure they were putting on and taking off PPE in the right way.

¿ The home was clean, and the staff were using recommended products to ensure it was cleaned effectively throughout the day and touch points were wiped regularly.

¿ People were generally receiving care in their bedrooms. Some people were living with dementia and moved around the home; the furniture had been arranged to ensure people maintained social distancing.

¿ Cleaning schedules and staffing levels within the home had been reviewed to reduce the risks associated with the infection and ensure there were enough staff to meet people’s needs.

¿ Testing was completed weekly for staff and monthly for people using the service. People using the service had consented to testing.

¿ People’s temperatures were checked throughout the day to ensure early signs of illness could be identified.

¿ The infection control policy was up to date and the audits reflected actions had been taken to maintain the standards within the home.

¿ There were no visitors allowed in the home. Only essential people had entered the home during the outbreak.

Gresley House Residential Home is a residential care home that was providing personal care for 23 people aged 65 and over at the time of the inspection.

The home has three lounges for people to use and a shared dining room. Bedrooms are on the ground and first floor, which can be accessed by a lift. There is secure garden to the rear of the property.

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

Risk assessments had been reviewed and generally ensured people could continue to enjoy activities as safely as possible and maintain their independence. Further review was needed to ensure all risks associated with eating and drinking and pressure care was managed. Medicines management systems were in place although these needed to be reviewed to ensure there were accurate records of all medicines in the home. Quality assurance reviews were completed, however further review was needed to ensure all aspects of the service were monitored.

Staff understood their responsibility to safeguard people from harm and they worked with the local authority to ensure people remained safe. People’s care needs had been assessed and reviewed to ensure they received care to meet their individual needs. The care plans detailed how people wished to be cared for and supported and evidenced where people had been involved with any review.

There was suitable staffing to meet the support needs of people. The staff understood their role and how to support people safely. Staff received training and support to gain the skills they needed to care for people.

People were being supported to make decisions about their care. 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 were encouraged and assisted to eat and drink and there was a varied choice of meals. People’s special dietary requirements were met and where concerns were identified, people’s weight was monitored. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported and had developed good relationships with staff. People chose how to spend their day and they took part in activities that interested them. People were confident they could raise any concerns with the registered manager or staff and were complimentary about the service provided.

The registered manager was approachable and provided support to the staff team. People were encouraged and supported to provide feedback on the service and there were effective systems in place to review and improve the quality of the service provided.

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 Inadequate (Published 24 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection and each month 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 May 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.

People’s experience of using this service:

The provider had failed to act to ensure improvements had been made within the service. Good care is the minimum that people receiving services should expect and deserve to receive and we found the systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor the service had not been effective in identifying the improvements that were still needed. People were not always protected from harm as action had not been taken where risk had been identified. Quality monitoring had been inconsistent, and the provider not fully assessed and reviewed people’s care and to ensure risks were mitigated to ensure their safety. Care plans were not sufficiently detailed to guide staff to provide people’s care needs or end of life wishes.

People’s support was not provided in line with current legislation and best practice guidelines; people did not always have a care plan which reflected how to minimise risks and record how they wanted to be supported. Staff had not received the necessary training to support people with complex behaviour.

People could make everyday decisions. However, where people were unable to make decisions about their care, capacity assessments did not include how decisions had been reached and people’s capacity had not been assumed. This meant some people were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice.

Improvements had been made with how people received their medicines and how these were recorded. Improvements had been made to ensure infection control procedures were maintained in the home.

People had opportunities to engage with activities that interested them. People had a choice of meals and staff were knowledgeable about their food preferences. People told us they enjoyed the meals provided and we observed staff monitored people who were at risk at mealtimes.

There was sufficient staff available to support people. People felt the staff were kind and supportive and they enjoyed living at the home. They provided reassurance and emotional support and encouraged people’s independence.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback.

Rating at last inspection: Requires Improvement and Inadequate in Well Led. (Published November 2018)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: 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: 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.

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

Gresley House 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. At the time of the inspection there were 27 people using the service.

There was a registered manager 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.

This inspection was unannounced. Gresley House was last inspected on 23 March 2017 and the service was rated as Requires improvement. This was because we identified concerns that people were not always kept safe from harm and some people were restrained without the need for this being assessed. Medicines were not always managed safely to ensure that the risks associated with them were reduced. Not all of the staff had the knowledge and skills to support people effectively.

At this inspection, although we saw some improvements had been made, further improvements were still needed. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor and improve the service had not always been effective in identifying improvements were still needed in the home. People were not always protected from harm as action had not been taken where risk had been identified. People did not always have a care record which reflected how to minimise risks and record how people wanted to be supported.

Further improvements were needed to ensure people’s medicines were accurately recorded to reflect when they received these, the storage arrangements was not secure for all medicines and the temperature of the room was too high to ensure the integrity of all the medicines.

Staff received training and support to develop the skills and knowledge to support people, however the provider had not ensured that people’s support was provided in line with current legislation and best practice guidelines; this had resulted in people being placed at risk of harm.

People had access to healthcare services and felt they received the support they needed from trained staff. There were sufficient staff available to meet the identified needs of people who used the service in a way that they wanted this. Health concerns were monitored and people received specialist health care intervention when this was needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People could decide how they wanted to be supported.

Staff had developed caring relationships with people and their privacy and dignity was respected. The staff were developing the service they provided to people who were living with dementia and no longer wore uniforms with the aim of providing a more homely feel.

People enjoyed the activities and opportunities to socialise. People were able to stay in touch with people who were important to them as visitors could come to the home at any time. People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns being raised.

Visitors were welcomed at any time. People knew who the registered manager was and the staff felt they were approachable and provided support to them. People were able to share their views about the service and received feedback on developments in the home. Mealtimes were not rushed and people enjoyed the food that was prepared and following consultation had decided to eat their main meal in the evening.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

At the last focused inspection on 7 July 2016 we found that improvements were required to ensure that people were safe and that the service was well led. At this inspection we found that some improvements had been made and further improvements were still required. People were not always kept safe from harm because staff did not always recognise what the signs of abuse could be and report them to be investigated. Some people were restrained without the need for this being assessed. There was no plan to ensure that it was completed safely and used only as a last resort. It had also not been considered when the provider reviewed people’s capacity to make decisions for themselves.

Medicines were not always managed to ensure that the risks associated with them were reduced. Some of the issues with medicines had been picked up by the provider’s quality audits but the situation had not been resolved.

Some staff did not competently communicate within the team to ensure that people’s needs were met. Not all of the staff had the knowledge and skills to support people effectively. The provider had not taken sufficient action to ensure that all staff took responsibility to complete their jobs to the required standard.

Other quality improvement tools were supporting the development of the service. Accidents and incidents were reviewed and risk was managed; for example, when using equipment to move people safely. Staffing levels were planned according to people’s needs and there were sufficient staff. The provider had invested in environmental improvements in the home.

Staff knew people well and had caring respectful relationships with them. They respected people’s dignity and privacy. They were also aware of their changing care needs. People’s records were up to date and amended to reflect changes in people’s health and wellbeing.

People had choice about their meals and had enough to eat and drink. They were supported to have their healthcare needs met and referrals were made to health care professionals for additional support and guidance.

People were encouraged to pursue interests and regular activities were planned for them. Visitors were welcomed at any time. People and relatives knew the manager and felt confident that any concerns they raised would be resolved promptly.

Staff said they were well supported by the registered manager and plans were in place to continue to develop their skills. There was an inclusive culture which welcomed feedback in order to support the development of the service.

We found breaches 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.

We undertook this focused inspection on 7 July 2016 to check that they now met legal requirements and to review the rating of inadequate in Safe. This report only covers our findings in relation to those requirements and that review. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gresley House on our website at www.cqc.org.uk

There was a registered manager 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.

Gresley House provides residential care and support for people, some of whom are living with dementia. It is registered to provide care for 27 people and at the time of our inspection 22 people were resident.

At this inspection the provider had made improvements in how they managed risks to people’s health and wellbeing. Staff had received additional training and they now supported people to move safely, using the correct equipment. The provider had purchased new equipment which assisted the staff to meet people’s needs safely. They had implemented new systems to analyse and review accident and incidents, including falls, and were putting actions in place to reduce the risk of them occurring more promptly. Staff supported people when they became anxious or when their behaviour could cause harm to themselves or others. Records were up to date and amended to reflect changes in people’s health and wellbeing and referrals were made to health care professionals for additional support and guidance.

The provider had made improvements in the management of medicines. People consented to take their prescribed medicine and there was enough in stock to be able to administer them. When people did take medicines as required there was guidance in place for staff to know when they should support people to take them.

The environment was improved to reduce risk as hazards were removed and renovations had taken place which reduced the risk of spreading infection. Staff had protective equipment more readily available and there were better arrangements in place for the disposal of clinical waste.

At our last inspection the provider had not ensured that there were adequate staff to meet people’s needs. At this focused inspection staffing levels had been increased and we saw that people did not have to wait for staff to attend to them. Falls which occurred at night had decreased with additional staff deployed to observe and support people.

Systems had been put in place to check the quality of the service to ensure that there was improvement in quality. These included auditing medicines management, infection control, pressure care, nutrition and environmental maintenance. The impact of these measures was already evident and the provider had plans in place to fully embed them to ensure that they were effective.

At this inspection the provider had not always considered people’s longer term care needs and there were not always plans in place to support staff to know what the next steps for people were. Some improvements had been made to ensure that people consented to their care and when they were unable to do this that assessments showed that decisions were made in their best interest. However, it had not been fully implemented.

We found one breach 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.

The service had a new manager in place that was in the process of becoming registered. 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.

Risks to people’s health and wellbeing were not adequately assessed and managed leaving people at risk of harm. Where risks had been identified the provider did not always take action to remove or minimise the risks. Changes to people’s health were not always responded to by referring them to healthcare professionals. Some people did not receive enough support with eating and drinking. Staff did not always have the skills to be able to support people effectively and the provider did not have a system in place to routinely assess their competence.

There had been a number of safeguarding concerns which occurred at night and a report had been written by the manager which recommended increasing the staffing numbers to reduce the risk of harm to people. The provider had not responded to this recommendation and there were not always enough staff to respond to people’s needs.

Medicines were not always available as prescribed and people did not always consent to the medicines they were given. Where people lacked capacity to make decisions for themselves, there was not an assessment completed to consider what decisions should be made in the person’s best interest. Some decisions were made without the person’s consent or the consideration of who should be included in deciding what was in their best interest.

The premises were not fully maintained and risks in the environment were not managed to reduce the possibility of harm to people. Plans to respond to emergencies such as evacuation were not adequate to ensure that people could be supported safely.

People’s dignity and privacy were not always upheld and staff reported that they were not always able to spend quality time with people. When they did, we observed respectful relationships and that were people were treated with kindness.

Peoples care plans were not always altered to reflect a change in their support needs and so did not assist staff to provide a personalised service. Opportunities to pursue hobbies and interests were limited for some people and some of the premises, such as the garden, were not maintained well enough for people to be able to use them.

Complaints were not well managed and formal complaints the provider had received had not all been responded to promptly and resolved to people’s satisfaction.

The service was not well led because the provider did not respond to assessed risk and concerns in a timely manner to provide people with the adequate care and support to keep them free from preventable harm. Staff reported that they did not feel their concerns were listened to and this meant that issues around people’s health and wellbeing were not always actioned. The systems in place to drive improvement were not effective because they did not identify areas for improvement or when they did these were not responded to.

We found breaches 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.