Polefield Nursing Home

Polefield nursing home is a residential care home providing regulated activities personal and nursing care to up to 40 people. At the time of our inspection there were 32 people living at the home.

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

The local authority had identified shortfalls in governance systems prior to the inspection. In addition, the monitoring of incidents and accidents needed to improve. We have made a recommendation about safeguarding guidance. The provider had responded positively to all concerns raised. People and staff reported a positive culture within the home and people told us staff were kind and caring.

People received their medicines safely and recruitment practices were safe. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. We have made a recommendation about adequate equipment storage space.

There was an established staff team that was motivated to carry out their roles. Staff worked in partnership with health and social care professionals. The service was accessible and had been adapted to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 20 June 2019).

Why we inspected

We received concerns in relation to training and supervisions. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led.

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has not changed based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the well led sections of this full report.

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

The provider responded positively to all the concerns raised and had been working closely with the local authority to resolve issues prior to the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Polefield nursing home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We identified 2 recommendations. We have made a recommendation about safeguarding guidance. We have made a recommendation about adequate equipment storage space.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Polefield Nursing Home is registered with the Care Quality Commission (CQC) to provide nursing care and accommodation for up to 40 people. The home is located in the Blackley area of Manchester and has adequate parking facilities onsite.

People’s experience of using this service:

Inspection activity began on 25 April and concluded on 30 April 2019. At the time of the inspection there were 30 people living at the home.

People said they felt safe living at the home, with staff demonstrating a good understanding about how to protect people from the risk of harm.

Some aspects of people’s mobility care plans were not always followed by staff such as ensuring people’s beds were at the lowest setting possible to reduce the impact of falls. Zimmer frames were not always in easy reach in communal areas. We raised these issues with the registered manager during the inspection and were given assurances this would be addressed.

Staff were recruited safely, with appropriate checks carried out to ensure there were no risks presented to people using the service.

Maintenance checks of the premises and the servicing of equipment was carried out throughout the year to ensure they were safe to use. Some repair work was required to the lift, however the registered manager had recently obtained quotes from a supplier to have the work undertaken.

There were enough staff to care for people safely and the staff we spoke with told us they felt staffing levels were sufficient.

People received their medication safely, although we spoke with the registered manager about ensuring topical creams were locked away safely and out of sight. This would reduce the risk of them being used inappropriately.

Accidents and incidents were monitored and any actions taken to prevent future re-occurrence were recorded.

People’s mental capacity was kept under review and deprivation of liberty safeguards (DoLS) applications were submitted to the local authority as required. However we have made a recommendation about ensuring capacity assessments are decision specific.

Staff received the necessary training and support to help them in their roles. Staff supervisions and appraisals were carried out and gave staff the opportunity to discuss their work.

People told us they liked the food available and we saw staff supporting people at meal times, if this was something they needed help with. Where people needed modified diets due to having swallowing difficulties, these were provided.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

There were a range of activities available for people to participate in and we observed these to be well attended by people living at the home during the inspection.

We received positive feedback from everybody we spoke with about management and leadership within the home. Staff said they felt supported and could approach the home manager with any concerns they had about their work.

Rating at last inspection:

Our last inspection of Polefield Nursing Home was in August 2018. The overall rating at that inspection was ‘Requires Improvement’. The report was published in October 2018. The ratings for each key question were as follows:

Safe – Requires Improvement

Effective - Requires Improvement

Caring - Good

Responsive - Requires Improvement

Well-led – Inadequate

We identified regulatory breaches regarding safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

Enforcement:

At our last inspection, we issued regulation 17 warning notices against both the registered manager and provider due to the governance issues were identified during the inspection. These needed to be met by 1 November 2018.

Why we inspected:

This inspection was carried out inline with our inspection methodology timescales for Requires Improvement services and where one of the key questions was rated as Inadequate. This meant we needed to re-inspect within six months following the publication of the last report.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for ‘Good’ rated services, however if any further information of concern is received, we may inspect sooner.

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

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is situated over two floors and has a passenger lift between the upper and lower level. The home is set back from the main road, with level access grounds. There is a large garden area which people can access.

We last inspected Polefield Nursing home on 27 September 2017 where the home was rated as Good overall and for each key question, safe, effective, caring and responsive. The well-led key question was rated as Requires Improvement to ensure the improvements made were sustained.

At this inspection in August 2018, we found several areas had since declined and identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) relating to safe care and treatment, safeguarding people from abuse and improper treatment (two parts of this regulation), good governance (two parts of this regulation) and staffing. We have also made two recommendations relating to staff recruitment and handling complaints.

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

We looked at how the service managed risk. Some people living at Polefield Nursing Home required the use of bedrails to help keep them safe whilst they were sleeping and prevent them from falling from bed and hurting themselves. However, we found appropriate risk assessments were not always in place to demonstrate how risks such as entrapment in the bedrails would be mitigated.

We looked at the systems in place to prevent pressure sores and keep people’s skin safe. We saw equipment was used such as pressure relieving mattresses and cushions, however we saw one person’s airflow mattress was not being maintained at the correct setting and in line with their body weight as required. This could have placed this person at risk of skin breakdown.

We looked at the systems in place to safeguard people from abuse and improper treatment. One person living at the home told us they had been roughly handled by a member of staff and that the registered manager was aware of this incident. This had not been reported as a safeguarding concern however and we requested this was done during the inspection.

Accidents and incidents were monitored and body maps completed to identify any injuries. One person had been found with some bruising to their stomach area when they moved into the home, however information had not been accurately recorded about what had happened to the person and if further investigation was required.

Medication was given to people safely, however we found a number of discrepancies with running totals, particularly on the upstairs residential unit, where staff were not accurately recording the correct number of tablets people had left once they had been administered. Cream charts were being completed on the nursing unit to show they were being applied as prescribed, however cream charts were not being completed on the residential unit.

The home was generally clean and tidy, however we noted some carpets and chairs, particularly on the residential unit were stained and would benefit from being replaced.

Effective systems were not in place regarding deprivation of liberty safeguards (DoLS) and the mental capacity act (MCA). Applications for DoLS were not always made in a timely way and mental capacity assessments were not always carried out when concerns were identified regarding people’s decision-making abilities.

Not all staff received timely supervision and appraisal to support them in their role effectively.

We looked at how people were supported to maintain good nutrition and hydration. People’s body weight was kept under review, although where there was a requirement to weigh people weekly, this was not always being recorded as required, particularly on the residential unit.

Accurate and contemporaneous records were not always being maintained regarding people’s personal care and fluid intake.

Staff were recruited safely, with appropriate checks carried out before staff commenced employment. However, we recommend the home keeps an accurate record of all interviews that are held to demonstrate the questions asked and responses received as this was not being done consistently.

We looked at how complaints were handled and saw they had been responded to appropriately. However we recommend all verbal complaints and concerns raised are clearly documented on the complaints log, in line with the home’s complaints policy and procedure.

At the time of the inspection, the home were actively trying to recruit an activities coordinator and some of the feedback we received from people was that there was not enough for people to do during the day.

Each person living at the home had their own care plan and this provided a clear overview about the care they needed to receive. Life histories, which provided an overview of people’s likes, dislikes and preferences had not been completed for each person however and this meant person centred information about people’s preferences was not always available for staff.

A range of policies and procedures were in place, however these were due for renewal in January 2018 and needed to be updated to show they had been checked and that the information was still current.

We found improvements were required to overall governance and quality monitoring systems. This was because concerns identified during this inspection were not always being identified through the home’s own auditing systems.

People told us they felt safe living at Polefield Nursing Home. Staff were trained in safeguarding and demonstrated a good understanding of the process to follow regarding suspected abuse.

We found there were enough staff to care for people safely.

Staff received sufficient training and induction to support them in their role.

People received enough to eat and drink and we saw timely referrals were made to other health care professionals when there were concerns about people’s nutritional status such as speech and language therapy (SALT) and the dietician service.

People received food and drink of the correct consistency which protected them from the risk of choking.

We received positive comments from people spoken with about the care provided at the home. People told us they felt treated with dignity and respect by staff.

Appropriate systems were in place to ensure people’s cultural beliefs were upheld and respected by staff.

Appropriate systems were in place to seek feedback from staff, relatives and people living at the home, through the use of satisfaction surveys and both residents and staff meetings.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is situated over two floors and has a passenger lift. There are four rooms on each floor which are double occupancy and a communal lounge and dining room on each floor. The home is set back from main road, with level access grounds. There is a large garden area which people can access.

We last inspected Polefield Nursing Home in April 2017. At this inspection, the home was rated as Inadequate overall and was also given an inadequate rating in three of the domains in which we inspect. These areas were Safe, Effective and Well-Led. The further two domains which are, Caring and Responsive were rated as Requires Improvement. As a result, the home was placed into special measures. This meant we would keep the service under further review and potentially take further enforcement activity improvements were not made. We also issued an urgent NOD (Notice of decision), informing the home that they were unable to admit any new residents into the home without the prior agreement of the CQC (Care Quality Commission). Following the inspection, the provider sent us an urgent action plan detailing the immediate action they had taken based on the concerns identified. We took this into account when planning this inspection to ensure these actions had been completed.

At the last inspection, we found people had been placed at risk because staff were not always providing the correct consistency of diets such as soft or fork mashed, placing people at risk of choking. These specific diets had been advised by the SALT (Speech and Language Therapy) team and their guidance was not being followed. This area of concern had now been addressed.

The kitchen area was safe and secure whereas at the last inspection it had been easily accessible which could have placed people at risk. The supplement, ‘Thick and easy’ was also being stored securely meaning it could not be consumed in an unsafe manner by people living at the home.

Appropriate recruitment checks were undertaken including seeking references and undertaking DBS (Disclosure Barring Service) checks before staff commenced employment.

There were enough staff working at the home to meet people’s care needs, however due to the restriction on admissions, the home was not at full occupancy. The provider said this would be reviewed when more people moved into the home.

At the last inspection, people living at the home were not always being protected from the risks associated with poor nutrition and hydration and guidance from services such as dieticians was not being followed. We saw improvements in this area at this inspection, with good systems in place to ensure people’s nutritional needs were not compromised. People also made positive comments about the food and drink available.

Staff training had improved since our last inspection which was clearly documented on the homes training matrix. Additional training completed included dysphagia, safeguarding and infection control. Staff told us the home provided enough training to support them in their roles with an induction, supervision and appraisal also available and we saw evidence of relevant documents relating to these discussions.

At the last inspection we found DoLS (Deprivation of Liberty Safeguards) applications were not being made to the local authority where people lacked the mental capacity to make their own choices and decisions. This was now being done consistently and we saw staff had followed these applications up with the local authority to check their progress if they had not yet been granted.

People living at the home and visiting relatives made positive comments about the care provided. People said they felt they were treated with dignity and respect and had their independence promoted as necessary.

Record keeping had improved greatly since our last inspection. We looked at samples of records relating to food/fluid intake and turning/re-positioning charts and saw they were completed with good detail about the care interventions staff had provided.

There were appropriate systems in place to investigate and respond to complaints. Compliment cards were also collated where people had expressed their satisfaction with the level of care provided. Residents and relatives meetings also took place and satisfaction surveys were sent out so that people could provide feedback on the service they received.

We found improvements had been made to the overall governance systems and leadership at the home. Audits and quality assurance checks were now in place to ensure any areas of concern could be followed up accordingly. Previous breaches of the regulations had now been addressed; however we have rated the Well-Led key questions as Requires Improvement because we need to see that these improvements are sustained moving forwards. Therefore we will continue to monitor the service and return to review these areas again at the next inspection.

Polefield Nursing Home provides accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 35 people were living at the service.

Our last inspection of Polefield Nursing was in October 2016 where the service was rated overall as ‘Requires Improvement’ and in four of the five key questions against which we inspected. These included Safe, Effective, Caring and Responsive, with Well-led rated as ‘Inadequate’. There were three breaches of the regulations identified at that time with regards to safe care and treatment, good governance and staffing. This inspection was carried out to ascertain whether improvements had been made since our last inspection.

At this inspection in April 2017, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, meeting nutritional and hydration needs, safeguarding people from abuse, good governance and staffing. We are currently considering our enforcement options and course of action.

At the time of the inspection the home did not have a registered manager in post. This meant the service were failing to comply with the requirements of their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not safe as they were not protected from the risk of aspiration. People assessed as being at risk from an ‘unsafe swallow’ were given foods by staff which could cause them to choke or aspirate. Some of these had been listed as foods to avoid when they had been referred to SALT (Speech and Language Therapy). The supplement ‘Thick and easy’ was also left accessible around the home which presented the risk of people consuming this accidently and placing themselves at risk.

We found the kitchen area was left unsupervised early in the morning when we arrived at the home, with large kitchen knives and a boiling hot water dispenser accessible to people living at the home. The risk assessment implemented following our first inspection visit was not followed and control measures were not adhered to which placed people at continued risk of harm.

Medication was not always given to people safely and we found instances where people had not received their medicines as prescribed. PRN (when required) protocols had still not been implemented which had been raised as a concern at our previous inspection visit.

People living at the home said they felt safe and staff had a good understanding about how to report any safeguarding concerns.

Staff recruitment was robust, with appropriate checks carried out before staff began working at the home.

The building and necessary equipment such as hoists were maintained regularly, with certificates of work completed held in an organised file.

We identified gaps in staff training in areas such as infection control, safeguarding dementia awareness, fire safety and health and safety. The manager was in the process of ensuring staff had access to appropriate equipment such as laptops, to be able to undertake this training during quieter periods of their working day.

People were not always protected from the risk of losing weight and we identified two people whose food was not being fortified with additional calories as advised by the dietician service following referral. There were also concerns with the recording of weekly weights and people being offered snacks in between meals. These measures could have helped peoples weight to increase over time.

The home was not working in accordance with the MCA (Mental Capacity Act). For instance, we found staff at the home did not carry out assessments of peoples capacity when they had been identified as having a severe cognitive impairment. One person was asking to leave the home during the inspection and in this case, an MCA assessment had been carried out, however an appropriate DoLS (Deprivation of Liberty Safeguards) referral had not been made. This meant people were being detained without lawful authority.

We saw evidence of supervision and appraisal being undertaken, with a staff induction programme in place to support staff in their roles.

Due to the wide spread failings found within the service, people living at the home did not always benefit from a caring culture. This was in relation to people being at risk of choking and weight loss due to recommendations not being followed and legislation not being followed when people lacked the capacity to make their own decisions.

The feedback we received from people living at the home was that they received a good level of care and they were happy. We saw staff treating people with dignity and respect and promoting people’s independence where possible.

We found accurate and contemporaneous records were not always maintained. This included re-positioning charts, weight monitoring, oral hygiene, nail care, fluid consistency and life history information for people living at the home.

There were systems in place to investigate and respond to complaints appropriately. The people we spoke with said they would speak with staff or the manager if they were unhappy with the service they received.

There were also systems in place to seek feedback from people living at the home and their relatives. This included residents/relatives meetings and satisfaction surveys. The results of these were then analysed, with action plans put in place to drive improvement.

The systems in place to monitor the quality of service being provided were ineffective. For example, there were no governance systems to monitor nutritional intake, people at risk of weight loss, staff training and MCA /DoLS. These had been some of the areas of concern that we identified during the inspection. There were also continuing breaches of the regulations and a failure to improve the overall rating of the home.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. 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, we will be inspecting 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 timeframe so that there is still a rating of inadequate in 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.

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.

The previous inspection took place in April 2016 where eight breaches of the Health and Social Care Act 2008 were identified. The provider was rated as Inadequate and placed into special measures by CQC. We took enforcement action after the last inspection. This inspection was carried out to check on the improvement actions identified in the provider’s representations.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There were four rooms on each floor which are double occupancy rooms. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 31 people were living at the service, 13 on the nursing floor and 18 on the residential floor.

At our last inspection we found the service to be in breach of some of the regulations, at this inspection we found the service was still in breach of some of these regulations. Due to these continued breaches the service continues to be inadequate in well led. This meant the service remains in special measures.

During this inspection we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The service did not have a registered manager. There had been no registered manager in post since March 2016. The provider intended to register as manager, but at the time of the inspection had not yet begun to undertake this role. 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.

When we arrived at the service, we found the service was not displaying their rating from our previous inspection. All services are required to display this rating both within the service and online if they have a website.

People felt safe with the care and support they received. Staff were aware of the safeguarding process and how to report any concerns they had. However not all staff had received up to date training in safeguarding adults and we found the policies and procedures staff were required to follow, remained out of date.

Risk assessments were in the process of being updated and becoming person centred. However not all of the identified environmental risks were being monitored as required which meant people were still at risk from harm.

Staff sought consent from people before providing care or support. The ability of people to make decisions was being assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people when necessary and the service were completing assessments on people’s capacity.

Care plans were being updated at the time of the inspection. The care plans we viewed were more person-centred and had been reviewed. However, it was not clear if people had been involved in writing the updated care plans. Pre-assessments included people’s likes and preferences and staff knew the people well.

Medicines were not always administered safely. We found staff on the nursing floor were not always signing when they had offered medicine which was ‘as and when required’. Some of the staff had recorded when people had refused the medicine, but this was not consistent and they had not recorded a reason why the person had declined it. The manager of the service had already identified this during previous audits, but no action had been taken.

People were well cared for and found the manager had brought in additional staff for the busy morning period, but the duty rota showed staffing levels at night and at the weekend to be insufficient to support them effectively. The staff were knowledgeable about the needs of the people and knew how to spot signs of abuse. The recruitment process was not robust and sufficient checks had not been implemented prior to staff commencing work.

Not all staff had completed training appropriate to their role. Staff were observed as being kind and caring, and treated people with dignity and respect. They spoke to people with respect. There was an open, trusting relationship between the people and staff, which showed that staff knew people well.

People were supported to access activities within the home; those who were cared for in their beds had time allocated for one to one support. People were able to make choices about how they spent their time and where they went each day.

We saw people and their relatives had been asked for feedback about the service since our last inspection. Staff meetings were being held. There was an open and transparent culture which was promoted amongst the staff team.

Policies and procedures had not been updated and were out of date and were not being followed. Quality assurance checks had been completed in some areas but not all.

The inspection was carried out on 18 and 20 April 2016 and was unannounced. We also made a return visit on the 4 May 2016 to check the provider had taken immediate actions to the concerns we raised.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There were four rooms on each floor which are double occupancy rooms. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 31 people were living at the service, 13 on the nursing floor and 18 on the residential floor.

The service did not have a registered manager as they had left a few weeks prior to the inspection. The provider intended to register as manager, but at the time of the inspection had not yet begun to undertake this role. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. 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 inspecting 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 timeframe so that there is still a rating of inadequate in 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.

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.

People felt safe and supported by the care staff. However, not all safety checks had been completed, meaning people were at risk from harm.

Staff sought consent from people before providing care or support. The ability of people to make decisions was not always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were not always taken in the best interests of people when necessary as bed rails were being used without completing assessments on the person’s capacity.

Risk assessments were not always up to date. Care plans were not written with the person or their families. People had not been supported to be involved in identifying their support needs. Pre-assessments included people’s likes and preferences and staff knew the people well.

Medicines were not always administered safely. We saw evidence staff signing before the medicines had been administered and medicines being potted up and left on the top of the trolley for a period of time before being administered which could result in them being given to the wrong person.

People were well cared for but there were not enough staff to support them effectively. The staff were knowledgeable about the needs of the people and knew how to spot signs of abuse. There recruitment process was not robust sufficient checks had not been implemented prior to staff commencing work.

Staff had not completed training appropriate to their role. Staff were observed as being kind and caring, and treated people with dignity and respect. They spoke to people with respect. There was an open, trusting relationship between the people and staff, which showed that staff knew people well.

People were not always supported to access activities within the home; those who were cared for in their beds lacked social interaction and meaningful activates. People were able to make choices about how they spent their time and where they went each day.

We saw people and their relatives had been asked for feedback about the service they received but there was no record of what actions had been taken to address any identified concerns. Staff did not always work well as a team as those working on the nursing floor did not always feel supported by the nurse on duty. There was an open and transparent culture which was promoted amongst the staff team.

Policies and procedures were out of date and were not being followed. Quality assurance checks had not been completed since 2014 and when incidents had occurred no apparent actions had been taken.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.