Pennine Lodge

Pennine Lodge is a residential care home providing personal and nursing care to up to 70 people. At the time of our inspection there were 60 people using the service.

The home has four separate units providing nursing and personal care for people with physical or dementia-related care needs.

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

The new management team had made changes so there was better oversight of people’s well-being and actions were taken where necessary. Improvements had been made to checking people’s potential risk of poor nutrition. Staff had retraining and there were better systems to about how to support people’s diet.

People and relatives praised the friendly atmosphere in the home. They described the manager and staff as “friendly”, “helpful” and “kind”. The home had a warm and welcoming culture. Staff were engaging with people.

People and relatives said the home was a safe place to live. The home was clean, bright and comfortable. The provider had systems to help reduce the spread of COVID-19.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice. People said they were encouraged to make their own choices.

Staff worked alongside health and social care agencies to support the well-being of the people who live there.

The management team were open and approachable. Staff said they felt supported by the new management team and said the culture had improved.

The management team carried out checks of the quality and safety of 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 and update

The last rating for this service was requires improvement (published 22 September 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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

Why we inspected

We carried out an unannounced inspection of this service on 25 July 2022. A breach of legal requirement was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

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

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

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 good. This is based on the findings at this inspection.

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

Follow up

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

Pennine Lodge is a care home providing personal and nursing care for up to 70 people. At the time of our inspection there were 63 people using the service.

Pennine Lodge has four separate units providing nursing and personal care for people with physical or dementia-related care needs.

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

People’s nutritional well-being was not always well-monitored and it was not always clear what actions were taken to support improved nutritional health. The provider’s systems for monitoring potential risk had not always been followed and identified improvements had not always been sustained.

People and relatives were positive about the caring nature of regular staff and had good relationships with them. There was a friendly culture in the home.

Staff contacted health professionals when people’s health needs changed. Staff followed good infection control practices and the home was clean and well maintained.

Staff said the management team were open, approachable and supportive. Staff received a range of training that was relevant to their role.

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

The provider used a number of ways to gain people’s views and was committed to improvement of the service. Staff were reintroducing activities and contacts with the local community for the benefit of people who lived at the home.

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

Rating at last inspection

The last rating for this service was good (published 1 January 2022).

Why we inspected

We received concerns in relation to people’s nutritional health. As a result, we undertook a focused inspection to review the key questions of Effective and Well-led only. We have found evidence that the provider needs to make improvements.

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

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

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 good governance at this inspection.

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.

Pennine Lodge is a care home providing personal and nursing care for up to 70 people, including people living with dementia or physical disabilities. There were 65 people living there at the time of this inspection. The accommodation is in four distinct units.

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

People’s medicines were managed in a safe way although there were some gaps in recording when prescribed creams had been applied. We have made a recommendation about this. The management team involved staff in better ways of managing this.

People and relatives felt the home was safe. The home was clean, comfortable and warm. Staff had practical training in infection control. They followed national guidance to prevent the spread of infection.

There were enough skilled, experienced staff to support people. Safe recruitment practices had been used to make sure new staff were suitable.

There had been several changes to management over the past year. There was a new management team in place and the new manager had applied to be registered. Staff and relatives said the manager was approachable and open to suggestions.

There was a friendly, warm atmosphere in the home and staff took an interest in the well-being of people.

The management team promoted good working relationships with local health and social care services to support the needs and well-being of the people who live there.

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 2 March 2020).

Why we inspected

We received concerns in relation to the cleanliness of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Follow up

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

Pennine Lodge is a care home providing personal and nursing care for up to 70 older people and at the time of the inspection there were 68 people living there.

The home accommodates people over two floors, the upper floor is designated for people who have a dementia related illness and people requiring nursing and personal care reside on the ground floor. There are several communal areas throughout the home including dining areas and lounges.

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

Medicines were handled safely with appropriate policies, records and systems in place, but we found some areas that required improvement. We have made a recommendation about the accuracy and consistency of records relating to the management of medicines.

People and visiting health professionals told us the service had improved since the last inspection. One person who has visited the home over the last three years said, “Since the new manager started communications and leadership have definitely improved. It’s had a knock-on effect I see the staff working more as a team now.” Another regular visitor to the home told us, “I have definitely seen improvements in the care here. Staff are motivated and there’s better communication. There’s some very good staff here at present.”

Safeguarding systems were in place to protect people from the risk of abuse or unsafe care. Staff were aware of the procedures, had received training on it and knew what action to take. The provider had policies and procedures to support the safe recruitment of staff. The registered manager made sure sufficient numbers of appropriately trained staff were on duty throughout the day and night to make sure people received the support they needed.

People received the right level of support to maintain good nutrition and hydration in line with their personal choice. Most people we spoke with were very happy with the quality and choices of food. One person said, “The food is nice I enjoy it.” Another person said of the food. "It’s not bad sometimes you get the same kind of food a lot, a bit repetitive.” Staff training was ongoing, and they had received enough training to safely care for people. Staff were regularly supported by the registered manager through staff meetings, supervision and appraisals.

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.

All the people we spoke with told us they were happy with the staff and care they received. One person said, “The staff are tip top, cream of the crop.” A relative said, "I think this is the best place for my family member. I find all the staff are caring and kind of like extended family really.”

People and their families had been fully involved in planning and reviewing the care and support provided. We saw staff treated people with kindness and respect and made sure their dignity was maintained. People were fully supported to maintain their independence. The provider planned people's care to meet their needs and take account of their choices. People could see their families and friends as they wished.

People knew how they could raise concerns about the service provided. The provider and registered manager monitored the quality of the service and identified areas which could be improved. Governance and quality assurance were well-embedded within the service. Staff said they felt valued and respected.

The leadership of the service promoted a positive, open culture. The registered manager and staff team displayed knowledge and understanding around the importance of openness and working closely with other agencies and healthcare professionals to make sure people had good care.

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

Rating at last inspection

The last rating for this service was requires improvement (published 29 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

Pennine Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Pennine Lodge provides nursing and personal care to 70 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs live on the ground floor. There were 64 people living at the home at the time of the inspection.

At our previous inspection in February 2018, we found three breaches of the Health and Social Care Act 2008. These related to safe care and treatment, receiving and acting upon complaints and good governance. We rated the service as requires improvement. We placed the service into special measures because we had rated the well-led key question as inadequate at our previous two inspections.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

At this inspection, we found that sufficient action had been taken to improve and we took the decision to remove the service from special measures. Continued improvements were still required in certain areas of the service.

The previous registered manager had recently left and an interim manager was in place at the time of the inspection. She had been in place for three weeks prior to our inspection and was not registered with CQC to manage the home. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

We identified several medicines recording issues. In addition, information and guidance about the use of prescribed thickeners for certain people was confusing and inconsistent. Immediate action was taken to address these issues.

There were safeguarding procedures in place. There were two ongoing safeguarding issues. Internal investigations were being carried out.

We received mixed feedback about staffing levels. Some people and relatives told us that more staff would be appreciated. At the time of the inspection, we observed that people’s needs were met by the number of staff on duty. However, due to the mixed feedback we received, we recommended that the provider keeps staff deployment under review.

The service was clean and well maintained. Sufficient equipment was available to meet people’s needs. Checks were carried out to ensure the premises and equipment were safe. Attention had been paid to the ‘dementia friendly’ design of the premises especially on the first floor where most people with a dementia related condition lived.

Since our last inspection, further training had been carried out and more training was being undertaken.

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 place supported this practice.

We received mixed feedback about the meals at the service. Some people and relatives felt meals could be improved. Staff raised issues about the availability of certain foods such as oranges, tuna and yoghurts. Following our inspection, the interim manager told us that this had been addressed.

We observed positive interactions between staff and people. Staff displayed warmth when interacting with people.

Care plans were in place which aimed to inform staff how people's physical, emotional, social and spiritual needs should be met. People’s social needs were met. Two activities coordinators were employed. A varied activities programme was in place.

There was a complaints procedure in place. There was one ongoing historic complaint.

The home had been through an unsettled period. There had been a number of unforeseen events which had impacted upon the service and staff morale. Most staff told us that morale had improved and positive changes had been made. Several members of night staff however, raised concerns about morale and support available. The interim manager was already aware of the issues and was actively monitoring the situation.

Audits and checks were carried out. Action was taken when issues were identified. We identified several shortfalls which had not been identified by the provider’s monitoring system. The interim manager wrote to us following our inspection visits and stated that all issues we had raised had been addressed.

This is the third consecutive time we have rated the service as requires improvement.

Pennine Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Pennine Lodge provides nursing and personal care to 70 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs lived on the ground floor. There were 60 people living at the home at the time of the inspection.

At our previous inspection in September 2017, we found three breaches of the Health and Social Care Act 2008. These related to safe care and treatment, staffing and good governance. We issued a warning notice in relation to good governance and told the provider they needed to take action to improve.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

We carried out this inspection to check whether the provider had met the breaches which were identified at our last inspection.

At this inspection, we found that the provider was taking action to address the previous concerns we had raised. Further improvements however, were still required.

There was no registered manager in post. The previous registered manager had left and an interim manager was in place at the time of the inspection. Following the inspection, the interim manager left to manage another of the provider’s homes. The regional manager wrote to us and stated that a new manager had been appointed. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

Prior to our inspection, several relatives contacted us regarding safeguarding concerns. We passed this information to the local authority and used the information we received to plan our inspection.

We found that a system to monitor safeguarding concerns and ensure these were notified to CQC was not fully in place. In addition, there were no details of the outcome of all safeguarding allegations and any lessons learned.

Staffing levels had increased; however, they were not always deployed appropriately to ensure people's needs could be attended to in a timely way. We have made a recommendation about this.

The service was clean and well maintained. Safe infection control procedures were now followed. Attention had been paid to the ‘dementia friendly’ design of the premises especially on the first floor where most people with a dementia related condition lived.

We checked equipment at the service. There had been a delay in obtaining suitable equipment for one person. In addition, there was a lack of evidence to demonstrate that specialist medicines equipment had been serviced in line with the manufacturer’s guidance.

The management of medicines had improved, however we found shortfalls and omissions with regards to the recording of topical and ‘when required’ medicines. We have made a recommendation about this.

Since our last inspection, further training had been carried out and more training was being undertaken. There were still gaps identified on the training matrix which the interim manager told us was being updated as training was being completed. This meant it was not always clear which training had been undertaken. Evidence of staff competencies was not available and the clinical skills of agency staff were still not always known.

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 place supported this practice.

We received mixed feedback about the meals at the service. Some people and relatives felt meals could be improved. We found that people’s nutritional needs were met. There was the option of fruit and vegetables at every meal.

Health care professionals and stakeholders told us that an effective system was not fully in place to ensure successful communication between staff and health and social care professionals. We spoke with the interim manager about the introduction of a more proactive and effective system to ensure the early detection of any health deterioration and to make sure that the advice and guidance of health care professionals was actioned in a timely manner.

We observed positive interactions between staff and people. Staff displayed warmth when interacting with people. They were very tactile in a well-controlled and non-threatening manner. However, due to the concerns identified during the inspection, we could not be assured that people received a high quality compassionate service.

Care plans were in place which aimed to inform staff how people’s physical, emotional, social and spiritual needs should be met. However, there were some omissions and shortfalls in certain care records.

We found continuing shortfalls with the management of complaints. Not all complaints were recorded on the home’s computerised management system. This meant that it was not clear what action had been taken in response to concerns and complaints.

Audits and checks were carried out. However, these had not always identified the issues raised during this inspection. The interim manager wrote to us following our inspection visits and stated that all issues we had raised had been addressed.

The overall rating for this service is ‘requires improvement.’ However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. We have rated the well led key question as inadequate at our previous inspection and at this inspection.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this 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.

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.

We found three breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. These related to safe care and treatment, good governance and receiving and acting on complaints. You can see what action we told the provider to take at the back of the full version of the report.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service which the provider is legally required to inform us of. This is being followed up and we will report on any action when it is complete.

Due to the breaches of the regulations and the continued rating of requires improvement; we have organised a meeting with the provider to discuss our concerns and the improvements required for this service to become compliant with the regulations.

We last inspected Pennine Lodge in January 2017 and rated the service as good. We found that they were meeting all the regulations we inspected.

We carried out the inspection on 7, 8, 25 and 27 September 2017. Our visits on the 7 and 25 September were unannounced. Our visits on the other days were announced.

Prior to the inspection, we received information of concern regarding staffing levels, the maintenance of records and certain aspects of people’s care. We brought forward our planned inspection in order to check the concerns raised.

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

There were safeguarding policies and procedures in place. The provider had not notified CQC of all safeguarding incidents in line with legal requirements. These omissions meant that CQC did not have oversight of all safeguarding allegations to make sure that appropriate action had been taken.

We raised five safeguarding alerts during our inspection. These related to the management of people’s medicines, concerns from a relative about their family member’s care and a whistleblowing alert raised by a member of staff. We will monitor the outcome of these safeguarding alerts and action taken by the provider.

At the time of the inspection, we found there were insufficient suitably qualified, competent, skilled and experienced staff deployed to ensure care was delivered as planned. We identified delays in seeking advice from health and social care professionals. We also identified shortfalls in record keeping.

There were shortfalls and omissions with regards to the management of medicines. We also identified concerns with certain staff practices in relation to infection control. Checks and tests had been carried out on the premises and equipment to ensure safety. The registered manager was unable to locate the electrical installations safety certificate during the inspection. They sent CQC a copy of the certificate following the inspection. This stated that the electrical installations were ‘unsatisfactory.’ We spoke with the registered manager about this issue. She told us the provider had recently changed to a new facilities management company who were in the process of addressing the deficits highlighted in the electrical installations report.

There were shortfalls regarding some people’s clinical care. There was a lack of evidence to confirm the competency and skills of nursing staff.

We received mixed feedback about meals at the home. One person put one thumb down and then both thumbs down when we asked them about the meals they received. On the first and second day of our inspection, there was a lack of fresh fruit available. On the third day of our inspection, the chef informed us that this had been addressed and people now received fruit options on the drinks and snack rounds in the morning and afternoon.

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.

Some people’s care records contained omissions. This meant it was not clear whether care and treatment had been provided. Some staff, relatives and health professionals considered that communication could be improved at the service. We found that advice from health care professionals had not always been sought in a timely manner.

There was a complaints procedure in place. However, we noted that not all concerns and complaints were documented. Therefore, it was not clear what action had been taken to resolve complaints and identify any changes in practice to ensure continuous improvement.

We identified shortfalls in many areas of the service including medicines and the maintenance of records, which had not been highlighted by the provider’s quality assurance system. In addition, the registered manager did not have a full overview of certain aspects of people’s care such as wound management and weight loss.

Following our inspection, the regional manager sent us an action plan detailing the actions they had taken/planned to take to address the shortfalls we identified. He also informed us that the deputy manager was now supernumerary in order to support the registered manager. Whilst we were satisfied, that action had been taken/commenced to address the concerns; this had only been instigated after we had highlighted the shortfalls.

We found three breaches of the Health and Social Care Act 2008. These related to safe care and treatment, staffing and good governance.

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.

Pennine Lodge is a purpose built care home that provides personal and nursing care to a maximum of 70 people, including people who live with dementia. There were 66 people living in the home when we inspected.

A registered manager was in place. 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.

On this inspection we found improvements in all the areas we had made recommendations in. There was a tangible upbeat atmosphere within the staff team who were enthusiastic and motivated to provide “The best care they could for people” they told us. Staff were positive about the opportunities for growth and improvement. People living in the home were benefitting from a more engaged workforce and people appeared more responsive and animated.

People living in the home and their relatives were happy with the care and support given. People told us that they felt safe and that staff were kind and treated them well. One person said, “It’s very nice, the girls look after you. I have all my things here and my family comes in.” A number of relatives said they had noticed improvements since the last CQC inspection. One relative said “The care is good now, it’s improved a lot lately, the girls are lovely to (relative).

People were treated with respect and dignity. A health professional said, “The staff are very respectful." A visitor said, “My (relative) passed away here and the care was brilliant, I come back to help sometimes now, I could not fault it.” And another relative wrote to tell us, “Pennine Lodge gave our relative exceptional care throughout their stay. We as a family observed the professionalism and total dedication of each and every member of Pennine Lodge. Our relative was nursed with love and respect. They also gave us comfort and support especially when they became so very ill. We were so very fortunate to find Pennine Lodge where my relative called home.”

However we received mixed views on the quality of the food and how it was presented. We recommended that the home looks at how this can be improved for people.

The accuracy, quality and detail recorded in people’s risk assessments had significantly improved. Risks to people, as a result of reduced capacity due to dementia, were now well managed. All staff we spoke to, from nurses to carers to auxiliary staff, were now fully aware of how to ensure people’s safety.

We saw the way staff were being utilised and deployed in the home had improved. This particularly helped at mealtimes. The mealtimes were better organised with clearer delegation of staff roles. This meant that people were receiving the support required to enjoy a calm and pleasant mealtime experience.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

We found that improvements had been made to people’s care and support plans. These had been made simpler and staff reported that these were easier to use in knowing exactly what support needs were required by each person. People’s care plans were also more individualised and staff demonstrated good knowledge of people’s backgrounds and how they liked to spend their time. We observed that there were interesting and appropriate activities available for people.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

We found that staff training and development had improved and that staff felt “better supported” with their roles and responsibilities. Training was now a real positive feature of the home, with dedicated training staff based in the home to deliver face to face training. Staff said the training had been “amazing” and “thought-provoking”.

Staff had received good levels of both formal and informal supervision which had helped them to develop. Staff said that communication at all levels had improved and “hand over” of shifts were well managed to ensure people’s changing needs were passed on to all staff.

Infection control measures in the home were good. The staff team had been suitably trained and had access to personal protective equipment. The home was clean and orderly. The home’s environment had improved with new furniture purchased and suitable redecoration and refurbishment being done. The home looked well maintained, homely and welcoming.

A complaints procedure was available. People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. Record keeping had improved and staff had received training on this as well as on care planning and tools to use to assess people’s needs.

We found the home was being well-led with a strengthened, more effective management structure in place.