• Care Home
  • Care home

Archived: Epworth House Care Centre

Overall: Requires improvement read more about inspection ratings

Park Road, Thurnscoe, Rotherham, South Yorkshire, S63 0TG (01709) 893094

Provided and run by:
Mr David Hetherington Messenger

Important: The provider of this service changed. See new profile
Important: We are carrying out a review of quality at Epworth House Care Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

27 March 2017

During a routine inspection

The inspection was carried out 27 March 2017 and was unannounced, which meant the provider and staff did not know we would be visiting. The service was last inspected in August 2016 at which time the service was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a history of breaches of regulation. We checked to see if any improvements had been made with the breaches identified at the last inspection, which included, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance. We checked and found improvements had been made, sufficient to meet regulations.

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

The registered provider was placed into special measures in December 2015 by CQC. The service has been in administration since November 2016 and was being run by Care Regeneration Services a company appointed by the administrators.

There was no registered manager in post; however there was a temporary manager who was responsible for the day to day running of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found improvements had been made sufficient to meet regulations. However, the registered provider must evidence to the commission that they can sustain the improvements made so that the service remains compliant with all regulations.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated into two units. One unit is for people living with dementia and is sited on the first floor. The second unit is for people who have personal care needs with the main living accommodation sited downstairs. At the time of our inspection 29 people were living at the home.

People who used the service told us they felt safe living in the home. Their relatives spoke positively about the standard of care and support their family member received.

Systems for the safe administration of medicines were in place. The manager must continue to closely monitor and audit medicines so that mistakes or omissions are dealt with promptly.

Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind.

Procedures in relation to recruitment and retention of staff had improved and were robust which ensured only suitable people were employed in the service. We found staff were skilled and experienced and there was a programme of training. Supervisions and appraisals were scheduled to take place throughout the year and staff told us they felt supported by the manager and deputy manager.

Staffing levels were appropriate to meet the needs of people who used the service. We saw staff engaging with people in an inclusive manner by encouraging them to join in conversations and activities.

The manager was aware her legal responsibilities with regard to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. The service had made improvements to the way they obtained consent to people’s care and treatments and we saw evidence of authorised DoLS in place for some individuals.

People’s health was monitored and reviewed as required. This included appropriate referrals to health professionals. Individual risks had also been assessed and identified as part of the support and care planning process.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way.

A varied activity programme was on offer to people. We saw people thoroughly enjoying the activities available on the day of the inspection.

Staff told us they felt supported and they could raise any concerns with the manager and felt that they were listened to. Relatives told us they were happy to raise any concerns directly with the manager.

There was a new manager in place who was working in partnership with other professionals to improve the quality of the service.

We found minor shortfalls in some areas and were provided with evidence that confirmed improvements to these were on going. Further improvements were required to make sure the service continued to improve. Systems in place to assess and monitor the quality of the service needed to be maintained and fully embedded into practice so that improvements were sustained.

26 July 2016

During a routine inspection

The inspection was carried out 26 July and 4 August 2016 and was unannounced on both days, which meant the provider and staff did not know we would be visiting. The service was last inspected in January 2016 at which time the service was not meeting the requirements of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a history of breaches of regulation. We checked to see if any improvements had been made with the breaches identified at the last inspection, which included, regulation 12 safe care and treatment, regulation 16 receiving and acting on complaints and regulation 17 good governance. The registered provider was placed into special measures in December 2015 by CQC. This inspection found there had still not been enough improvement to take the registered provider out of special measures. 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.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated into two units. One unit is for people living with dementia and is sited on the first floor. The second unit is for people who have personal care needs with the main living accommodation sited downstairs. At the time of our inspection 38 people were living at the home.

There was no registered manager in post; however there was a manager who was responsible for the day to day running of the service, who told us it was their intention to register with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they felt safe at the home, and they were satisfied with the care and support which was being given by the staff team.

Staff had received training and were able to demonstrate their knowledge and understanding of how to safeguard vulnerable adults. However, we found there had been a serious incident which had not been investigated thoroughly or in a timely manner.

We found there were updated personal emergency evacuation plans in place in all the care files we reviewed, which had been a concern at the previous inspection.

There were risk assessments in place for particular risks, however, we found these were not always correctly completed and information contained within them did not always match other records in the care file.

We looked at the management of medicines. We found there were still concerns with record keeping for medicines, which were being administered within the service and the temperature at which medicines were stored was not always within the recommended range.

Recruitment records we looked at showed that there were some staff who had not had a recent disclosure and barring service check (DBS). We also found that previous employers had not always been contacted to gain references to ensure the good character of staff.

There was sufficient staff on duty to meet the needs of the people who used the service.

There had been a significant improvement in the training of staff, however we found there was an concern with how this had been recorded which meant it was not possible to identify whether training had been face to face or a booklet.

We found that whilst there had been applications made for Deprivation of Liberty Safeguards (DoLS) to be authorised, the records were disorganised and there was no clear record of who required a DoLS, when the application had been made, if the DoLS had been authorised or when the provider needed to apply to renew the DoLS.

We found there was very little evidence of the provider seeking consent to care from people who used the service. We found clear evidence that consent was being signed for by staff and relatives who did not have any legal authorisation to do so. This meant the provider was not working within the Mental Capacity Act 2005, and best interest decisions were not being made where people did not have capacity to consent to their own care.

People told us they enjoyed the meals and had access to a good range of snacks and drinks throughout the day.

Care staff treated people with dignity and respect. We observed staff interacting with people kindly and considerately, kneeling by their sides to address them at their own level and being patient when assisting people.

We found there had been some improvement to care plans, however, there was still further work to be done to ensure personal information was included and care plans were written in a person centred way with the person’s involvement.

The processes which were in place to monitor the quality and safety of the service were not effective and were not bringing about change. There was evidence that concerns were being identified during audits which were carried out, however there was no action taken to ensure concerns identified were resolved.

Monthly audits were completed and supplied to senior management and the registered provider; however, there was no oversight resulting from this information, as no feedback was given to the manager and no action plans were created.

We found the breach of regulation 16 receiving and acting on complaints had been resolved as the complaints process had sufficiently improved. We found continued breaches of regulation 12 safe care and treatment and regulation 17 good governance. We found additional breaches of regulation 13 safeguarding service users from abuse and improper treatment and regulation 11 need for consent 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.

18 and 26 January 2016

During a routine inspection

This inspection took place over two days on 18 and 26 January 2016. The inspection was an unannounced inspection, which meant the provider and staff did not know we would be visiting.

The home was last inspected on 26 May 2015 and 4 June 2015 and the service was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a history of breaches of regulation. We checked to see if any improvements had been made with breaches of regulation identified at the last inspection. These included, regulation 12 safe care and treatment, regulation 13 safeguarding service users from abuse and improper treatment, regulation 16 receiving and acting on complaints and regulation 17 good governance, on this inspection.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated in to two units. One unit is for people living with dementia and is sited on the first floor. The second unit is for people who have personal care needs with the main living accommodation sited downstairs. At the time of our inspection 42 people were living at the home.

There was a registered manager in post at the service, but this person was no longer managing the service. 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 and associated Regulations about how the service is run. There was an acting manager who was in day to day charge of the location and they were present during the inspection. It was not their intention to become registered manager.

Staff had developed positive relationships with people and people were relaxed in the company of staff. Relatives told us staff were caring towards their family members and treated them with respect and we found staff to be respectful and caring to people. Staff enjoyed working at the home. They knew people and were able to describe people’s individual likes and dislikes, their life history and their personal care needs.

People told us they felt ‘safe’ and staff had received training in safeguarding and were aware of the procedures to follow to report abuse. The record of safeguarding incidents contained no evidence of any lessons learnt and of any further action taken to protect people from further harm.

We found people were at risk of potential harm, because the service had not always managed risks to people and the service well and had not rectified this in a timely way when those risks were identified. This meant there continued to be care records that did not contain up to date or accurate information about people.

The service provided some day time activities for people, but there was a mixed response about the impact this had in improving people’s wellbeing.

Meal times were an enjoyable experience for people, where they were able to make choices and overall where people felt the quality of the food was good.

The home did not have effective systems in place to manage medicines, which meant people were not always protected from the risks associated with medicines.

Staff recruitment procedures were in place, but there remained gaps in some of the information and documents required about a person seeking to work in care to help employers make safer recruitment decisions were available.

A system was in place for staff to receive training relevant to their role, but staff had not received training in people’s behaviour that challenged and they did not have sufficient knowledge of the decision making process when a person lacked capacity following the principles of the Mental Capacity Act 2015.

The acting manager demonstrated her commitment to listening and learning from stakeholder’s experiences, concerns and complaints, but we found they were not always aware of complaints that had been made, so that they could respond in a timely way to them.

Staff told us senior managers visited the home regularly and they had the opportunity to speak with them if they needed to. The home held residents and relatives meetings, some of which had not been attended by people or their relatives.

Quality assurance systems were in place to monitor and improve the quality of service provided, but these had not always been effective in achieving the required improvements to meet regulations.

We found three continued 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.

26 May and 4 June 2015

During a routine inspection

This inspection took place over two days on 26 May 2015 and 4 June 2015. The inspection was an unannounced inspection, which meant the provider and staff did not know we would be visiting.

The home was last inspected on 27 October 2014 and 3 November 2014 and the service was not meeting the requirements of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We issued four compliance actions and two warning notices. The registered provider submitted an action plan stating how they would make improvements. We checked to see those improvements had been made on this inspection.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated in to three units. One unit is for people who have a diagnosis of dementia, the second unit is for people who are in a period of rehabilitation, with the intention of returning home and the third unit is for people who need personal care. At the time of our inspection 53 people were living at the home.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

The home did not have effective systems in place to manage medicines, which meant people were not always protected from the risks associated with medicines.

Staff recruitment procedures were in place, but there were gaps in some of the information required to be in place before staff commenced employment. This meant people were cared for by staff who had not been appropriately assessed as safe to work with people.

People told us they felt ‘safe’, but we found that, because some people wanted to go outside, they were at risk of being deprived of their liberty or being moved to units where people were subject to greater control and restraint.

A system was in place for staff to receive training relevant to their role, but staff had not received training in people’s behaviour that challenges and the training staff had received in safeguarding and MCA/DoLS had not been effective in practice as we found one person’s liberty had been restricted without lawful authority.

The arrangements for meal times for people living with dementia were not person centred to meet their needs.

People did have access to health care professionals, but the advice provided by them was not always recorded in people’s care files, which meant there was not an accurate, record in respect of those people.

We found staff to be respectful and caring to people, but this was not consistently reported in feedback from people who used the service and their relatives.

Staff enjoyed working at the home. They knew people well and were able to describe people’s individual likes and dislikes, their life history and their personal care needs.

There continued to be care records without written assessments, care plans and risk assessments that had taken place in a timely way or records that did not contain up to date or accurate information about people.

The service provided some day time activities for people to take part in to promote their wellbeing, but for some people this could be improved.

The complaints system was ineffective in listening and learning from people’s experiences, concerns and complaints.

Staff told us senior managers visited the home regularly and they had the opportunity to speak with them if they needed to. The home held residents and relatives meetings, some of which had not been attended by people or their relatives. When we asked people and their relatives about them they did not always know about them.

Quality assurance systems were in place to monitor and improve the quality of service provided, but these had not been effective in practice leading, which meant the required improvements to meet regulations had not been made.

We found four 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.

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

27 October 2014 and 3 November 2014

During a routine inspection

This inspection took place over two days on 27 October 2014 and 3 November 2014. The inspection was an unannounced inspection, which meant the provider and staff did not know we would be visiting.

The home was last inspected on 25 October 2013 and was meeting the requirements of the regulations we checked at that time. On our three previous visits to the home on 10 December 2012, 22 April 2013 and 6 August 2013 the service was not meeting the requirements of the regulations we checked at that time.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to sixty seven older people. The home is separated in to three units. One unit is for people who have a diagnosis of dementia, the second unit is for people who are in a period of rehabilitation, with the intention of returning home and the third unit is for people who needed personal care. At the time of our inspection 49 people were living at the home.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

The service’s system for maintaining fire safety had not been maintained, resulting in a breach of the Regulatory Reform (Fire Safety) Order 2005. You can see what action we told the provider to take at the back of the full version of the report.

The home did not have effective systems in place to manage medicines, which meant people were not always protected from the risks associated with medicines. You can see what action we told the provider to take at the back of the full version of the report.

Staff recruitment procedures were in place, but there were gaps in some of the information required to be in place before staff commenced employment. The recruitment and selection procedure in place for staff to follow did not identify fully what those documents were. This meant people were cared for by staff who had not been appropriately assessed as safe to work with people. You can see what action we told the provider to take at the back of the full version of the report.

People did not always have a written assessment, care plan and risk assessments in place. Where assessments, care plans and risk assessments were in place they did not always contain up to date or accurate information about people. People and/or their relatives were not routinely included in the formulation and review of their care plans. This meant people and/or their representatives were not fully involved in the assessment and care planning process. You can see what action we told the provider to take at the back of the full version of the report.

A system was in place for staff to receive training that was relevant to their role, but there were gaps in the training they had received and the training had not ben refreshed/updated in accordance with the service’s own requirements. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us senior managers visited the home regularly and they had the opportunity to speak with them if they needed to. The home did hold residents and relatives meeting, but these were not at the frequency the home had identified in their quality assurance process.

The registered manager had not always informed the Commission about notifiable incidents in line with the Health and Social Care Act 2008, for example, allegations of harm and outcomes of Deprivation of Liberty Safeguard (DoLS) applications. The manager had not completed the provider information return as required.

Quality assurance systems were in place to monitor and improve the quality of service provided, but these were not fully embedded at the service and had sometimes been ineffective in identifying actions needed to improve the service in a timely way. You can see what action we told the provider to take at the back of the full version of the report.

The home was clean and had a pleasant aroma. There was a calm atmosphere in the home. Our observations during the inspection told us people’s needs were being met in a timely manner by staff. People told us staff responded promptly when they used their call buzzers for assistance during the day or night. Staff were respectful and treated people in a caring and supportive way.

People told us they felt safe and were treated with dignity and respect. Our discussions with staff told us they were aware of how to raise any safeguarding vulnerable adults concerns and were confident senior staff in the home would listen and act on those concerns.

People spoken with told us they were satisfied with the quality of care they received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received.

We saw information in people’s care files that health professionals were contacted in relation to people’s health care needs. This was confirmed by the people who used the service and staff and included doctors and the community mental health team.

People were satisfied with the quality of the food provided and said their preferences and dietary needs were being met.

The service promoted people’s wellbeing by providing daytime activities for people to participate in. We saw that there was a range of activities available for people to participate in. We also saw care staff spending time chatting with people about the day, their past lives and providing choices of how they might want to spend their day.

People told us they had no complaints with the service and if they did they would raise them with staff and/or the manager and they would be ‘sorted out’.

Staff told us they enjoyed caring for people living at the home. They demonstrated familiarity and knowledge of people’s individual needs, life history, their likes and dislikes and particular routines.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. However, we found the registered manager was not fully up to date with the Deprivation of Liberty Safeguards (DoLS). These safeguards form part of the MCA and ensure where someone may be deprived of their liberty, the least restrictive option is taken.

30 October 2013

During an inspection looking at part of the service

This inspection was a follow up inspection to check that suitable arrangements were in place to ensure the dignity and independence of people using the service and enable people using the service to participate in making decisions relating to their care, because the provider had been non-compliant on our last visit on 12 August 2013.

On this visit we found the delivery of care did respect people and maintain their dignity. This was because when we checked people's bedding on the dementia unit we found bedding was clean and ready to use when people wanted to use their bed.

People had call alarms to use or pressure mats in place, so they could summon assistance when required to maintain their dignity.

12 August 2013

During an inspection looking at part of the service

This inspection was a follow up inspection to check that improvements had been made to the effective operation of systems to maintain appropriate standards of cleanliness and hygiene, because the provider had been non compliant on our last visit on 23 April 2013.

We had also received some information of concern about how the service were respecting and maintaining the dignity of people who used the service and this information was also checked on this visit.

People we spoke with told us that staff respected them and maintained their dignity. People told us they always had bedding for their bed and staff made sure their call alarm was to hand. One person said, 'I've always had a clean bed. Sometimes you get 'sticky' when it's hot with having plastic covers over the mattress.'

We found the delivery of care did not always respect people and maintain their dignity. This was because on the dementia unit we found bedding was not always clean when beds had been made for people to use. People did not have call alarms to use and there had been no assessment of their capacity to make decisions in regard to their ability to use a call alarm.

We found in the sample of bathrooms, shower rooms and toilets we looked at that the areas were clean, tidy and hygienic.

23 April 2013

During a routine inspection

This inspection included checking that improvements had been made to the care and welfare of people as the provider was non compliant following our inspection on 10 December 2012. We found that the issues identified had been addressed.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Discussions with people confirmed they made their own choices in their day to day care, for example, rising and retiring when they wished.

People experienced care, treatment and support that met their needs and protected their rights.

An effective operation of systems to maintain appropriate standards of cleanliness and hygiene to prevent and control the spread of health care associated infection had not been maintained in all areas of the home.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received, for example, audits, staff and resident/relative meetings.

People were protected from the risks of unsafe or inappropriate care and treatment. This was because the service had accurate and up to date information about people using the service.

10 December 2012

During an inspection looking at part of the service

People were not protected against the risks of receiving care that was inappropriate or unsafe due to a lack of assessment of their needs and not ensuring that care delivery met people's needs. A health professional told us one person had not been supported with their exercise plan for over a week. This was a specialist plan designed to aid this person's recovery. This information was confirmed by our conversations with the person, their relatives, staff and by documents within their care records. However, the person also said, 'I'm well looked after. Staff are friendly and do what I ask.' Their relative said, 'It's not all doom and gloom. [My relative] enjoys being with other people. Essentially, it's the same staff, which is good, there's just not enough of them. They have also followed up on medical requests.'

Effective systems were not in place to identify, assess and manage risks relating to the health, welfare and safety of people against the risks of inappropriate or unsafe care and treatment.

There was a lack of proper information about people because their care records were not accurate. This did not protect people against the risks of unsafe or inappropriate care and treatment.

15 October 2012

During an inspection looking at part of the service

We found people on the dementia unit had limited opportunities for stimulation and activities with staff. In contrast people downstairs were taking part in bingo, which provided a meaningful activity for those people. DVD's of old films were playing in both of the lounges.

One person using the service said, 'It's alright living here.' Another person said 'They're (staff) not too bad if you need help. Night staff are brilliant. They get me dressed. They do anything I need and come straight away. I'm one of the first up.'

We found there was a lack of assessment of people's needs and care delivered, did not correspond with the care documented in care plans. This meant people were not protected against the risks of receiving unsafe or inappropriate care.

Sufficient numbers of staff were provided to care for people. People said, 'Biggest part of them (staff) are brilliant. They're not too bad if you need help. They do anything I need and come straight away.' and 'Staff are very nice. Sometimes when you use the buzzer they can be a bit late, but you don't have to wait long. They're polite. They come quickly.'

15 May 2012

During a routine inspection

This service has three different types of service provision, provided in three different units.

On the first floor there was a separate unit for 15 people with a diagnosis of dementia.

On the same floor was a unit for intermediate care. This is where people are admitted through an intermediate care contract with the local health authority. The purpose is to provide rehabilitation for those people to enable them to return home. Therapy staff were provided by the hospital, for people needing rehabilitation.

The ground floor was for people using the service on a permanent and respite basis.

Each type of service provision has their own dedicated staff group.

We spent our time during the inspection on the dementia unit. Because people with dementia are not always able to tell us about their experiences, we sat in the lounge to observe their mood and how they interacted with staff and their environment. We call this the 'Short Observational Framework for Inspection' (SOFI). This involved us observing in a formal way five people who used the service for a period of one hour and recording their experience at five minute intervals.

On entering the unit we saw the activity co-ordinator in the lounge area, painting people's nails in readiness for 'looking nice' for entertainment the following day.

Throughout our time on the dementia unit we saw staff members treated people with respect and courtesy and were kind and supportive to people when engaging with them.

We saw people reacting positively to staff interactions. This included them smiling and laughing. We saw that staff utilised eye contact and touch to support and engage people.

The atmosphere was relaxed and staff seemed comfortable when they were talking and interacting with people using the service.

At all times when we were on the unit the TV was on. No-one was watching any of the programmes.

For the majority of the time whilst conducting the SOFI one member of staff was available in the lounge area, supervising and interacting with people using the service. The majority of their time was spent with one person. This was because this person was agitated and displayed anger and needed more staff input. The staff member was patient, offering reassurance and attempting to engage the person on other topics. No other form of distraction was used, for example, joining in a task. This meant the four other people received little attention, other than when needed. Two other people using the service may have responded to stimulation. This was because one was watching what was happening around them and trying to engage with another person using the service who was sat next to them. The other appeared asleep, but was not. We knew this because they fidgeted with their clothing and reached out, as if touching objects and talking with themselves.

In general, we found people were clean and tidy and they had received a good level of personal care.

We saw that staff demonstrated genuine affection, care and concern for people using the service. Staff members were attentive and provided support when needed, for example, when people were angry and assisting people with drinks and responding when people needed the toilet.

We saw staff met people's needs in a safe way, by using appropriate equipment and moving and handling techniques to move them.

There was no orientation on the unit to the day, date or weather. This would provide orientation for people using the service. One person during the SOFI observation kept asking what day it was. There was also no orientation of the different rooms available, for example, people's bedrooms and toilets.

The dementia unit was the only unit in the building that didn't have it's own dining room. People from the dementia unit were taken to the dining room downstairs for their meals, if they wished to go. The staff members informally assessed people's current state of wellbeing, to assess whether taking those people downstairs would make this worse. Also, the way people were moved downstairs was done in an institutionalised way. Everyone going downstairs was moved to their wheelchair and left in it, at various places in the lounge, until everyone was ready to go downstairs.

We did not see any information for people on the dementia unit about their meal, or any choices of meal that may be available. People's lunch was brought to them pre-plated. A staff member said they do have pictures of food to help people make a choice about their meal, but this choice was offered the day before.

Evidence gathered during our SOFI observation indicated that people were protected from abuse and their human rights were protected