Belgrave Court Residential Care Home

Belgrave Court Residential Care Home is a residential care home providing accommodation and personal care to up to 30 people, some of whom may be living with dementia. At the time of our inspection there were 20 people living at the home.

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

People told us they felt safe living at Belgrave Court Residential Care Home and received care in line with their needs and wishes. One person told us, "I didn't believe I could get such wonderful care and treatment."

The provider, management team and staff had worked hard to make improvements in the home, and to improve people’s outcomes. People, their relatives and staff told us the home was well managed and there was a positive atmosphere. One persons relative told us, "They are very friendly carers here, we see it all the time. It's first class care and informal."

Governance and oversight systems had been embedded, sustained and were fully effective in ensuring appropriate standards of quality and safety were maintained at the home.

Staff had received training in safeguarding and knew how to identify and report concerns. Any safeguarding issues had been reported in line with guidance.

Systems and processes to mitigate risks to people’s safety and wellbeing had been improved to ensure staff had sufficient information to support people in line with their needs, risks and preferences. Accidents and incidents were documented, investigated and reviewed to identify any patterns and trends, with lessons learned considered to help reduce future risks.

There were enough well-trained staff available to meet peoples care and support needs. Medicines were managed safely by trained staff.

The home was clean, with effective cleaning and infection control processes in place.

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 Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

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

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

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of safe and well led which contain those requirements. 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 remained requires improvement based on the findings of this inspection. Please see the safe and well led sections of this full report.

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.

You can read the report from our last inspection, by selecting the 'all reports' link for Belgrave Court Residential Care Home 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.

Belgrave Court Residential Care Home is a residential care home providing accommodation and personal care to up to 30 people, some of whom may be living with dementia. At the time of our inspection there were 19 people using the service.

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

The provider had actively worked to make improvements in the home to improve people’s experiences of living at the home but further time was required to ensure the level of governance and oversight implemented could embed and become fully effective.

Systems and processes to assess, monitor and mitigate risk to people had been improved. Standards had been improved to ensure actions were taken in response to incidents and accidents, and these were used to learn lessons and improve safety.

Improvements had been made to the management of people’s medicines. A more robust recruitment process was in place and there were sufficient numbers of trained staff to meet people’s needs.

Staff received safeguarding training and knew what to do if they thought someone was at risk.

Plans were in place and there was ongoing refurbishment of the home.

The culture of the service was positive, and people and staff were complementary about the management team. Staff felt well supported to undertake their roles.

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 and update

The last rating for this service was inadequate (published 11 October 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made, breaches had been met in relation to safe care and treatment, staffing and fit and proper persons. Further work was needed in relation to good governance and the provider was found to be in continued breach of this regulation.

This service has been in Special Measures since 7 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of safe and well led which contain those requirements. 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 inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make further improvements. Please see the safe and well led sections of this full report.

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.

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

You can read the report from our last inspection, by selecting the 'all reports' link for Belgrave Court Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a continued breach 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.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People did not receive a safe, well led service. Governance systems in place to ensure the safety of people continued to fail to identify concerns.

Auditing systems continued to be ineffective and paperwork continued to be inaccurate or available. Lessons had not always been learned because the same issues remained from the previous inspections and outcomes for people were not always positive.

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs, as well as environmental risks.

Medicines management continued to be unsafe which put people at risk of harm. We still could not be assured people received their medicines as directed. People who received time specific medicines did not receive these in line with the prescriber’s instructions. Stock checks were not always consistently completed or correct.

Recruitment and staffing remained a concern. Appropriate robust checks were not always completed prior to new staff commencing employment. Staffing levels were not sufficient to meet the needs of the people in the service. People, relatives and staff all commented about the need for more staff at the service.

At our last inspection, we found concerns related to the management of medicines, welfare and environmental risks, infection control practices and limited and ineffective oversight of the service.

At this inspection, there continued to be a lack of effective oversight. The provider had failed to learn lessons from the previous inspection and had failed to implement measures to improve the quality of the service.

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

There had been some improvements made to the environment, bedrooms had been refurbished. The provider had an action plan in place to show when the remaining rooms would be completed in line with the refurbishment plan for the service.

A new manager has started at the service and was hopeful to improve the shortfalls identified. Following the inspection, they informed us that they had increased staffing levels at busier times and were working alongside staff to improve their practice.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 7 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, recruitment and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore remaining in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Belgrave Court Residential Care Home provides accommodation and support with personal care for up to 30 older people, some of whom may be living with dementia. At the time of this inspection there were 26 people using the service.

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

The service was not well led. Governance arrangements continued to be ineffective and could not demonstrate how people were safe, or how their care and support needs were being consistently met. This was the fourth consecutive inspection where the provider had not achieved a rating of good.

People's safety and welfare was compromised. People's health needs had not always been addressed as requested by healthcare professionals, and there was a delay in people receiving healthcare treatment.

Risks to people were not mitigated and people were not safeguarded from abuse and improper treatment.

The providers systems had failed to highlight the gaps in staff’s knowledge about the monitoring of peoples health and Diabetes management, and safe evacuation in the event of an emergency.

Peoples care plans and risk assessments did not contain accurate information about their healthcare risks, contained conflicting information, and did not reflect their current needs.

People were not always supported to receive their medicines as prescribed in a safe way. Recruitment processes were not robust which put people at risk of being supported by unsuitable staff.

Further work was required to ensure government guidelines for working safely in care homes during the COVID-19 pandemic were implemented, adhered to, and appropriately monitored.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff did not always receive effective training to support their role.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 May 2021). There were breaches of Regulations 12 (Safe care and treatment), for which we served an Urgent Notice of Decision to place conditions on the registered providers registration, and Regulation 17 (Good governance).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

At a previous inspection published on 12 November 2019 we recommended the provider reviewed staff training, taking into account best practice guidelines. The provider had not made improvements.

At a previous inspection published on 12 November 2019 we recommended the registered provider ensured that where people lacked capacity to make a decision, the principles of the Mental Capacity Act 2005 are followed and recorded. The provider had made some improvements.

Why we inspected

We carried out an announced focused inspection of this service on 17 March and 1 April 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, and 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 safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, fit and proper persons, and governance of the service at this inspection.

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

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Belgrave Court Residential Care Home provides accommodation and support with personal care for up to 30 older people, some of whom may be living with dementia. At the time of this inspection there were 24 people using the service.

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

People were not receiving a service that provided them with safe, high-quality care. The service was not consistently well-led. Quality assurance systems failed to identify all the improvements required within the service.

The provider had failed to ensure government guidelines for working safely in care homes during the COVID-19 pandemic were implemented and adhered to.

There were gaps in recruitment checks, and staff training.

People were supported by enough staff and appeared comfortable and happy with staff interaction with them.

There had been clear improvements made to the safe management of people’s medicines, and how people, and their relatives were consulted and engaged with about their views of the service.

Improvements had been made and were ongoing to ensure peoples care plans and risk assessments contained information about their healthcare risks and reflected their current needs.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 13 November 2020). There were breaches of Regulation 9 (Person-centred care), Regulation 12 (Safe care and treatment), and Regulation 17 (Good governance) for which we issued a warning notice.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 13 November 2020. At this inspection the provider demonstrated that some improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced focused inspection of this service on 27 August, 01 and 17 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Person centred care, Safe care and treatment, and 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 safe 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. 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 Belgrave Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, and governance of the service at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Belgrave Court Residential Care Home provides accommodation and support with personal care for up to 30 older people, some of whom may be living with dementia. At the time of this inspection there were 26 people using the service.

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

People living at Belgrave Court did not receive a safe, caring or well-led service. There continued to be shortfalls with the management of people's medicines and governance systems.

People were at increased risk of experiencing harm, accurate records regarding medicines and prescribed creams were not always maintained. Care plans and risk assessments did not contain up to date and accurate information to inform staff how to provide safe care to people in relation to their medicine needs. People were not always supported in line with their individual needs.

The management and oversight of the service was still not robust enough to identify areas of concern and put actions in place to continuously improve quality and safety. This was the second inspection where the provider had not achieved a rating of good.

The registered manager made sure they alerted the appropriate authorities if there were allegations of abuse. Shortfalls in recruitment practices had been addressed and people could be assured new staff were asked to provide the robust information needed to make sure they were suitable for their role providing care and support to people. Staffing levels were adequate to meet people’s needs.

Improvements had been made to the environment. The service was clean, pleasant and well maintained. Infection control practice in relation to the latest COVID-19 government guidance for the use of PPE in care homes was followed to keep people and staff safe.

We observed people were relaxed in the company of staff; and staff had some time to spend with people. Improvements had been made and privacy and dignity were respected.

Staff had received some individual supervisions and the registered manager held staff meetings to keep staff up to date. People told us the culture of the service was improving.

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

Rating at last inspection

The last rating for this service was requires improvement (published 12 November 2019) there were five breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 29 August, 04, and 06 September 2019. Five breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve compliance with dignity and respect, safe care and treatment, premises and equipment, good governance, and fit and proper persons employed.

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 safe, caring and well-led which contain those requirements. We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this report.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. 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 Belgrave Court Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person centred care, and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Belgrave Court Residential Care Home provides accommodation and support with personal care for up to 30 older people, some of whom may be living with dementia. At the time of this inspection there were 28 people using the service.

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

Leadership was ineffective and governance systems did not identify multiple shortfalls within the service. There were gaps in staff’s skills and knowledge and not all staff had received opportunity for appraisal to support their development.

People were not always safe. Standards of cleanliness were poor and infection control procedures were not followed. Medicines were not safely managed. Risks associated with people's individual care needs were not always assessed and guidance was not always available to staff on how to minimise known risks to keep people safe.

The provider failed to ensure safe recruitment practices or to deploy enough staff to provide people with the care and support they needed. Staff did not provide appropriate person-centred care and failed to promote people’s dignity. Interactions were brief and often task focussed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People had access to activity and stimulation; some people were supported to pursue hobbies. People told us staff were kind, caring and friendly. They told staff and management were approachable and open to feedback.

The provider responded proactively to our concerns acted immediately to make changes and improvements.

We have made recommendations about recruitment process, staffing levels, and the application of the Mental Capacity Act (MCA).

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 21 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified five breaches in relation to safe care and treatment and the safety of the premises, dignity and respect, recruitment and governance at this inspection. The provider took some action to mitigate the risks after the first and second days of inspection, however further improvement is still required.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Belgrave Court Residential Care Home is located in the seaside town of Bridlington, in the East Riding of Yorkshire. The home provides accommodation and support with personal care for up to 30 older people, including those living with dementia. At the time of this inspection there were 29 people using the service.

The registered provider was required to have a registered manager in post. A manager that had been registered and in post for the last nine and a half months was available on the day we inspected. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury or harm.

The premises were not safely maintained on the day of our inspection. The registered provider informed us that all safety certificates had been handed over to them at the time they purchased the business in May 2016 and had been advised that certificates were all in date. However, we identified that this was not so and the registered provider took swift action as soon as they were made aware of shortcomings in the safety of the premises. The registered provider ensured safety of the premises by the time this report was completed. We received evidence in the form of maintenance certificates and reports to show this.

Staffing numbers were sufficient to meet people’s needs and we saw that rosters corresponded with the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safely carried out.

People were cared for and supported by qualified and competent staff. Staff received regular supervision and appraisal of their performance. People’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager explained how the service worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity to make their own decisions.

People received adequate nutrition and hydration to maintain good levels of health and wellbeing. The premises were suitable for providing care to older people and while there were no adverse effects to people living with dementia, the environment was not quite as conducive to their needs as it could have been in terms of patterned fabrics and carpets.

People received compassionate care from kind staff, who knew about people’s needs and preferences. People were involved in all aspects of their care and were always asked for their consent before staff undertook care and support tasks. People’s wellbeing was monitored. People’s privacy, dignity and independence were respected.

People were supported according to their person-centred care plans, which reflected their needs well and which were regularly reviewed. People had the opportunity to engage in some pastimes, occupation and activities if they wished to. People had good family connections and support networks, which was encouraged by staff. An effective complaint procedure was in place and people’s complaints were investigated without bias.

The service was well-led and people had the benefit of a culture and management style that were positive. An effective system was in place for checking the quality of the service using audits, satisfaction surveys and meetings. People were assured that recording systems used in the service protected their privacy and confidentiality as records were well maintained and held securely on the premises.