Copper Beeches

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

The manager was not registered with CQC at the time of our inspection. Positive feedback was received about the quality and leadership of the service. Systems in place showed effective governance processes were available to monitor the service and drive improvement. The manager was building bonds with people and their families to ensure they had a full oversight of people’s choices. Feedback from people, relatives and staff was positive about the management of the service.

Risk management plans were in place to ensure risks were managed safely. Recommendations had been followed and where needed changes had been made. The premises were clean, and staff followed infection control principles, the cleaning schedules were reviewed and updated. Systems and processes were in place to protect people from avoidable harm. There was enough staff available to respond to people’s needs in a timely manner. Electronic systems were in place to manage and monitor medicines, which helped to reduced errors. People received their medicines as and when they needed them. The provider had systems to review and monitor accident and incidents to prevent recurrence. The provider was working in line with the principles of the Mental Capacity Act.

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.

At this inspection we found the provider had acted upon the recommendations and made improvements to the environment and updated their cleaning schedules.

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

Rating at last inspection

At our last inspection we recommended that the provider reviewed government guidance for using personal protective equipment (PPE) in a care home and reviewed their cleaning processes to ensure they kept the cleanliness of the home to a high standard. At this inspection we found the provider had acted on the recommendations and had made improvements. Staff adhered to PPE guidelines and wore appropriate equipment to keep people safe. The cleaning schedules had been updated and were more robust. Recruitment for housekeeping staff had increased.

The last rating for this service was requires improvement (published 4 August 2021).

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Follow up

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

We found the following examples of good practice.

Copper Beeches had robust arrangements for visitors which reflected government guidelines. There were protected mealtimes in place to ensure social distancing was maintained and clear signage was displayed on the front door for all visitors.

Personal protective equipment (PPE) was available for visitors. Visitor were required to show negative Lateral Flow Test (LFT) result and were screened for symptoms of COVID-19 prior to entry to the service. Vaccination status for visiting professionals was recorded and stored securely.

The home looked clean and hygienic. Domestic staff carried out regular cleaning with additional cleaning and disinfection of high touch points such as door handles or handrails.

The manager and staff ensured that people living at Copper Beeches fully understood the ongoing pandemic. People were supported to make informed choices regarding testing for COVID-19 and receiving the vaccination. Advocates had been included in best interest decisions for people unable to give consent.

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

The service has a history of being rated as 'Requires improvement' and 'Inadequate'. Although we saw improvements had taken place, which was an ongoing process we found not enough had improved to ensure the environment was clean and effective with infection control measures.

We were not fully assured infection control was managed safely. People told us they felt safe. There had been no COVID-19 in the home during the pandemic.

Systems were in place to monitor and record safeguarding incidents to keep people from harm. There were sufficient staff for the number of people living in the home at the time of the inspection. Medicines were managed safely. Lessons were learnt when issues were identified.

People were complimentary about the registered manager and their staff team; they felt they did a good job. People received positive outcomes for their health and well-being.

People were engaged and involved in how the service was run. The service worked well with other professionals. Any concerns were escalated and referrals to relevant professionals were made in a timely manner.

We have made a recommendation about the provider reviewing government guidance for using PPE in a care home.

We have made a recommendation about the providers cleaning processes to ensure they keep the cleanliness of the home to a high standard.

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 4 July 2019). 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. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the provider had followed their action plan and to confirm they now met legal requirements regarding Regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. 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 not changed. 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Copper Beeches is a care home that provides personal care for up to 20 people. At the time of the inspection, the home had 16 people living there.

People’s experience of using this service:

The home was unclean and this can impact on good infection control. Areas of the environment were not managed safely (for example, hazardous substances were not locked away). Areas of the home require refurbishment to ensure a safe and clean environment. We have had long standing concerns about the management of the environment. These concerns have caused a repeated regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We have observed some improvements since the last inspection. However, ongoing work is required for this service to be rated at the expected level of ‘Good’.

Care plans and risk assessments followed evidence based guidance. Further work was required to ensure these records were thorough and robust enough to guide effective and safe care. Some work had been done to gather people’s preferences, again this required further work to ensure that people’s individuality was reflected in the care offered.

We found there were now enough staff during the day. Staff commented on the improvement this had on care. People told us that they did not need to wait long for support. We remain concerned about the amount of staff at night to respond in an emergency. This is because there are two staff and six people required two staff to mobilise. This could limit the effectiveness of a safe evacuation. Staff were recruited safely to ensure that they were appropriate (for example, staff had DBS checks.)

There were improvements to the management of medicines. Some minimal medicine concerns still required resolving, for example writing the date on topical medicines to ensure they were disposed of when needed. People told us that medicines were provided on time and all staff had been re-trained to ensure that they were competent to support medicine administration.

People told us that they felt safe at the service. Staff understood how to keep people safe, and how to raise concerns about potential abuse. We saw that incidents had been reviewed and clear actions put in place to prevent re-occurrence.

Improvements had been made in line with The Mental Capacity Act (2005). However, further work was required to ensure assessments reflected individual decision-making abilities. This would support people to have maximum choice and control of their lives and staff support them in the least restrictive way possible. Due to capacity assessments requiring improvement, the policies and systems in the service did not currently supported effective practice.

Records showed us that staff training was sometimes still out of date. The manager gave assurances that this was arranged for June 2019. Despite training being out of date, staff had been competency checked by the manager. We noted an improvement in knowledge and skill set among the staff.

People received a varied diet and had a choice about what they ate. Efforts had been made to develop the menu offered to people. People who were at risk of weight loss and dehydration were supported and monitored to ensure they remained as well as possible.

Staff were caring in their approach. However, this was attributed to the approach of individual staff members rather than a caring organisation. For example, most staff had expired dignity and respect training. The environment was not adequate to evidence a caring culture, for example bedding and towels required replacement and people’s individuality was still not adequately reflected across care records.

The inspection identified ongoing concerns about the environment which had not yet been fully resolved by the service. We expect all services to reach a rating of ‘Good’. The improvements shown by the service highlight that this service does have potential to continue to improve.

Rating at last inspection:

At the last inspection, the service was rated ‘requires improvement’ (Published 12 April 2019)

Why we inspected:

At our last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 9, 12,15,17 and 18. We inspected this service to see if improvements had been made as required.

Enforcement:

At this inspection we found one ongoing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was regulation 15. While the service was no longer in breach of other regulations, further work was required to ensure that the service could be rated as ‘Good’.

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

Follow up: We will continue to monitor the level of risk at the service until the next inspection visit.

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

People’s experience of using this service: Risks associated with people’s care and support were not always managed safely. Improvements were needed to ensure people received their medicines as required. There were not always enough staff to meet people’s needs. Improvements were required to ensure the home was clean and well maintained. People felt safe and there were systems and processes in place to minimise the risk of abuse. Accidents and incidents were reviewed and analysed to try to prevent future incidents. Safe recruitment practices were followed.

Further work was needed to ensure people’s rights under the Mental Capacity Act 2015 were protected. Staff required more training to enable them to provide safe and effective. Mealtimes were positive experiences and risks were managed. People had access to a range of health care professionals, but care plans required more information about people’s health to ensure consistent support. Overall, the home was adapted to meet people’s needs, but some areas were in a poor state of repair.

Although staff were kind and caring this was based upon the approach of individual staff and not promoted by the culture of the organisation. People were supported to be as independent as possible. People had access to advocacy services if they required this.

People did not consistently receive personalised care that met their needs. People were not always provided with opportunity for meaningful activity. There were systems in place to respond to complaints.

The service did not have a clear vision. Swift action had not always been taken to address risks to people’s safety. Records of care and support were not accurate or up to date. The new service manager had been proactive in identifying areas for improvements at the home. Improvements were underway to develop auditing systems and work had started to better involve people who used the service and staff in the running of the home.

The service met the characteristics of requires improvement in most areas we inspected. More information is in the detailed findings below.

Rating at last inspection: Inadequate (report published 20 November 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that work was underway to make improvements to the safety and quality of the service. However, further work was needed to ensure these improvements continued and were sustained.

Enforcement: We identified five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safety, staffing, the environment, care and governance. Details of action we have asked the provider to take can be found 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: During our inspection we requested an action plan and evidence of improvements made in in relation to staffing and fire safety. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be 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.

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 carried out an unannounced comprehensive inspection of this service in June 2018. Breaches of legal requirements were found in relation to; risk management, safeguarding, cleanliness and infection control, person centred care, dignity, consent and leadership and governance.

Since our June 2018 inspection we received concerns in relation to the safety, management and leadership of Copper Beeches. As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copper Beeches on our website at www.cqc.org.uk.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the home in September 2017. 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.

During our inspection we found the service was not safe. People were subject to improper treatment that did not respect their rights. Restrictive practices were used to manage people’s behaviour. People were not always protected from risks associated with their care and support. People were placed at risk of falls as assistive technology was not used effectively. Risks associated with people’s health conditions were also not managed safely. This placed people at risk of harm. Risks associated with the environment, specifically legionella, were not safely managed. Furthermore, some areas of the home were unsafe, placing people at risk of harm. People were at risk of not receiving their medicines as prescribed, as there were not always medicines trained staff on shift. Medicines practices were not always hygienic. Infection control and prevention measures were not effective, this exposed people to the risk of infection. Staff were not always deployed effectively to meet people’s needs in a timely way. Safe recruitment practices were not always followed.

Copper Beeches was not well led. Quality assurance processes were not effective, this had led to a failure to identify and address areas of concern. Serious incidents were not investigated; this meant action had not been taken to reduce the risk of reoccurrence. The provider had not kept up to date with current guidance and legislation. Decisions about people’s care and support were not always based upon specialist advice or best practice. The culture of the home was not respectful or person centred. There were limited opportunities for people living at Copper Beeches to influence the running and development of the home. The provider was not compliant with their own policies. We received mixed feedback from the staff team about the leadership and management of the home.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be 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.

At the last comprehensive inspection in June 2017, we asked the provider to take action to make improvements across a number of areas including; risk management, safeguarding, recruitment, person centred care, consent and leadership and governance. We conducted a focused inspection of Copper Beeches in September 2017. That inspection only looked at whether the service was safe and well led. We found ongoing concerns in relation to the safety and leadership of the home.

During this inspection, we found continued concerns about the safety and quality of the service provided at Copper Beeches . We found eight breaches of the Health and Social Care Act 2008 regulations. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the 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.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the home in September 2017. 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 was a manager in post who told us they were planning to register. We will monitor this.

During our inspection we found the service was not safe. People were not always protected from risks associated with their care and support. People were placed at risk of choking as risks were not assessed and staff did not have adequate guidance to inform their care and support. People were not protected from the risk of pressure ulcers. Incidents were not analysed or investigated; this meant action had not been taken to reduce the risk of reoccurrence. Risks associated with the environment, specifically fire, were not safely managed and this exposed people to the risk of harm. Medicines were not stored or managed safely, poor record keeping meant people may not receive their medicines as prescribed.

People were not protected from abuse and improper treatment. We found evidence of an allegation of abuse that had not been referred to the local authority safeguarding adults team for investigation. The cause of unexplained marks to people’s skin were not investigated. Infection control and prevention measures were not effective, this exposed people to the risk of infection spreading. People could not be assured that good hygiene practices were followed, effective cleaning procedures were not in place for some items of equipment and some areas of the home.

Staff levels were not based upon an assessment of people’s need and consequently, there were not enough staff to meet people’s needs and ensure their safety. Staff were not always deployed effectively and this placed people at risk of harm. Safe recruitment practices were in place to reduce the risk of people being supported by unsuitable staff.

People were supported by staff who did not always have appropriate training or support. Staff lacked training in key areas, such as people’s health conditions and we found this had a negative impact on people living at the home. Furthermore, when staff did have training this did not always ensure their competency. Staff did not receive regular supervision which meant opportunities to monitor staff performance and development may have been missed.

People were not supported to have maximum choice and control over their lives; the policies and systems in the service did not support this practice. Where people lacked capacity to consent to their care and treatment their rights were not always upheld. There was a risk people may not receive person centred support when they moved between services and systems to gather and share information were not always effective. The design and decoration of the building accommodated people’s diverse needs; however, some areas of the building and grounds had not been adequately maintained.

Risks associated with people’s health were not managed safely. Staff had a poor knowledge of people’s health conditions and did not always identify deteriorations in people’s health. Advice from specialist health professionals was not always followed. We received mixed feedback about the food, but found that overall people were provided with enough to eat and drink.

People did not consistently receive caring support. People were not always treated with dignity and respect and staff did not always communicate effectively with people when providing care and support. The language used by staff to describe people did not always promote their dignity.

People were supported to be as independent as possible. People were involved in day-to-day choices and decisions, but feedback about involvement in care planning was mixed. People had access to advocacy services if they required this to help them express their views. People’s right to privacy was respected.

People were at risk of receiving inconsistent support as care plans did not contain accurate, up to date information. People did not receive support that met their preferences. The quality of care for people who were coming towards the end of their life was poor. People were offered some opportunities for social activity, however, these were not always based upon their individual needs or preferences. Consequently, some people told us they had little to do or were bored. There were systems to investigate and respond to concerns and complaints; there had not been any complaints recorded since our last inspection. We were aware of a complaint regarding the quality and safety of care which had been upheld by the Local Government Ombudsman.

Copper Beeches was not well led. A lack of effective governance systems meant areas of concern had not been identified or addressed. This placed people at risk of harm. The approach to quality assurance was reactive and was limited in scope. Care was not always based upon specialist advice or best practice. Systems to monitor and improve quality and safety were not comprehensive and when systems were in place they were not consistently effective in identifying and addressing areas for improvement. Sensitive personal information was not stored securely. Staff and people living at the home only had limited opportunities to express their views in relation to how the service was run.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be 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 carried out an unannounced comprehensive inspection of this service on 14 and 16 June 2017. Breaches of legal requirements were found. After the comprehensive inspection we took action against the provider and issued two Warning Notices to ensure that improvements were made in relation to the safety and governance of the home. The provider was required to be compliant with the notices by 4 September 2017 (safety) and 9 October 2017 (governance). We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Copper Beeches on our website at www.cqc.org.uk.

At this inspection we found that the provider had not made the all of the required improvements and remained in breach of these legal regulations. We also found a breach of the Care Quality Commission (Registration) Regulations) 2009. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found that the service was still not safe. People were exposed to the risk of harm and action had not been taken to protect them from risks associated with their care and support. Risks associated with falls, moving and handling and pressure ulcers were not effectively assessed or managed.

Equipment was not always used safety. We found a number of unsafe practices in relation to the use of bedrails. Risks resulting from environmental hazards, such as windows and portable heaters, were not safely managed, consequently we found that people were exposed to the risk of harm.

Improvements had been made to ensure that people received their medicines as prescribed. However, where people were prescribed creams; these were not always applied as required. Improvements had been made to the cleanliness of the environment and effective food hygiene practices were now followed.

Since our last inspection action had been taken by the provider to ensure that the risk of people experiencing improper treatment or abuse were minimised. There were enough staff to provide care and support to people when they needed it. Safe recruitment practices were followed.

The service was still not well led. Auditing systems were not effective in identifying or addressing risks to people who used the service and this placed people at risk of harm. There were concerns with the competency of the management of the home.

Opportunities for people living at the home to provide feedback on the service were still limited and people told us that communication required improvement. In contrast, staff felt supported and were able to express their views in relation to how the service was run. The provider was not conspicuously displaying their rating in line with our requirements and CQC was not notified of significant events as required.

The provider was responsive to our feedback and took swift action to respond to our concerns and address the risks to people who used the service.

The overall rating for this service is ‘Requires improvement’. However, the service remains in ‘special measures'. This is because the service has been rated as ‘inadequate’ in a key question over two consecutive inspections.

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.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our inspection. 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’s medicines were not always given as prescribed or managed in a safe way. Risks to people’s health and safety were not always managed appropriately or safely. Risks associated with the environment were not always assessed, the environment was not always clean and hygienic, and basic food hygiene practices were not always followed. Although people told us they felt safe, people were not always protected from abuse and improper treatment. People were not supported by staff that had been safely recruited.

There were enough staff available to meet people’s needs and ensure their safety. Staff received an induction to their role and had access to ongoing training to meet people’s needs.

The principles and application of the Mental Capacity Act were not always understood or followed where people lacked capacity to make decisions for themselves.

People had enough to eat and drink and were provided with assistance as required, however people’s feedback about the quality of the food was varied and action had not been taken to address this when issues were raised. People’s day to day health care needs were met, but there was a risk that action may not be taken in response to changes in people’s health, as staff did not always have access to information about their health conditions and how to support them with these.

People’s views about their care and support were not consistently acted upon which meant people’s preferences were sometimes not met. There was a risk that people may not have access to advocacy services if they required this to help them express their views.

Staff understood how people communicated and they were supported to maintain their independence. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. Staff also respected people’s right to privacy.

People told us they received inconsistent support from staff, care plans did not always contain adequate detail of the support people required and staff were not always aware of people’s specific needs. People could not always be assured that they would receive support that was based on their individual needs, as some routines were in place to suit the needs of the staff at the service rather than the people living at the home.

People had the opportunity to get involved in social activities. People knew how to complain and complaints were documented, investigated and action was taken to address concerns raised.

The service was not well led and we identified a number of shortfalls in the way the service was managed. There were not sufficiently robust or comprehensive systems in place to ensure people were provided with safe and effective care that met their needs. Appropriate action was not taken by the provider to investigate incidents which posed a risk to the health and wellbeing of people who used the service. Swift action was not taken in response to known issues and people’s feedback was not used to drive improvements.

Given the issues identified above the overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be 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.