Wilkinson Park

Wilkinson Park is a residential care home which provides personal care for up to 21 people, including people with learning disabilities and those with complex behaviours. Accommodation is provided over two floors and there are three separate accommodation areas where people live more independently. There were 19 people using the service at the time of our inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

An effective system to ensure risks were assessed, monitored, and managed was not fully in place. We identified shortfalls relating to the safety and security of the premises, infection control and cleanliness relating to one person’s room and the safety of visitors to the service.

There were sufficient staff deployed to meet people’s needs.

The service was working within the principles of the Mental Capacity Act (2005) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

Right Care:

Some people told us they were bored. Records of activities which people took part in were not always detailed or evidenced meaningful occupation.

Whilst a staff training and support system was in place; records relating to agency staff did not always demonstrate what training they had undertaken to meet the specific needs of people who lived at the service.

Right Culture:

An effective system to monitor the quality and safety of the service was not fully in place.

Management staff gave us examples of how being at the service, with the support of staff, had led to an improvement in people's independence and wellbeing. They also explained how several people had moved onto independent living.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 October 2022). There were breaches of the regulations relating to safe care and treatment, good governance, and the notification of incidents. We asked the provider to send us an improvement plan which detailed the actions they had taken/were going to take in relation to the issues identified during inspection. At this inspection, whilst action had been taken to improve in certain areas and the provider was no longer in breach of the regulations relating to safe care and treatment and the notification of incidents, further improvements were required and the provider remained in breach of the regulation relating to good governance.

Why we inspected

We undertook this focused inspection to check they had followed their improvement plan and to confirm they now met legal requirements. Prior to our inspection, we also received concerns relating to the security of the service and staff training including agency staff.

This report only covers our findings in relation to the key questions of safe, effective, responsive, and well-led which contain those requirements.

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

For the caring key question not inspected, we used the rating awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the full report below.

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

Enforcement and Recommendations

We have identified 1 breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. This related to good governance.

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

We have made recommendations in the effective, responsive, and well led key questions in relation to records relating to agency staff training, the monitoring of complaints and communication and engagement. Please see these sections for further details.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Wilkinson park is a residential care home which provides personal care for up to 21 people, including people with learning disabilities and those with complex behaviours. Accommodation is provided over two floors and there are three separate accommodation areas where people live more independently. There were 15 people using the service at the time of our inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Some people had one to one hours with staff. However, records did not always evidence that this one to one support was provided.

Right Care:

Some people told us that activities at the service was limited. Records of activities which people took part in were not always detailed or evidenced meaningful occupation.

Right Culture:

An effective system to monitor the quality and safety of the service and ensure people achieved good outcomes was not fully in place. A new manager was in place. She was going to apply to become a registered manager.

Following our visits to the service. we asked the provider to send us an improvement plan which detailed the actions they had taken/were going to take in relation to the issues identified during our inspection. The provider responded and explained that management and their quality and compliance team were monitoring and supporting the home. They also stated that they were in the process of reviewing each individual's activity plans with the support of one of their occupational therapists and had linked up with a charity to provide an opportunity for individuals to meet on a monthly basis for various activities and engagement opportunities. In addition, an artist was employed who provided a fortnightly art. The provider explained that these actions had commenced/were in place before the start of the inspection.

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 good (published 29 December 2020)

At our last inspection we recommended that the provider revisited best practice guidance in relation to infection control and the use of PPE and reviewed their information management system to ensure documentation and information requested by CQC is available and submitted to us in a timely way. At this inspection we found that improvements had been made in relation to the use of PPE; however further shortfalls were identified with infection control and the environment. Action had been taken to ensure information requested by CQC was submitted in a timely manner.

Why we inspected

The inspection was prompted due to concerns received from the local authority about the cleanliness of the environment, the assessment of risk and staff deployment. A decision was made for us to inspect and review the key questions of safe and well-led and examine those risks.

When we inspected, we found there was a concern with meeting people’s social needs, so we widened the scope of the inspection to include the responsive key question.

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

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

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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

Enforcement and Recommendations

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

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to safe care and treatment and good governance. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents).

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response in relation to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (notification of other incidents) is added to reports after any representations and appeals

have been concluded.

We have made recommendations in the safe and responsive key questions in relation to medicines management and the monitoring of complaints and concerns. Please see these sections for further details.

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.

Wilkinson Park is a care home providing accommodation and personal care for up 21 people with learning disabilities. There were 11 people living at the service at the time of our inspection.

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

Risks relating to people’s care and support needs were documented and reviewed. There was one ongoing fire safety action relating to the premises. Construction work to address this issue had been delayed due to Covid-19. This work was due to be completed imminently and the provider was liaising with Northumberland Fire and Rescue Service regarding this issue.

Government guidance relating to the use of Personal Protective Equipment [PPE] in respect of the Covid-19 pandemic, was not always fully followed by a small number of staff. Following the inspection, the registered manager and provider told us the issues relating to staff use of PPE had been addressed. We have made a recommendation about this.

Systems were in place to protect people from the risk of abuse. There were sufficient staff deployed to meet people’s needs. Medicines were managed safely; one person was being supported to become more independent with their medicines.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were aiming to meet the underpinning principles of Right support, right care, right culture. The restrictions which the provider had put in place because of Covid-19 relating to accessing the local community, did have an impact upon people’s choice and control. We recognised the service was trying to balance people’s rights whilst aiming to ensure the safety of people at the home. We have recommended that the provider seeks advice from a reputable source to ensure decisions relating to any restrictions incurred during the pandemic are based upon an individualised and dynamic risk assessment to help reduce the impact of Covid-19 upon people’s wellbeing.

There was a system in place to ensure staff were suitably trained and skilled. Staff told us they felt supported.

Staff treated people with kindness. There was a positive atmosphere within the home with laughter and friendly banter throughout our visit. People’s privacy, dignity and independence was promoted. Housekeeping skills were encouraged to promote people’s independence.

Electronic care records were detailed and described how people’s needs should be met. A system was in place and followed, to review people’s needs to ensure care plans were up to date and reflected the support people required. Additional activities were being carried out within the home due to Covid-19. Prior to the pandemic, people were accessing the local community. Another vehicle had been purchased to provide additional access to transport.

The provider had a quality assurance system in place. However, information we requested during and following our inspection was not always sent in a timely manner. We have made a recommendation about this.

A new registered manager was in place. He had become registered since our last inspection. People, relatives and health and social care professionals spoke positively about him and the improvements he had made. One health and social care professional told us, “[Name of registered manager] is a fair gentleman and appears to want to do his best for the residents living at Wilkinson Park.”

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 14 January 2020) and there were multiple 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 that action had been taken and the provider was no longer in breach of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

Follow up

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

People’s experience of using this service: People were supported by staff they liked and knew well, however, risks relating to people using the service were not effectively monitored, mitigated or recorded. There was insufficient attention to the monitoring of supervision arrangements for people who required additional support to keep them and others safe.

An effective system to demonstrate that sufficient staff were deployed to meet people’s needs was not fully in place. Some staff were regularly working excessively long hours. Some people were bored and there was a lack of evidence that people’s social and occupational needs were being met.

Electronic records were not maintained to a satisfactory standard. There were gaps in record keeping and key information about people’s care including risks was not always clearly recorded. Following the inspection, the provider wrote to us and stated, “Since the inspection, care plans have all been reviewed and been rewritten where necessary and will be reviewed monthly.”

The home was not satisfactorily clean. There were no domestic staff employed at the time of the inspection meaning care staff were also responsible for cleaning. Environmental risks we found had not been identified by the provider’s own health and safety audit. This placed people at risk of harm. Following our inspection, the provider wrote to us and said that external cleaning contractors had been recruited to deep clean the service and a refurbishment plan was being implemented.

People were supported day to day to have maximum choice and control of their lives by staff however, they were not always supported in the least restrictive way possible due to issues with staff deployment and access to transport. Where formal restrictions had been placed on people, these were not always clearly recorded. Following our inspection, the provider told us they had purchased a second vehicle to help improve people’s access to transport.

Safe staff recruitment procedures were followed, recruitment was ongoing. Medicines were managed safely.

Staff received regular training. There were some gaps in supervision and appraisals however plans had already begun to address these when we started our inspection. Appraisal and supervision records were detailed.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 21 people. 14 people were using the service. This is larger than current best practice guidance although the service was registered before the registering the right support guidance was in place. However, the size of the service having a negative impact on people was mitigated in part by the building design which meant some people could live in smaller domestic style premises on the property.

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always consistently applied them.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. Whilst the provider sought to promote choice and independence, we found access to and choices of activities were restricted through issues with staff deployment and transport availability.

The environment needed updating and refurbishment. We requested a plan and timescales for upgrading the premises and facilities but had not received this at the time of the report. The provider contacted us to say they would share these plans with us our following our inspection. The grounds were very well maintained.

People were supported with eating and drinking. The provider told us there were plans to replace the kitchen as part of wider refurbishment plans, with the addition of a new kitchen and dining facilities for people to use.

Staff knew people well and showed care and concern for their welfare. People liked staff and knew how to raise any concerns about their care.

A new manager had been appointed but had not yet registered with the Care Quality Commission (CQC) and resigned from their position during our inspection. Communication was not always effective in the service and records were disorganised. Important information could not always be located.

Audits and checks were carried out on the quality and safety of the service. These had not always identified all the issues we found and where they had, timely action had not been taken.

Several incidents had not been notified to CQC in line with legal requirements. We are dealing with this outside the inspection process.

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

Rating at last inspection: Good (published October 2017).

Why we inspected: This inspection was prompted by information of concern.

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to safe care and treatment, person centred care and good governance. Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to comply with the condition to have a registered manager in post and had failed to notify CQC of all incidents in line with legal requirements. This was a breach of regulation. 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.

Wilkinson Park is registered to provide accommodation, personal care and support for up to 21 adults with learning difficulties. The home is subdivided into a main house, a courtyard semi-independent living area and two cottages attached to the home, where people also live on a semi-independent basis. At the time of the inspection there were 17 people using the service.

The home had a registered manager who had been registered with the Care Quality Commission since August 2017. This registered manager had left the home approximately three weeks prior to the inspection, but had not cancelled their registration at the time of the inspection. An acting manager had been appointed and had been in post for two weeks. A registered manager is a person who has registered with the Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The acting manager was supported in their role by regular visits from the provider’s Head of home operations. Both individuals were in attendance and supported the inspection over the two days.

The service had previously been in organisational safeguarding, but had worked closely with the local safeguarding adults team and had recently come out of this overarching safeguarding process. The provider had dealt with recent safeguarding issues appropriately.

There had been previous concerns with regard to staffing at the home and in particular the high use of agency staff. At this inspection we saw the provider had taken action to address this issue. Several new staff had been recruited and people and staff told us this had had a beneficial effect on the service. Appropriate recruitment processes and checks had been followed.

Checks on the safety and security of the premises were undertaken and safety certificates for gas, electricity and small electrical appliances were in place. Checks related to fire safety were also undertaken. Medicines at the home were dealt with safely and appropriately. The provider had introduced a new electronic medicines system, which staff said made the administration of medicines easier and safer.

The home was generally clean and tidy. An outside contractor was currently used twice a week to thoroughly clean the home until full time domestic support could be appointed. A basic infection control audit had been completed. Some people raised issue about odours in the home at times, potentially linked to ongoing issue with drainage. The handyman told us a solution was being considered.

Staff told us they had access to a range of training and new staff had completed a detailed induction programme before starting work at the home. Training records indicated staff were up to date with mandatory training areas. We had previously found issues with annual appraisals not being undertaken at the home. At this inspection we found the issue had been addressed. Staff confirmed they had regular appraisals and supervision and support sessions.

People told us they found the food acceptable, although a number suggested the variety of dishes could be increased. Some people told us they were also able to go shopping and were supported to prepare their own food, where they lived in the semi-independent accommodation. People continued to have access to health care professionals to help maintain their wellbeing.

The acting manager confirmed appropriate assessments and applications had been made, where people met the criteria laid down in the Deprivation of Liberty Safeguards (DoLS) guidance, and records confirmed this. They told us people living at the home had the capacity to make the majority of decisions. Where there was any concern capacity assessments were conducted and we saw copies of these. Where appropriate, people had signed consent forms and staff sought day to day consent in an appropriate manner.

People told us, and we observed decoration in communal areas was in need of updating. The acting manager told us there was a planned programme to refresh the home over the next few weeks, including the renewal of furniture.

People told us they were happy with the care provided and the support they received from the staff. We observed staff treated people with kindness and respect and there were good relationships and interactions. People said they valued their privacy and staff respected this.

People had individualised care plans that addressed their identified needs. However, we found some reviews of care plans and associated risk assessments were not always undertaken in a timely manner. The acting manager and the Head of home operations told us a new electronic care records system was being introduced and demonstrated how this would work when fully integrated. Staff told us they found the new electronic system easy to access and complete. They felt it was an improvement on previous paper records. We have made a recommendation about ensuring timely updates are made in the future.

People told us they were still able to access a range of outings and activities, although continuing issues with access to vehicles meant these had to be re-timetabled on occasions. The Head of home operations told us a new seven seat vehicle had been ordered and was awaiting delivery. We have made a recommendation about transport needs at the home. Complaints and concerns continued to be recoded and were addressed appropriately.

The Head of home operations showed us records confirming periodic checks and audits were carried out at the home. We noted some of these check were largely tick box in nature. The Head of home operations told us new audits formats were being developed to focus more on quality of service. At the previous inspection staff morale had been low and people told us they lacked confidence in senior management. At this inspection staff were more positive about the leadership of the home and felt well supported by management. People and staff talked about the increasingly positive atmosphere at the home and felt the service was ‘on the up.’ Previously, records had not been well maintained and were not always accessible. At this inspection records were better maintained and required documents readily available for inspection.

This report only covers our findings in relation to these domains. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Wilkinson Park’ on our website at www.cqc.org.uk’

We carried out a comprehensive inspection of the service in June 2016. The overall rating for the home at this time was 'Requires Improvement.’ We found a breach in Regulation 18 relating to staff support and made recommendations regarding revising the tool used to determine staffing levels and also that an infection control audit should be undertaken. The provider wrote to us and told us what action they were going to take to address the breaches and said the matters would be addressed bu August 2017. There was no registered manager in post at the June 2016 inspection.

Wilkinson Park is registered to provide accommodation, personal care and support for up to 21 adults with learning difficulties. The home is subdivided into a main house and integral semi-independent living area. There are two cottages attached to the home, where people also lived on a semi-independent basis. At the time of the inspection there were 17 people living at the service.

At the time of this inspection there continued to be no registered manager registered at the location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The day to day running of the location was carried out by an acting manager who was not available on the day of the inspection.

Safeguarding records were not well kept or completed and there were discrepancies between notifications received by the CQC and copies of safeguarding alerts sent to the local authority. We could not be certain that safeguarding matters were managed appropriately.

There was high use of agency staff at the home, although people living at the home told us most of the agency staff were very good at supporting them. Some shifts had more agency staff than permanent staff. The Head of homes told us some new staff had been recruited but there was still a shortfall in support workers at the home. A new deputy manager was awaiting references and DBS checks. Interviews for a registered manager had not been successful. People told us staffing had improved although the use of agency staff still limited their access to the community.

A recommendation made at the last inspection, to review the dependency tool used to determine staffing levels at the home, had not been undertaken. The Head of homes said this was because of the lack of a permanent manager.

Accidents and incidents were recorded, but had not been analysed to identify any trends or issues. Actions listed to prevent further accidents were not always detailed or appropriate.

Checks on fire equipment and safety systems at the home had been undertaken and recorded. Staff recently recruited had been subject to a proper interview and recruitment process, including the taking up of references and DBS checks.

Medicines were managed appropriately and there were no gaps in the recording of medicines at the time of the inspection. Checks were maintained on the stock of medicines at the home.

A recommendation made at the last inspection, to undertake an infection control audit, had not been followed, to date. The Head of homes said this was because of the change in managers at the home.

At the previous inspection in June 2016 we had found staff annual appraisals had not been undertaken. This was a breach of Regulation 18. The provider sent us an action plan stating this matter would be completed by August 2016. However, we found there were still no appraisals completed and regular supervision had also not been recently completed.

Training records showed the majority of staff were up to date with training provided internally by the provider. The Head of operations told us the home was linked to the local Learning and Development Unit (LDU). LDU staff said a limited number of staff had signed up to the service since they first visited the home in February 2016.

Agency staff said they had received appropriate training through their agency. The provider said they had provided additional training to agency staff but we have not received information supporting this.

The provider was working within the requirements of the Mental Capacity Act (2005) and applications for DoLS had been made. People at the home could give day to day consent to care and treatment.

A new chef had recently been employed at the home. People said food was improving.

The Head of homes said regular checks and audits at the home had not been sustained, because of the change in managers. She said the provider was also changing their overall quality monitoring process meaning provider checks had not been followed up. An outside agency had carried out a review of the home, but all actions identified had not been addressed within suggested dates.

At the previous inspection people told us they had not felt listened to by senior managers. At this inspection they said they still felt senior managers in the organisation were not always listening, although previous concerns over transport options had been partially addressed.

The Head of home told us the home needed a period of consistent management and oversight to improve the situation.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Staffing and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Wilkinson Park is registered to provide accommodation, personal care and support for up to 21 adults with learning difficulties. The home is subdivided into a main house and integral semi-independent living area. There are two cottages attached to the home, where people also lived on a semi-independent basis. At the time of the inspection there were 16 people living at the service.

At the time of the inspection there was no registered manager registered at the location. This was because the previous manager had recently retired. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The day to day running of the location was carried out by a service manager, who would report to the registered manager.

At the previous inspection in March and April 2015 we found two breaches in regulations. Some windows at the home did not have appropriate window restrictors in place and care plans were not always clear or dated appropriately to show when they had been reviewed. The provider wrote to us and told us these matters would be dealt with by June 2015. At this inspection we saw care plans had been updated with clear information to help staff support people and that reviews took place regularly. We also saw that window restrictors had been fitted throughout the home. A range of checks were also undertaken on other safety equipment and systems, such as fire and water systems.

People and staff told us it would be helpful to have more staff and that sometimes it was difficult to participate in activities because there were not enough experienced staff on duty. The provider had a dependency tool in place to help determine staffing levels. However, this did not always take into account the specific needs of the home’s rural location. We have made a recommendation this is reviewed.

The home was clean and tidy and appropriate personal protective equipment was available throughout the building. We found action to support one person using a commode was not in line with national guidance. We have recommended a review of infection control procedures at the home.

Appropriate safeguarding procedures were in place to help protect people from abuse. The provider had in place systems to ensure staff recruited to the service were relevantly experienced. Risks related to supporting people with care and the running of the home were assessed and action taken to minimise them. Medicines at the home were managed effectively.

Staff at the home had access to a range of training and development opportunities. Staff told us they had regular supervision by managers or senior staff. Annual appraisals had not been undertaken, some for as long as two and a half years.

The acting manager confirmed some people were subject to Deprivation of Liberty orders under the Mental Capacity Act (2005). We saw assessments and applications in relation to DoLS had been undertaken. People who were subject to other legal restrictions also had these matters reviewed. Staff had received training in managing challenging behaviour and had a good understanding of dealing with these situations. People were supported to make choices and assisted to maintain good health and wellbeing.

People told us food at the home was good and they could request particular items if they wished. Some people were supported to go shopping and cook their own meals. Individual rooms were decorated to personal taste, although the decoration in some of the public areas were in need of refreshing.

People told us they were happy with the staff who cared for them and we saw that relationships were positive, supportive and friendly. They told us they were involved in determining and reviewing their care. They also told us staff respected their privacy and helped maintain their dignity during the delivery of care.

A range of activities took place at the home and people also went out into the local community. People said vehicles used at the home regularly broke down and this sometimes caused inconvenience if they wished to go out. The acting manager said this issue was being looked at. The provider had a complaints procedure in place and any concerns were investigated.

People and staff told us they felt well supported by the acting manager and deputy manager. They did not feel there was sufficient support or appreciation from the provider’s senior managers who visited the home. The acting manager said there was regular attendance at the home by senior staff and HR staff.

A range of audits were undertaken at the home on both the environment and the delivery of care. The home continued to have links with the local community and engaged in activities in local villages. Records at the home were up to date and maintained effectively.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Staffing. We have also made two recommendations to the provider.

We looked at the arrangements in place for infection control as we had concerns about this at our last visit. We found improvements had been made and we concluded people were cared for in a clean, hygienic environment.

We looked around the environment in which people were cared for and the equipment available to support them in their daily lives. We found the provider had taken action to address the issues identified at the last inspection. We were satisfied people were protected from the risks of unsafe or unsuitable premises.

We found people's care and treatment was planned and delivered in line with their individual care plan.

We concluded people were provided with adequate nutrition and hydration.

We found people were not always cared for in a clean, hygienic environment.

We saw the provider had not protected people, staff and visitors against the risks of unsafe or unsuitable premises.

There were effective recruitment and selection processes in place.

Staff records and other records relevant to the management of the service were accurate and fit for purpose.