Avon Court Care Home

Avon Court Care Home is a nursing home providing accommodation and personal care for up to 60 people. At the time of our inspection there were 41 people living at the service. Accommodation was provided on two floors accessed by stairs and a lift. People had their own rooms and use of communal areas such as lounges, dining rooms and a conservatory. The home also provided rooms for people on a short stay arrangement in partnership with the local authority. These rooms were for people being discharged from hospital and in need of rehabilitation before moving back to their own homes.

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

Risks to people’s safety had been identified and assessed. Plans were in place for staff to use to support and provide care safely. Plans were reviewed regularly or when people’s needs changed. Two plans we reviewed needed more details, we informed staff during our inspection so action could be taken to update them. The provider had identified improvement was needed for care planning and taking action to improve quality of records.

People had their medicines as prescribed. The service had an electronic medicines management system which helped to identify shortfalls. We did note one person had not had their time sensitive medicines in a timely way. This was shared with the manager who took action to address this. Staff had medicines training and were assessed for competence.

People were supported by sufficient numbers of staff. There had been staffing challenges and agency staff were used to fill gaps in staffing rotas. The provider and the manager were working to recruit new staff using various methods. People told us staff were busy, but staff responded to them in a timely way. Staff had been recruited safely.

The home was clean and had been decorated shortly before our inspection. Cleaning schedules were in place to make sure all areas of the home were cleaned. Staff were observed to be wearing personal protective equipment (PPE) safely. Staff told us they had training on infection prevention and control good practice and received regular updates when needed. The home was following government guidance on testing for COVID-19.

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.

Prior to our inspection we received information of concern about staff interaction with people particularly at night. We visited in the evening and spent time observing staff interactions. We did not find evidence to substantiate any concerns. People told us staff were caring and kind and they felt comfortable with staff. People and relatives told us people were safe at the service. Staff had been given training on safeguarding and understood their responsibilities.

People could share their feedback using quality surveys and reviews of care. The service used a ‘Person of the day’ process to review people’s care and make sure they were satisfied. Staff were able to attend staff meetings to share views and have updates on events and people’s needs.

There was a registered manager in post who was on long term leave at the time of this inspection. The provider had placed an experienced interim manager at the service who had worked for the provider for many years. Feedback from people, relatives and staff about the manager and deputy manager was positive. We were told they were visible, approachable and very supportive. Staff told us there was good teamwork and despite staffing challenges morale was high amongst staff.

Staff worked in partnership with various healthcare professionals to make sure people had their health needs met. Due to the service having a number of ‘short stay’ rooms there were professionals regularly visiting the home to provide rehabilitation. Some professionals told us communication could be improved with the management. We shared this feedback with the manager and area director who told us they would review current systems.

Quality monitoring systems were in place to make regular checks on quality and safety. The provider had systems that gave senior management access to key data such as weight loss, pressure ulcers and medicines incidents. This enabled the provider to make sure the right action had been taken to support people safely.

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 4 February 2021). At our last inspection we recommended that the provider review their policy about making sure end of life medicines were included in the care planning process. At this inspection we found this action had been taken.

Why we inspected

The inspection was prompted in part due to concerns received about personal care, staff approach and some risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. 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.

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 good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avon Court 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.

Avon Court is a residential care home providing personal and nursing care for up to 60 people. At the time of this inspection 24 people were living at the home and one person was in hospital. People lived across two floors, the upper floor was for people living with a diagnosis of Dementia and ten intermediate care beds. These were short stay admissions to the service, for people who required time for rehabilitation following recent hospital admissions.

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

Medicines were now being managed safely at the home. A recommendation has been made in relation to anticipatory end of life medicines.

We saw one example of an undignified interaction that did not promote a person’s dignity. All other interactions observed were dignified and respectful. Staff we spoke to were passionate about promoting people’s privacy and dignity. People and their relatives did not raise any concerns with us about how they were treated. The provider was no longer in breach of Regulation 10 Dignity and respect.

The provider had submitted one late notification. Action around the failure to notify was taken by the service. All other incidents have been submitted. Although there had continued to be some issues with the notification process enough action had now been taken to improve this and the service was no longer in breach of Regulation 18 (Registration) Requirements The failure to notify the Care Quality Commission of incidents of alleged abuse.

At our last inspection on 19 August 2020 the provider had failed to ensure people received a consistently safe and good service and implement sustained improvements. Although we identified some areas still requiring improvement, enough work had been undertaken to demonstrate the service had improved enough to now be meeting the breach of Regulation 17 Good governance.

The service did not currently have a manager registered with the Care Quality Commission at the time of this inspection. We saw that the service was not displaying the most current and up to date report.

At this inspection we found that improvements had been made and the provider was no longer in breach of Regulation 13 Safeguarding service users from abuse and improper treatment. People and their relatives told us they felt safe and had no concerns. Staff were knowledgeable about their responsibilities to safeguard people

Risks to people had been identified and plans to manage these put in place. Improvements had been made to ensure information was available and correctly recorded in risk plans. Incidents and accidents were being reviewed by management to ensure the appropriate actions were taken. The provider was no longer in breach of Regulation 12 Safe care and treatment.

The service had introduced ‘high touch point’ cleaning in order to reduce the risk of Covid-19 transmission. However, we saw the documents used to record this cleaning were not always used. Sufficient PPE was available to staff and visitors. In home testing for Covid 19 was being completed regularly with all staff and people living at the service. Following our inspection people living in the home and staff members have begun the vaccination programme to further protect against the Covid-19 pandemic.

People were supported to have maximum choice and control of their lives, the policies and systems in the service supported this practice.

The management team completed regular audits, where improvements were identified, these were addressed with staff.

People and staff spoke positively about the service and it was clear that the improvement journey was one involving people and staff in order to sustain the improvements long term. All staff spoke very positively of the support they received from the current management team and the difference it had made to the service having them in place. The management team spoke of the importance of ensuring the staff team were happy and understood what changes were being made and why.

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 29 September 2020). 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 any regulations.

This service has been in Special Measures since 15 November 2019. 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.

In 2020 we inspected this service three times. We have had regular fortnightly monitoring calls with the service. In these calls the provider has shared their improvement plans and we have discussed in an open and reflective way the progress made and areas still needing work. These calls have been undertaken by supporting management at the service daily and senior management who have oversight. The report and ratings are reflective of the improvements made, the assurances gained and the commitment to sustaining these improvements going forward. The provider has a condition on their registration in which monthly action plans are submitted to CQC to enable monitoring of these improvements and the timescales for completion.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm.

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.

Avon Court is a residential care home providing personal and nursing care for up to 60 people. At the time of this inspection 33 people were living at the home. People lived across two floors, the upper floor was for people living with a diagnosis of Dementia and ten intermediate care beds. These were short stay admissions to the service, for people who required time for rehabilitation following recent hospital admissions.

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

Staff were knowledgeable about local safeguarding procedures and knew how to raise safeguarding concerns. However, we found that there was a failure to act on safeguarding concerns when these were raised to management. This was a breach of Regulation 13 Health and Social Care Act 2008 (HSCA) RA Regulations 2014 Safeguarding service users from abuse and improper treatment.

Risks to people’s well-being and safety had been assessed and a risk assessment put in place. We saw however, there was not always clear guidance documented for staff on how to mitigate these risks. At this inspection the provider had made some improvements however, medicines were still not always being managed safely. This continues to be a breach of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment.

Two notifications of alleged abuse had not been notified to CQC or managed appropriately. This is a breach of Regulation 18 (Registration) Regulations 2009 Notifications of other incidents.

The service had continued to complete regular quality monitoring of the service. A report of improvement actions was in place and updated as the service progressed. However, where things had been identified these were not always sustained or managed successfully to drive change. This is a continued breach of Regulation 17 HSCA RA Regulations 2014 Good governance.

Staff had mixed views on the culture of the home and their feelings of the staff working as a team. Most staff felt the registered manager was approachable and could see improvements to the service.

Care plans had been re-ordered to be clearer in the layout and finding specific information needed. Repositioning charts were being completed and we did not see any gaps in these. We saw some examples of things recorded in records that did not have further evidence of being followed up. We have made a recommendation that the provider reviews how to monitor recorded evidence.

The service had been successful in recruiting staff to the team to fill vacant positions. Staff told us there was enough staff to support people safely.

People had been supported to maintain contact with their family and friends. People had been receiving more one to one activities during the pandemic. People and their relatives were aware of who the registered manager was and how to contact him. Relatives said he was responsive and available when needed.

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 5 December 2019). The service has now been rated Requires Improvement.

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 9 HSCA RA Regulations 2014 Person-centred care. However, the provider continued to be in breach of Regulations 12 HSCA RA Regulations 2014 Safe care and treatment and 17 HSCA RA Regulations 2014 Good governance. Two new breaches of regulation were identified, 13 HSCA RA Regulations 2014 Safeguarding service users from abuse and improper treatment and 18 (Registration) Regulations 2009 Notifications of other incidents. A recommendation was made around monitoring documentation to drive improvements.

The last rating for this service was requires improvement (published 5 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that some areas of improvements have been made. However further breaches of regulations have been identified and improvements were not always sustained. The service remains Inadequate in safe and will therefore remain in special measures at this time.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 September 2019. Five breaches of legal requirements were found. We served three warning notices against the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We completed an unannounced targeted inspection on 24 January 2020 to follow up on the three warning notices served. The provider was found to have only met one of the three at that time.

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 of Safe, Responsive and Well-led. 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. We have found evidence that the provider needs to make improvement. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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 keeping people safe, mitigating risks, medicine management, leadership and governance and failure to notify allegations of abuse at this inspection.

A positive condition has been applied to the provider's registration at this location in respect of the breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance. Requirement notices have been made for Regulations 13 Safeguarding service users from abuse and improper treatment and Registration Regulation 18 Notification of other incidents.

Follow up

We have held meetings with the provider following this inspection to discuss the concerns. We are continuing to meet with them to seek assurances that people are safe and necessary improvements are being made to ensure they improve their rating to at least good. We will work with the 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.

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. 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, 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.

Avon Court is a residential care home providing personal and nursing care for up to 60 people. At the time of this inspection 31 people were living at the home. People lived across two floors, the upper floor was for people living with a diagnosis of Dementia and ten intermediate care beds. These were short stay admissions to the service, for people who required time for rehabilitation following recent hospital admissions.

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

Medicines were not being managed safely, which continued to place people at risk of harm. Care plans for medicines did not always have adequate information related to prescribed medicines.

There was not a clear overview of people’s behaviour incidents in order to assess if the approach taken was effective or what could be changed and tried.

The registered manager had put a system in place whereby he, or a team leader had to sign completed documentation to show it had been checked. However, this was not always adhered to and had not picked up issues we identified.

There were still examples of limited or inaccurate information recorded in people’s care plans.

Risks were being managed more effectively in relation to pressure care and choking risks.

People were being supported appropriately with their meals and drinks. The mealtime experience was much improved.

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 5 December 2019) when 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.

Following our last inspection, we served three warning notices on the provider. We required them to be compliant with Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment) and Regulation 14 (Meeting nutritional and hydration needs) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 21 November 2019.

Why we inspected

This was a targeted inspection based on the warning notices we served on the provider following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they now met legal requirements. This report only covers our findings in relation to person centred care, safe care and treatment and meeting nutritional and hydration needs at the service. The overall rating for the service has not changed following this targeted inspection and remains inadequate. This is because we have not assessed all areas of the key questions.

Follow up

Following this inspection a Section 65 letter was issued to the provider A Sections 65 letter requires a specified person to give us documents and information,to request how they would take immediate action to meet these issues. An action plan was sent by the provider in response to this. We will further assess this action plan at the next inspection to ensure they have addressed these outstanding concerns.

The remaining breaches found at our last inspection will be reviewed at our next scheduled inspection. This is to allow the provider time to embed their improvements.

The overall rating for this service is ‘Inadequate’ and the service remains 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 the six 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.

Avon Court is a residential care home providing personal and nursing care for up to 60 people. At the time of this inspection 46 people were living at the home. People lived across two floors, the upper floor was for people living with a diagnosis of Dementia and also had ten intermediate care beds. These were short stay admissions to the service, for people who required time to rehabilitate following time in hospital.

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

Pain management medicines had not been managed effectively, palliative medicines had not been followed up as a priority or administered to provide effective pain control.

Learning from incidents and accidents had not been embedded in the service to drive improvements for people.

Risks were not safely monitored or managed in order to avoid harm. Staff did not effectively communicate to ensure people received consistent and safe care.

People were not always supported appropriately with food and drink. The chef was unaware of some people’s specific dietary requirements including their allergies. This put people at increased risk.

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

Although staff were kind in their direct interactions with people, when communicating with other staff they did not always maintain this respect.

Monitoring records in place were not completed correctly. It was unable to be established from the lack of recorded documentation how many times people had received the required care needed.

The service had not always managed people’s palliative care needs appropriately or sensitively. The Care Quality Commission is currently reviewing information in relation to a potential specific incident concerning end of life care.

The provider had taken minimal action to address issues that had been raised in previous inspections, but any improvements had not been sustained and people had not received a good service.

We observed some of the events from the programme of activities that people had the opportunity to be involved in. These were well attended, lively and enjoyed by people.

Everyone we spoke with felt that the new registered manager was a welcome addition to the service. People and their relatives praised his friendly and approachable nature.

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 (report published 05 October 2018) 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, enough improvement had not been made and the provider was still in breach of regulations. The service is now rated Inadequate.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was also prompted in part by notification of a specific incident. The information CQC received about the incident indicated concerns about the management of palliative and end of life care. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of regulations in relation to safe risk management, maintaining people’s dignity, nutritional management, person centred care and the governance of the service 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

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.

This inspection took place over two days. The inspection started 4 June 2018 and was unannounced. We returned on the 5 June 2018 to complete the inspection.

People living at Avon Court received accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Avon Court is registered for up to 60 people to live at the service. At the time of the inspection there were 45 people living at the home.

There was a registered manager in post. 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.

We previously inspected the service in February 2017 and found there to be one breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that care plans did not always reflect accurate details around how care staff could support people’s care needs. We issued the provider with a requirement notice to ensure improvements were made. At this inspection we found that care plans continued to not always provide sufficient detail in explaining what support a person required. This was a continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we also found five additional breaches of the Regulations.

People and their relatives gave us mixed feedback about how caring the service was. Some people told us they felt the staff team were caring. While other relatives we spoke with were upset when speaking about the quality of care their family member received.

Some care plans were out of date. To find out a person’s up to date needs we had to look at monthly reviews over a period of one year. We observed that people who required support to drink were not always supported in accordance with the guidance in their care plans. There was guidance in place where healthcare professionals had been consulted with, yet this was not always followed. Some people’s drinks remained untouched throughout the day. Some relatives told us they had to visit daily to ensure that their family member had something to drink. Where people were prescribed thickener for drinks, used to reduce the risk of choking, this was not recorded or used consistently. This left people at risk.

There were gaps in people’s care records. Repositioning records suggested that people went for long periods of time without being repositioned. Pressure ulceration develops when people are not supported to change their position regularly. We also found that the recording process for pressure ulcers was not following best practice. Wounds were photographed, but details of the wound were not recorded. For example, where the wound was on the person’s body, the size of the wound, or whether the wound improved had not been documented. After the inspection we received information that an additional two people had developed pressure ulceration. The fact that people had developed pressure ulceration supports our findings that this aspect of people’s care is not well managed.

People’s personal hygiene charts were not always completed. This included no recordings for one person’s oral hygiene support during a period of one month. The administration records for topical medicines, such as creams and lotions, were not always completed.

Daily records were task focussed. We reviewed records that focussed on what was done to people, rather than the choices people were supported to make.

People, their relatives, and staff told us the service was short staffed. At times during the inspection we saw that staff were not always present and available to people when they were needed. At other times the staffing levels meant that people were still being supported with morning personal care at lunch time. This meant that people were kept waiting in the dining room for staff to be available to offer them support. The information and concerns that have been received following the inspection support our findings that there are not enough staff to meet people’s needs.

We observed undignified interactions. These included staff moving people in their wheelchairs without communicating with them. We saw that one person was upset and asked staff if someone was free to spend time with them. It took over one hour for a staff member to see the person, and by that time they had fallen asleep.

People’s privacy wasn’t always respected. We saw staff frequently walking into people’s bedrooms without knocking or introducing themselves.

Staff understood how the Mental Capacity Act 2005 (MCA) applied when people lacked capacity. Capacity assessments and best interest decisions were in place. We observed that staff were not always offering people choice or seeking their consent to give support.

Where people received their medicines covertly, the appropriate capacity assessments were in place. Relevant healthcare professionals were consulted around decisions made in people’s best interests.

Despite our observations of poor interactions, we also saw short periods of kind and caring engagement between people and staff. People and their relatives praised the activities provision and we saw evidence that people received one to one time on average once a week.

The quality monitoring systems identified most of the concerns we found at this inspection. There were audits of the service being completed and the findings from the audits were added to an overall home improvement plan. Action was not taken in a timely manner by the provider to make positive changes in response to shortfalls identified by the registered manager.

This provider of this service changed registration to BUPA Care Homes Limited in January 2017. This was the first inspection under this registration and therefore this is the first rated inspection under the new registration.

The inspection took place on 21st February 2017 and was unannounced. We returned on 22nd February to complete the inspection.

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

Where people had risks which had been identified, there was not always sufficient guidance available in people’s care records to guide staff on how to mitigate these risks. For example, one person’s care plan did not give guidance to staff on how to help control their pain and the ongoing assessment of this was not consistently completed. The care records of another person who had developed a grade four pressure ulcer had information which stated their skin integrity could be at risk yet no steps had been taken to help mitigate this.

There were few details in people’s care records about their likes, dislikes, preferences, interests and hobbies. Although staff said they knew people well, there was insufficient information documented for staff to refer to.

People told us at times they had to wait a long time for staff to respond to their call bell. One person told us “Staff work very hard but they really need more of them. The waiting time for the call bell to be answered is okay but at other times they can be quite a wait.”

Medicines were mostly managed safely. However, advice had not been sought from a pharmacist regarding adding medicines to foods when giving them covertly. This was not in line with the service’s policy on medicines and put people at risk from receiving medicines that may have had their therapeutic effects altered from being administered in this way.

There was a wide and varied activities program run by two activities coordinators. People said they enjoyed these activities and people looked happy and comfortable during the group activities we observed. However, people who remained in their rooms and chose not participate in the group activities did not have the same degree of attention. Some people told us they only saw staff when they came into their rooms to do specific tasks such as bringing drinks or meals to them. There was a lot of documentation for people who had participated in group activities, but very little for those who had not and therefore it was unclear what level of social interaction they had.

People told us they felt safe. Comments included “I feel much safer than I did when I lived at home by myself” and “Knowing that there is always someone here to help me when I need it makes me feel safe”. Staff were able to tell us what the different types of abuse were and how to report safeguarding concerns.

Documentation was available detailing when accidents and incidents had occurred. Where people had sustained an injury, this had been noted and followed up until the person was stable.

Staff told us they were confident that the training they received gave them the necessary skills and knowledge to enable them to support people in line with their needs.

People said they liked the food. We saw alternatives were offered when people did not like what was on the menu for that day.

People spoke positively about the care they received from staff. One person told us “I need help with my bath and the carers here will all take their time and they never rush me as I’m quite slow these days. I’m sure they must have lots of other jobs that they need to be doing, but they never let that show”.

People, their relatives, friends and staff all spoke positively about the management team. They told us there was an open door policy where staff were able to approach the manager with any issues or concerns.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.