Timperley Care Home

Timperley Care Home is a nursing home providing personal and nursing care. There were 52 people living at the home at the time of the inspection. The service can support up to 56 people. The home provides en-suite rooms over 2 floors. The first floor predominantly supports people living with dementia and the ground floor for people needing general nursing care as well as people living with dementia. Both floors have communal lounges and dining areas, accessible bathrooms and there is a large accessible garden to the rear of the home.

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

Medicines were managed safely. However, we recommend the records to support staff to administer medicines to people via a feeding tube or covertly, hidden in food or drink are reviewed.

The home was clean throughout. We have made a recommendation about using current government guidance for wearing personal protective equipment.

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 did not always support this practice.

Deprivation of Liberty Safeguards were applied for where applicable. However, we have made a recommendation to improve the systems to ensure re-applications are completed on time.

People and their relatives said they felt safe living at Timperley Care Home. Staff knew how to report any concerns and all incidents and accidents were recorded and reviewed by the manager to ensure actions had been taken to reduce the risk of a re-occurrence.

People said the food was good. Staff made referrals to medical professionals appropriately and followed any guidance provided. Staff received the training and support to carry out their roles.

A quality assurance system was in place with a series of planned audits. Action plans were automatically developed for any issues found. We saw the manager had a home action plan, with many of the actions already completed or in progress.

The provider had oversight of the home through weekly visits and a monthly provider audit. The area manager and director also had remote access to the care planning and quality systems.

Staff said the manager was visible within the home and was approachable. Relatives felt listened to and if they raised a concern it was resolved.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was one person using the service who had a learning disability and or who was autistic.

The person’s family was very involved in their relative’s care and support. They had provided information about their learning disability and needs for the staff to follow. We discussed with the manager the new regulation for all staff to have completed training in learning disability awareness.

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 24 June 2021).

Why we inspected

We received concerns in relation to the management of the home, managing the risks people may face, medicines management, nutrition, staff training and equipment at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained good based on the findings of this inspection.

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

Recommendations

We have made recommendations about medicines management, infection control and the Deprivation of Liberty Safeguards. Please see the relevant key questions safe and effective sections of this report.

Follow up

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

Timperley Care Home is a nursing home providing personal and nursing care and the treatment of disease, disorder or injury. There were 47 people, some living with dementia, at the time of the inspection. The service can support up to 56 people. The home provides en-suite rooms over two floors. One of the floors has a designated dementia care wing. Both floors have communal lounges and dining areas, accessible bathrooms and there is a large accessible garden to the rear of the home.

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

The management of medicines has improved since the last inspection. Further work was required to ensure the electronic system was person-centred. This was actioned following the inspection. Risks to people were assessed, mitigated and reviewed. Staff were aware of the risks people presented and how to provide the most appropriate support. Infection control was well managed across the home. Actions had been taken in response to the COVID-19 pandemic and relatives were visiting their relation following the most up to date guidance. Relatives felt their relation was safe in the home and staff were recruited appropriately to ensure they were suitable to work with vulnerable people. Staffing levels were being consistently reviewed.

There had been a number of positive improvements at the home following some recent concerns being raised. The provider had responded pro-actively and worked with commissioners and stakeholders to produce action plans and embed improvements in a timely manner. A new manager had been recruited to support the strategic direction of the home and a new clinical lead and deputy manager were undergoing recruitment checks, which will be an additional support to the management team. Relatives told us they had been regularly kept up to date with changes in their relations well-being. The manager was in the process of updating staff and relatives of the staffing changes across the home.

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 21 April 2021). 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.

Why we inspected

We received concerns in relation to the management and oversight of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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

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.

Timperley Care Home is a nursing home providing personal and nursing care and the treatment of disease, disorder or injury. There were 54 people, some living with dementia, at the time of the inspection. The service can support up to 56 people. The home provides en-suite rooms over two floors. One of the floors has a designated dementia care wing. Both floors have communal lounges and dining areas, accessible bathrooms and there is a large accessible garden to the rear of the home.

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

Medicines were not always safely managed. There was evidence of some medicines being incorrectly recorded as out of stock and medicines patches were not always applied as directed. Refrigerators for medicines did not always have the correct temperature recorded. Staff received training and a competency check of their ability to administer medicines safely. Families felt their relative was safe at the home and complimented the staff team on the care they gave. Recruitment of staff was safe, and staff received training appropriate to their job role. The safety of the premises was continually under review and internal and external safety checks were regularly completed. Risks to people were assessed and mitigated. Staff could describe how to minimise risks to people. Infection control processes across the home were well managed.

Further work was required for the management team to understand and scrutinise the electronic medicines management system and auditing processes for medicines. Family members and staff were complimentary of the support they received from the registered and deputy manager and we received positive comments about the work undertaken to maintain contact with relatives during the pandemic. The provider had begun to collect feedback from staff and visitors which was positive. A home improvement plan was in place to identify and improve aspects of the service. Stakeholders such as the local authority spoke positively of the improvements across the home. Staff and family members told us the registered manager was responsive and they felt supported.

We have made a recommendation for the provider to consider further training for the management team in relation to the electronic medicines system, medicines reconciliation and medicines audits.

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 26 October 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

We received concerns in relation to the safe management of covert medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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

We have identified breaches in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Timperley Care Home is a purpose-built nursing home located in the borough of Trafford. The home was fully occupied at the time of our inspection with 56 people living at the home.

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

At this inspection we identified a number of issues associated with safety. Whilst we found no evidence of actual harm, we have made two recommendations associated with the passenger lifts and for the safe management of medicines.

We found the provider had not acted within a reasonable time frame to rectify faults associated with the passenger lifts, in particular, faults that had been known to the provider since 2016.

We found some people's medicines were not consistently managed in a safe way. This related to record keeping for thickened fluids and medicines administered 'when required.'

We found a communal bathroom and toilet was being used as an equipment store and was cluttered with wheelchairs and hoists. We observed a care assistant support a person to use these facilities and then leave the door unlocked afterwards. This posed a potential trip and falls hazard to people living at the home.

Newly recruited staff received an induction and competency checks were completed before they worked unsupervised.

People told us they considered staff to be caring and that they were well looked after.

Care and support was provided in a non-discriminatory way and the needs of individuals from different groups were met.

People were treated with kindness and care was delivered in a dignified and respectful way.

People were involved with planning their care and support and we saw that where possible, people and their family members or people who knew the person well, had been consulted.

The activity coordinators were an integral part of the team in helping to ensure care and support was delivered in a meaningful person-centred way that took account of a person’s individual life story, likes, dislikes, interests and hobbies.

The home was accredited to deliver end of life care through the ‘six steps to success’ programme. This meant people could be cared for within the home, by staff who knew them well.

Staff told us the new registered manager had been effective since their appointment. Positive changes had started to take effect and the majority of staff said they felt valued and were able to contribute ideas for continuous improvement.

The registered manager and deputy sought to promote a culture and ethos of openness and transparency. Staff told us they were not afraid to speak up when things went wrong, and people were keen to learn lessons to reduce the likelihood of negative events occurring again in future.

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

Rating at last inspection:

‘Requires Improvement’ (report published on 31 January 2018).

Why we inspected:

This was a planned follow-up inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated ‘Requires Improvement.’

The first day of inspection was unannounced, which meant the service did not know we were coming. The second and third day was by arrangement. We were required to return to the service on the third day in order to gather additional information. This was due to circumstances beyond the control of the lead inspector or the service.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges, there is a hairdressing salon situated on the first floor next to the passenger left. All bedrooms are single with their own en-suite shower facilities. There is an enclosed accessible, secure garden off one of the lounges on the ground floor.

Timperley Care Home is registered with the CQC to provide accommodation to a maximum of 56 people who require nursing or personal care. At the time of our inspection, 51 people were accommodated, one person was in hospital and the home had four vacancies. Ground floor accommodation is dedicated to people living a diagnosis of dementia. First floor accommodation is specific to people with more general nursing needs, but some people also live with dementia.

We last inspected Timperley Care Home on 23 and 25 January 2017. During that inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This resulted in an overall rating of ‘requires improvement.’

In respect of this inspection, the scheduling of our return visit was brought forward as a result of information of concern received by CQC. This information related to the homes management of falls, staffing levels and the fact the previous registered manager had left.

During this inspection, we found three new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to the safe recruitment and selection of staff, staff training and meeting people’s nutritional and hydration needs. You can see what action we have taken at the back of the full report.

Due to the nature of the service provided at Timperley Care Home, we were unable to gather the views of the vast majority of people who used the service. However, during the inspection we completed a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with visiting relatives to ascertain their views on the quality of care being provided.

In response to concerns raised with CQC about how the service managed specific incidents such as accidents, incidents and falls, we reviewed a wide range of information including accident reports, risk assessments and quality assurance audits. Following this review, we were satisfied safe systems and procedures were operating in the home which sought to keep people safe.

With regards to staffing levels, we looked again to staff rosters, the dependency tool used by the home and we spoke with staff, management and relatives. On the basis of the evidence gathered, we were satisfied that staffing levels were sufficient to meet the needs of people accommodated at the time of our inspection.

We looked again at the homes approach to the safe recruitment and selection of staff and found this was not consistent. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made. This has resulted in a breach of regulation.

At our last inspection, we found people’s medicines were not always managed safely. Since our last inspection, the provider had introduced a new and comprehensive system for managing people’s medicines. The system, ‘Wellpad’, had a number of key features which sought to improve safety and reduce the likelihood for errors or omissions. We found medicines to be stored, administered, recorded and disposed of safely.

The service sought to protect people from abuse and we found there were appropriate safeguarding and whistleblowing policies and procedures in place. Staff we spoke with demonstrated a good understanding of the types of abuse and the procedure to follow if they suspected a person was at risk of or was being abused.

At our last inspection, we found staff supervision was not always completed. During this inspection, we found progress had been made. However, the timetable for completing staff supervision in a timely manner had been interrupted by the resignation of the registered manager. This meant the focus of those staff responsible for completing supervision sessions had been diverted to other key duties. Following discussions with the management team, we were satisfied the service had taken all reasonable steps to recover the situation and progress was continuing to be made.

Due to the nature of the service provided at Timperley Care Home, a significant number of people who used the service lived with a diagnosis of dementia. For some people, this also meant they would at times, present with behaviours that challenge. However, we found staff were not sufficiently trained and lacked the necessary skills and experience in this area. This has resulted in a breach of regulation.

During our last inspection in January 2017, we identified a number of issues related to the mealtime experience. Whilst improvements had been made in respect of the provision of appropriate equipment, other areas of concerns as identified in our last report had not been addressed effectively. For example, the mealtime experience on the ground floor unit was chaotic and people did not receive their meals in a timely manner. Deployment of staff was also not effective. This has resulted in a breach of regulation.

Staff demonstrated a working knowledge of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS).

We looked at the homes approach to end of life care (EoLC) and found the service was engaged in the ‘Six Steps’ End of Life Care Programme. This is the North West End of Life Programme for Care Homes and is co-ordinated by local NHS services. This means that for people who we are nearing the end of their life, they could choose to remain at the home to be cared for in familiar surroundings by people they know and could trust.

We looked to see how the service sought to promote the principles of equality, diversity and human rights (EDHR). We were satisfied the culture within was not discriminatory and the rights of people with a protected characteristic would be respected. However, improvement are required relating to how information is captured about a person’s life history, their culture and who is important to them. We have made a recommendation about this.

We looked at improvements that had been made since our last inspection to create a dementia friendly environment. Whilst significant improvements had been made, further work was required to ensure consistency across the home in creating a dementia friendly environment. We have made a recommendation about this.

Throughout our inspection visit we observed a number of positive interactions between staff and people living at Timperley Care Home and we saw staff treating people with kindness and respect. Two people who used the service kindly showed us their bedrooms. We found their rooms to be personalised with individual items and were homely and welcoming. We observed staff being respectful of people's private spaces and knocking on doors before entering.

We spent a considerable amount of time speaking with the regional operations director and the service quality manager. This was important as we sought to understand some of the recent challenges the home had faced and aspirations for future success. Through these discussions, it was clear the management team had oversight of the key issues and we learnt of their plans for continuous service improvement. However, the three regulatory breaches identified during this inspection, demonstrated there was further work still to be done and improvements were not yet fully embedded. Furthermore, the effectiveness of the new home manager needs to be demonstrated through real, tangible, positive outcomes for people living at Timperley Care Home.

As this inspection represents a third consecutive rating of ‘requires improvement’ we plan to meet the provider and members of the management team to seek further assurance. Additionally, we will return to the home in due course to review progress.

The previous inspection took place in July 2016 when we rated the service as “requires improvement”. We found breaches in six areas of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Following our previous inspection, the service submitted and action pal dated 15 July 2016 stating how they would meet the requirements identified. At this inspection we found improvements in these areas.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges, there is a hairdressing salon situated on the first floor next to the passenger left. All bedrooms are single with their own en-suite shower facilities. There is an enclosed accessible, secure garden off one of the lounges on the ground floor.

Timperley Care Home offers primarily nursing care for up to 56 people. The home specialises in care for people living with dementia. At the time of our inspection there were 55 people living at the service.

At the time of this inspection the home was managed by a registered manager who was registered with CQC in. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found some people’s medicines were not managed and administered in a safe and proper way, which meant there was a risk of people not receiving their medicines as required.

Waste management at the service was not being managed appropriately. This increased the risk of cross infection or vermin infestation.

There were sufficient staffing levels on duty throughout our inspection. The recruitment process was robust, however were found despite the staff receiving appropriate training. Staff were not receiving regular supervision which provides staff with the opportunity to raise concerns and identify any additional training needs they may have.

Staff knew how to keep people safe and people we spoke with felt they were safe with the care and support they received from staff at Timperley Care Home. Safeguarding incidents had been reported and accidents were recorded and action taken to minimise the risk of reoccurrence.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions for themselves.

We observed caring interactions between people and staff who knew them well. Care plans reflect people’s current needs and were regularly reviewed and updated as required. People’s care files contained details about their wishes in respect to end of life care.

At the time of inspection there was no activities coordinator in post due to outstanding checks to ensure they were safe to work with vulnerable people. This meant that at the time of the inspection there was limited activities being undertaken with people living at Timperley Care Home.

The service had a formal complaints procedure in place, but this was not available in different formats to support people living with dementia to understand. Any complaint received was recorded and acted on in a timely manner.

The service now had clear records detailing the audits which had been completed and showing any actions taken when issues had bene identified. We had received a high number of notifications in relation to people living at Timperley Care Home, having falls. We noted the service was now monitoring these falls, looking for possible causes and making referrals to the falls team in order to minimise the risk of reoccurrence.

During this inspection we found seven breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The previous inspection took place in February 2015 when we rated the service as “requires improvement”. We found a breach of the regulation relating to failure to apply the principles of the Mental Capacity Act 2005. Following our report the manager at the time submitted an action plan dated 18 June 2015 stating how they would meet the requirements of the Mental Capacity Act 2005 in future. At this inspection we found improvements in this area.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges. All bedrooms are single rooms with en-suite shower facilities. There are two enclosed accessible secure gardens.

Timperley Care Home offers primarily nursing care for up to 51 people. The home specialises in care for people living with dementia. On the first day of this inspection there were 50 people living in the home. There was building work in progress to create five additional bedrooms and expand the dining rooms.

At the date of this inspection there was no 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 found that the staffing levels had decreased since our previous inspection, although the numbers of people and their needs had not changed. This was a breach of the regulation relating to staffing levels.

There had been a number of serious safeguarding incidents in the months prior to our visit. In one case a person living in the home had left the building unnoticed and been found several hours later. Two staff had falsely recorded that the person was present in the home, after they had left the building. This was a breach of the regulation relating to keeping people safe. There had also been a number of concerns raised about failure to prevent and treat pressure sores. Several of these concerns had been discussed at strategy meetings. At this inspection we checked and saw that appropriate action had been taken to make sure lessons had been learnt and risks to people reduced as a result of action taken by the provider.

The building was kept clean but we had received reliable information that a staff member’s dog had been allowed to wander freely and soil the floor, on a regular basis. This was a breach of the regulation relating to infection control.

Medicines were administered and recorded appropriately.

Recruitment records showed that checks were made to ensure people who were unsuitable were not recruited. Staff were trained to recognise and report signs of abuse. Where necessary firm disciplinary action was taken against staff in order to protect people.

The building was well maintained. There was ongoing building work to extend the home.

In contrast with the previous inspection Timperley Care Home was now implementing the Mental Capacity Act 2005 and had applied for authorisations under the Deprivation of Liberty Safeguards (DoLS). Best interests meetings were held and well documented.

The home had been subject to criticism by a coroner in April 2016 for not keeping accurate records about whether a person had a DoLS authorisation, but we saw a file listing all applications and authorisations.

Training was arranged for new recruits and on an ongoing basis for existing staff. There was regular supervision and staff were supported with performance development plans.

The dining rooms were small but due to be extended. People were supported to eat appropriate diets and their weight was monitored. People’s health needs were met.

The décor of the building was colourful. There were some adaptations to make the environment suitable for people living with dementia.

People living in the home and their relatives spoke highly of the care provided. There was high praise from families of some people who had passed away in the home.

An informal homely atmosphere was encouraged by staff not wearing uniforms, but some people including staff told us they would prefer for staff to wear name badges.

We saw some good examples of a caring approach by staff. However, we also saw some instances where the care should have been better. These were perhaps partly caused by the staffing levels. We also observed that care planning was not meeting everyone’s needs. These examples were a breach of the regulation relating to meeting people’s needs.

Advocates were used to represent people’s interests when needed.

Timperley Care Home was validated to deliver end of life care, and arrangements were made when it was appropriate for people to die in the home rather than in hospital.

Care files were kept on the computer system which was designed to remind staff when documents needed to be updated and reviewed. On some people’s files there was contradictory information. Some information we would have expected to see was absent.

Activities were organised but there was scope to devise some more suitable activities. There was an attractive garden but it was not being used to its full advantage.

There had been a lack of continuity in the leadership since January 2015. There had been a series of home managers, none of them had registered with the CQC. Several other senior staff had left. The operations manager had remained through this time but had other responsibilities in the region. A new deputy manager was now in post and a new home manager was about to start.

This lack of permanent leadership had affected staff morale and the quality of the care in the home. We saw evidence of stress amongst the nurses and poor leadership, which had contributed to the safeguarding issues in recent months.

There was an audit programme but audits had not been completed recently. This was a breach of the regulation relating to assessing and monitoring the quality of the service.

The provider was displaying the rating of our previous inspection on their website but not within the home. We were told it had been on display but had been moved because of the building works. This was a breach of the regulation regarding displaying of ratings.

We found breaches of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 .You can see what action we told the provider to take at the end of the full version of the report.

We found there were enough staff and observed people being supported in a way that met their needs and promoted their wellbeing and safety. The atmosphere was calm, comfortable and relaxed.

We found the service to be well led and person centred taking into account individual needs as well as more complex care needs associated with dementia care.

Family members told us they had no concerns with the care or support their family member received and believed the service was so "calm and peaceful" due to the "kindness and love" shown by the staff and management.

Our expert by experience observed lunch was simple but nutritious. Staff spoke with people in a respectful manner.

We spoke with four visiting relatives. One person told us 'I think my X is well looked after. She likes the carers and enjoys the food.'

The staff we spoke with were aware of whistle blowing procedures and they would be confident to use these procedures if they suspected abuse. One person we spoke with told us 'Whistleblowing is when you suspect care is not right and you can go to a higher authority for example the Care Quality Commission'.

We looked around the home and saw most areas were clean and tidy and free from clutter. We spoke with visiting relative and received complimentary feedback. One person said 'I was here yesterday and this room was as clean as it is now. They are very good.'

We spoke with two visiting health professionals who gave positive feedback. One person said 'I have been coming for years, things are much smoother when the manager is here, the staff are more knowledgeable and open'.

People who used the service we spoke with told us 'I don't have a complaint, but I would talk to my carer'. A visiting relative told us 'If I had a complaint, I would talk to the manager.'