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Chandlers Ford Care Home Good

The provider of this service changed - see old profile

Reports


Inspection carried out on 25 April 2018

During a routine inspection

We undertook an unannounced inspection of this home on 25 April 2018. When we completed our previous comprehensive inspection of Chandlers Ford Care Home in April 2016 we found concerns relating to the management of people’s pain and their wounds. At this time these concerns were reported under the key question of, “Is the service effective?” We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these concerns are included under the key question of “Is the service responsive?” Therefore, for this inspection, we have inspected both of these key questions to make sure all areas are inspected to validate the ratings.

In April 2016 the home was rated Good overall with Requires Improvement in the Responsive domain as improvements were required in wound care and pain management in the home. At this inspection we saw these improvements had been made. In September 2017 we carried out a focussed inspection in response to concerns people had raised about the levels of staffing in the home. We were unable to substantiate these concerns at that time and the rating of the home remained Good. At this inspection we found the home remained Good in all domains.

Chandlers Ford Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home provides accommodation, nursing and personal care for up to 45 older people. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 25 people lived in the home.

A registered manager had been in place since 12 March 2018 at the time of our inspection. 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.

Before the inspection, we had received concerns about the cleanliness and hygiene in the home from members of the public. At this inspection we were unable to substantiate these concerns. The home was clean and odourless and staff had a good understanding of infection control measures which were in place.

Whilst we received mixed feedback at our inspection about staffing levels in the home, there were sufficient staff deployed to meet people’s needs and ensure their safety and welfare. Staff recruited to the home had been assessed as to their suitability to work with people.

People received care which was person centred and individual to their specific nursing needs. Staff had a good understanding of people’s needs and clearly knew people well. The registered provider was taking steps to improve the recording of people’s social and personal histories in their care records.

There were effective systems in place to plan and implement end of life care for people to ensure this met their needs and preferences.

Risks associated with people’s care, including the safe administration of medicines, had been identified and actions identified to mitigate these.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom. Staff knew how to keep people safe and understood how to report any concerns they may have about the care people received.

People received nutritious food in line with their needs, likes and preferences.

People were cared for in a kind and compassionate way and were encouraged to interact with each other and participate in a wide variety of stimulating activities and events.

There was a system in place to allow people to express any concerns or complaints they may have, and p

Inspection carried out on 26 September 2017

During an inspection looking at part of the service

This unannounced inspection took place on 26/09/17.

At our last inspection in April 2016 we rated the service overall as Good.

The most recent registered manager left in January 2017. Since then the service had been overseen by four managers, some of whom were always expected to be interim. At the time of our visit a new manager had been appointed. They had been in post for one day when we visited but had already applied to become registered with CQC. 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 and associated Regulations about how the service is run. The new manager was being supported by an experienced interim manager who had worked at the service for

Chandlers Ford Care Home provides accommodation and nursing care for up to 45 older

people. There were 31 people living in the home on the day of this inspection. The home is in the centre of Chandlers Ford behind the Methodist Church and close to local shops and amenities. The service is located on the ground and basement floors of a large purpose built building. The first and second floors are flats with separate access.

This was a focussed inspection as a result of concerns people raised over staffing levels. This meant during our visit we specifically considered staffing skills, levels and staff deployment. We also looked at management structures to see if there were suitable management arrangements in place to ensure they were appropriate.

We found although there were mainly sufficient staff deployed, the high number of agency staff included in these numbers had impacted in a negative way upon the experience, and at times on the care requirements of people who lived at Chandlers Ford Care Home. The fragmented management arrangements since the last registered manager deregistered in January 2017 had compounded this impact.

During our visit we found current managers were aware of the staffing concerns raised to us and had taken some action to mitigate the situation. They were actively recruiting staff and were not admitting any new service user with high needs until more regular staff had been employed. They, along with senior managers had identified where other improvements were needed. The service had produced a very detailed action plan and had made a copy of the action plan available for all to see (this was located by the signing in book for visitors to the home) This showed the service was being transparent in acknowledging shortfalls and documenting how and when they were going to achieve these objectives.

We have updated the safe and well led part of our published report without amending our previous ratings as we will review these as part of our next comprehensive inspection of the service. This will take place once we have given the service the time to implement and embed the improvements they have identified themselves as being needed.

Inspection carried out on 5 April 2016

During a routine inspection

This inspection took place on 5 April 2016. It was unannounced. We returned on the 8 April 2016 to complete the inspection. Our previous inspection had taken place in May 2015. At our inspection in May 2015, we found although improvements had been made to the service here were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were: In the management of medicines; in the application of the Mental Capacity Act 2005 and in how staff maintained records regarding people's care and treatment. At this inspection in April 2016 we found the required improvements had been made.

Chandlers Ford Christian Nursing Home provides accommodation and nursing care for up to 45 older people. There were 30 people living in the home on the days of this inspection. The home is located in the centre of Chandlers Ford behind the Methodist church and close to local shops and amenities. The home is located on the ground and basement floors of a large purpose built building.

The first and second floors are flats with separate access.

There was a registered manager in post. 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.

A key improvement to the service overall was that the management team were now established which enabled them to demonstrate consistently the values of the service. They lead by example and this helped to enable people who lived at the service, their relatives and staff to express their opinions and to feel they were being listened to. This helped to promote a positive culture which was person centred and inclusive.

Whilst we found some further improvements were needed during our inspection of April 2016, these were mainly responded to and completed during our visits. The management team also agreed to review and improve how they managed people's wound care and to how they assessed people's experience of pain. This could not be completed quickly. We said as a result of this that the service continued to need to improve and to demonstrate they were consistently providing effective care.

Medicines were safely managed. People said they felt safe at the service. Staff understood how to manage risk and took action where they could to reduce the possibility of any identified risk causing people unnecessary harm. There were sufficient numbers of appropriately recruited , well trained staff deployed to meet peoples' needs.

People were supported to have sufficient amounts to eat and drink and people told us they liked the food. People's day to day health needs were met and staff ensured people and, where appropriate, their relatives had information and explanations about their healthcare options.

People told us that staff in the main had positive and caring relationships with them. Staff had a good knowledge and understanding of people's preferences and personal histories which helped them to provide care and support tailored to peoples individual needs. There was a range of activities available which people could choose to take part in, or if they preferred, they could keep their own company Staff respected people's wish for privacy.

There were systems in place to review how effectively the service was running. These helped to drive continuous improvement.

Inspection carried out on 15 May 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 7 January 2015 and 2 February 2015. At which breaches of legal requirements were found. This was because risk assessments had not been regularly reviewed and updated, people were not supported to eat food which was suitable to their needs and there were not sufficient numbers of staff to keep people safe and meet their needs. People were at risk of dehydration, staff had not received sufficient training to meet people’s needs and advice from health professionals had not been transferred to care plans and care was not being delivered in the recommended way. The provider was not acting in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and there was a risk that people were being illegally detained against their wishes because Deprivation of Liberty Safeguards (DoLS) were not followed. Privacy and dignity was not always respected, staff didn’t have a detailed knowledge of people’s individual needs and staff were unable to respond appropriately to people’s needs due to a lack of detailed and accurate care plans, risk assessments, daily records and handovers. The home was not responding appropriately to people’s concerns and complaints and audits were carried out but were not effective in detecting and responding to concerns.

After the comprehensive inspection, we issued three warning notices requiring the provider to meet legal requirements in relation to three regulations by 13 March 2015. We also asked the provider to tell us what they would do to meet legal requirements in relation to seven other breaches.

We carried out an unannounced focussed inspection on 24 March 2015 to check whether action had been taken in relation to the three warning notices. We found that the provider had complied with the requirements of the warning notices relating to meeting nutritional needs, however the warning notices in relation to care and welfare and consent to care remained in breach. We met with the provider and asked them to produce an additional action plan with a clear timescale on when the remaining warning notices would be met. The provider told us this would be met four weeks from the date we met.

We carried out a further unannounced focussed inspection on 18 May 2015 to follow up whether action had been taken to meet all outstanding breaches. We found significant improvements had been made and the two outstanding warning notices in relation to consent and care and welfare had been met. Legal requirements had been met in relation to all but one breach which was in relation to record keeping. Two new breaches of regulations were identified.

This report only covers our findings at the inspection on 18 May 2015. You can read the reports from our last comprehensive and focussed inspection, by selecting the ‘all reports’ link for ‘Chandlers Ford Christian Nursing Home’ on our website at www.cqc.org.uk.

Chandlers Ford Christian Nursing Home provides accommodation and nursing care for up to 45 older people. The home is located in the centre of Chandlers Ford behind the Methodist church and close to local shops and amenities. The home is located on the ground and basement floors of a large purpose built building. The first and second floors are flats with separate access. There were 28 people living in the home on the day of the inspection.

Chandlers Ford Christian Nursing Home did not have a registered manager in post on the day of the inspection. A relief manager was in post. 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.

At our focussed inspection on 18 May 2015 we found that the provider had not complied with all legal requirements.

Medicines were not always safely administered. Care plans in relation to medicines to be taken ‘as required’, known as PRN were not consistently in place. The risks in relation to a person’s medication regime had not been fully assessed.

Since our last inspection staff had received training in respect of the Mental Capacity Act 2005 (MCA) and showed an understanding of its principles. The provider was aware of the need to consider the mental capacity of those people with a cognitive impairment; this process was partially complete.

There was some improvement in record keeping since the last inspection, for example topical medicine administration records were now being completed, however there were still some significant gaps in other records, such as records relating to wound care.

Risk assessments were in place to manage risk appropriately. Care plans included a number of risk assessments in relation to people’s individual risks such as dependency, falls, moving and handling and continence.

There were sufficient numbers of staff on duty to meet people’s needs. Dependency assessments had been completed to ensure that staffing remained at appropriate levels. The atmosphere in the home was calm and staff did not appear to be rushed.

Where the care and support arrangements in place, whilst in people’s best interests, meant there was a risk of the person’s liberty or freedoms being restricted, relevant applications for a deprivation of liberty safeguards (DoLS) had been submitted.

Staff had received sufficient training to meet people’s needs which included clinical training on aspects of clinical care for the registered nurses. Staff confirmed that they had had recent supervision meetings and records showed this.

People’s privacy and dignity was respected and promoted. People were assisted, without being rushed, in a caring way.

The new relief manager was more visible ‘on the floor’ which meant there were opportunities for people and staff to discuss any concerns, and people were encouraged to do so. Staff and people’s concerns about low staffing levels had been addressed and meetings had been held with relatives, people and staff to encourage feedback.

The atmosphere in the home had improved. Staff said that morale had increased, and they knew the importance of teamwork. Improved quality monitoring processes were in place, such as a care plan audit and a falls audit. Monthly trends were recorded and analysed.

As a result of this inspection, we revised the ratings in respect of each of the five domains and this meant the overall rating changed from inadequate to requires improvement.

We found three of breaches. You can see what action we asked the provider to take at the back of the full version of the report.

Inspection carried out on 24 March 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 7 January 2015 and 2 February 2015. Breaches of 10 legal requirements were found and we issued warning notices for breaches in care and welfare, meeting nutritional needs and consent to care and treatment. The provider was required to meet the regulations by 13 March 2015.

As a result we undertook an unannounced focussed inspection on 24 March 2015 to follow up whether action had been taken to deal with the breach.

You can read a summary of our findings from the two inspections below.

Comprehensive Inspection 7 January 2015 and 2 February 2015

The inspection took place on 7 January 2015 and 2 February 2015 and was unannounced.

Chandlers Ford Christian Nursing Home provides accommodation and nursing care for up to 45 older people. The home is located in the centre of Chandlers Ford behind the Methodist church and close to local shops and amenities. The home is located on the ground and basement floors of a large purpose built building. The first and second floors are flats with separate access.

Chandlers Ford Christian Nursing Home had a registered manager in post on the day of the inspection. The registered manager left two days after our first visit. The provider told us a relief manager was in post. 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.

At the last inspection on 9 July 2014, we asked the provider to take action to make improvements in respect of acting in accordance with the Mental Capacity Act 2005 (MCA), care and welfare and meeting nutritional needs. This was because the provider had not acted in accordance with the requirements of the MCA, did not always provide care in line with people’s needs and had not protected people from the risks of inadequate food and hydration. The provider submitted an action plan which stated that the home would be compliant by 30 August 2014. We found that the provider had not carried out the required improvements.

During our first visit on 7 January 2015 we were so concerned about the management of medicines that we asked a specialist pharmacist inspector to visit the home. They visited on 2 February 2015 and identified improvements in the management of medicines since our last visit.

Medicines were not stored or managed safely. When we visited the home on 7 January 2105 we found large quantities of prescription medicines stacked up in the hairdressing salon. The door was wedged open. Labels indicated that some medicines had been stored unsafely in the room since the beginning of December 2014. We found the treatment room to be open and unlocked and medicines were stored in unlocked cupboards in the room. There was a risk that people, staff or visitors to the home would take the medicines inappropriately. Action had been taken to address these issues by the time of our second visit on 2 February 2015.

Staff understood about safeguarding and when to report a concern and people told us they felt safe. However, people’s individual risks were not clearly assessed, documented, reviewed and changed in response to their changing needs.

There were not sufficient numbers of staff to keep people safe and meet their needs. Staffing levels had recently been reduced from seven to five care workers per day shift. Staff were rushed and task focussed, spending minimal amounts of time with people and only to perform a function such as supporting a person to drink. Call bells were ringing constantly and continued for long periods. People told us they waited a long time for call bells to be answered and their meals were served late.

People were at risk of choking because they were not supported to eat food which was suitable to their needs.

Although food and fluid monitoring charts were in place for some people, details recorded were not sufficient to support staff in ensuring people had eaten and drunk enough to meet their needs.

People did not receive support to eat sufficient quantities of food to meet their needs. Support from staff was inconsistent, sporadic and provided by various members of staff with long gaps in between of no support. This was not a pleasant mealtime experience for people.

Staff had not received sufficient training to meet people’s needs. Not all staff had completed essential training. There was no clinical training specifically to improve competencies for nurses. Supervision meetings had not been carried out in line with policy and two members of staff said they had not had a supervision meeting in the last year.

There was evidence that advice had been sought from health professionals such as GPs, occupational therapists, speech and language therapists and psychiatrists, however we found that advice was not transferred to care plans and care was not delivered in the recommended way.

The provider was not acting in accordance with the requirements of the Mental Capacity Act 2005 (MCA). The MCA is a law that protects and supports people who do not have the ability to make decisions for themselves. This meant that the service was not obtaining valid consent for treatment and care in relation to people whose mental capacity was in doubt.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager did not understand when a DoLS application should be made and was not aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. As a result appropriate applications had not been made.

Although staff were kind and caring they were not able to provide personalised support in line with people’s individual needs because the written and verbal handover information was inaccurate and lacking in detail. People were not involved or consulted in their care planning.

Staff were unable to respond appropriately to people’s needs due to a lack of detailed and accurate care plans, risk assessments, daily records and shift handovers. Care plans were not in place in relation to people’s specific risks and needs such as pressure ulcers, continence, pain and behaviours which may challenge others. There were no care plans in place in relation to specific conditions such dementia, diabetes and osteoporosis.

Staff morale was low and staff were not actively involved in developing the service. The home was not well organised, care was not provided in a consistent way, staff didn’t feel listened to and we found errors in people’s medicines and care plans which should have been detected through routine audits. Some aspects of the service were unsafe, such as the storage of medicines in the hairdressing salon for up to a month. Staff training was not up to date and staff competencies had not been checked. People said they didn’t know who the registered manager was, but they would like to know.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the back of the full version of the report.

Focussed inspection 24 March 2015

Following our inspection on 7 January 2015 and 2 February 2015, the provider was served three warning notices in relation to care and welfare, meeting nutritional needs and consent to care and treatment. These required the service to be compliant by 13 March 2015. We undertook this unannounced inspection to check that the breaches of regulations had been addressed.

We found that regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, continued to be breached. People did not receive personalised care that was responsive to their needs. Risks in relation to dysphagia (difficulty swallowing) had not been appropriately addressed and assessed. It had taken 10 weeks for one person to be referred to a speech and language therapist even though they had severe difficulty swallowing.

There was no care plan in place for a person with a urinary tract infection and staff had not appropriately delivered care to meet their needs. Staff continued to give one person showers even though a relative had stated they preferred baths. It was not clear whether topical medicines were being appropriately administered in line with the care plans because the records were incomplete and inconsistent and care staff instead of nurses made decisions about whether people required cream.

Improvements were noted in respect of the handover process and specific care planning to address the risks of acquiring pressure ulcers. Pain assessment tools meant that nurses were better able to ascertain whether people were in pain and administer analgesia appropriately.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, continued to be breached. The provider was not acting in accordance with the requirements of the Mental Capacity Act 2005 (MCA) as people’s capacity to make specific decisions was not appropriately and consistently assessed and acted upon.

Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, was being met. Detailed records were kept in the kitchen about people’s individual dietary requirements and the chef was knowledgeable about these. People were served a meal in line with their required consistency and support was offered where appropriate.

Additionally we identified a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We observed staff members to be providing care in a manner which was not kind and caring and was not in line with the required support identified in the person’s care plan.

As a result of this inspection we met with the provider and asked them to produce an action plan showing how they would achieve compliance within four weeks. The provider agreed to provide us with weekly updates demonstrating progress. The provider agreed to voluntarily stop new admissions until they met the requirements.

Inspection carried out on 7 January 2015

During a routine inspection

The inspection took place on 7 January 2015 and 2 February 2015 and was unannounced.

Chandlers Ford Christian Nursing Home provides accommodation and nursing care for up to 45 older people. The home is located in the centre of Chandlers Ford behind the Methodist church and close to local shops and amenities. The home is located on the ground and basement floors of a large purpose built building. The first and second floors are flats with separate access.

Chandlers Ford Christian Nursing Home had a registered manager in post on the day of the inspection. The registered manager left two days after our first visit. The provider told us a relief manager was in post. 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.

At the last inspection on 9 July 2014, we asked the provider to take action to make improvements in respect of acting in accordance with the Mental Capacity Act 2005 (MCA), care and welfare and meeting nutritional needs. This was because the provider had not acted in accordance with the requirements of the MCA, did not always provide care in line with people’s needs and had not protected people from the risks of inadequate food and hydration. The provider submitted an action plan which stated that the home would be compliant by 30 August 2014. We found that the provider had not carried out the required improvements.

During our first visit on 7 January 2015 we were so concerned about the management of medicines that we asked a specialist pharmacist inspector to visit the home. They visited on 2 February 2015 and identified improvements in the management of medicines since our last visit..

Medicines were not stored or managed safely. When we visited the home on 7 January 2105 we found large quantities of prescription medicines stacked up in the hairdressing salon. The door was wedged open. Labels indicated that some medicines had been stored unsafely in the room since the beginning of December 2014. We found the treatment room to be open and unlocked and medicines were stored in unlocked cupboards in the room. There was a risk that people, staff or visitors to the home would take the medicines inappropriately. Action had been taken to address these issues by the time of our second visit on 2 February 2015.

Staff understood about safeguarding and when to report a concern and people told us they felt safe. However, people’s individual risks were not clearly assessed, documented, reviewed and changed in response to their changing needs.

There were not sufficient numbers of staff to keep people safe and meet their needs. Staffing levels had recently been reduced from seven to five care workers per day shift. Staff were rushed and task focussed, spending minimal amounts of time with people and only to perform a function such as supporting a person to drink. Call bells were ringing constantly and continued for long periods. People told us they waited a long time for call bells to be answered and their meals were served late.

People were at risk of choking because they were not supported to eat food which was suitable to their needs.

Although food and fluid monitoring charts were in place for some people, details recorded were not sufficient to support staff in ensuring people had eaten and drunk enough to meet their needs.

People did not receive support to eat sufficient quantities of food to meet their needs. Support from staff was inconsistent, sporadic and provided by various members of staff with long gaps in between of no support. This was not a pleasant mealtime experience for people.

Staff had not received sufficient training to meet people’s needs. Not all staff had completed essential training. There was no clinical training specifically to improve competencies for nurses. Supervision meetings had not been carried out in line with policy and two members of staff said they had not had a supervision meeting in the last year.

There was evidence that advice had been sought from health professionals such as GPs, occupational therapists, speech and language therapists and psychiatrists, however we found that advice was not transferred to care plans and care was not delivered in the recommended way.

The provider was not acting in accordance with the requirements of the Mental Capacity Act 2005 (MCA). The MCA is a law that protects and supports people who do not have the ability to make decisions for themselves. This meant that the service was not obtaining valid consent for treatment and care in relation to people whose mental capacity was in doubt.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager did not understand when a DoLS application should be made and was not aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. As a result appropriate applications had not been made.

Although staff were kind and caring they were not able to provide personalised support in line with people’s individual needs because the written and verbal handover information was inaccurate and lacking in detail. People were not involved or consulted in their care planning.

Staff were unable to respond appropriately to people’s needs due to a lack of detailed and accurate care plans, risk assessments, daily records and shift handovers. Care plans were not in place in relation to people’s specific risks and needs such as pressure ulcers, continence, pain and behaviours which may challenge others. There were no care plans in place in relation to specific conditions such dementia, diabetes and osteoporosis.

Staff morale was low and staff were not actively involved in developing the service. The home was not well organised, care was not provided in a consistent way, staff didn’t feel listened to and we found errors in people’s medicines and care plans which should have been detected through routine audits. Some aspects of the service were unsafe, such as the storage of medicines in the hairdressing salon for up to a month. Staff training was not up to date and staff competencies had not been checked. People said they didn’t know who the registered manager was, but they would like to know.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the back of the full version of the report.

Inspection carried out on 9 July 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found �

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people�s care needs had been assessed, recorded, and risk assessed. However, some people were supported to eat in positions which put them at risk of choking. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting people to eat safely.

The home was clean on the day of our inspection. There were effective systems in place to protect people from the risk of infection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been submitted under the safeguards, we have asked the provider to consider whether any applications should be made.

Is the service effective?

The service was not effective. The provider was not complying with the requirements of the Mental Capacity Act 2005 (MCA). We saw that, people�s mental capacity had not been assessed, where appropriate. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the MCA.

People told us they were happy with the care they received and it met their needs.

Is the service caring?

The service was caring. We observed care workers who were sensitive in the support they offered people and the way they asked people about their wishes. Many staff had worked in the home for a long period of time and this was reflected in the consistency of care people received.

Is the service responsive?

The service was responsive to people�s needs. We found evidence which showed that the service was regularly monitored and that changes were implemented where necessary.

Is the service well led?

The service was well led. We found there was evidence that care plans were reviewed regularly and the registered manager carried out monitoring checks. The registered manager responded to our concerns immediately on the day of the inspection.

Inspection carried out on 16 August 2013

During a routine inspection

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were easy to talk to, approachable and helpful, and that their privacy was respected whilst they were supported to maintain their independence. One person told us "we are very lucky, staff ask my opinions about my care and I feel confident that I can change anything I want."

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with each other in the dining room. During our inspection we observed people spending time in their bedrooms listening to their choice of music and reading. We observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

We saw staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

Inspection carried out on 11 February 2013

During an inspection looking at part of the service

People expressed their views and were involved in making decisions about their care and treatment. One person was able to tell us about a detailed form they had completed which included their personal history, details of their family, which food they particularly liked and what they liked to do. A relative told us how a member of staff had spent some considerable time with them collecting detailed information about their relative in order to produce an individualised care plan for them. They explained how, using the information collected the staff had �used little touches to make (their relative) feel more comfortable.�

People were cared for by staff who were supported to deliver care and deliver treatment safely and to an appropriate standard. During our inspection we reviewed records which showed that all staff had received dignity training and equality and diversity training. 87.5% of staff had received safeguarding training. We also spoke with three members of staff who all confirmed they had received a recent supervision from their line manager. One staff member said �they are supporting me very well.�

Inspection carried out on 11 September 2012

During a routine inspection

During our visit we spoke with four people who used the service, two relatives and a visiting health care professional. People were very pleased with the care they received. Two people commented on the quality of the food and how much they enjoyed it.

One person told us how much they liked living at the home �We are like a family here.�

A visiting relative told us that their family member always appeared well dressed, clean and tidy. �The clothes in the wardrobe are always ironed.�

The health care professional we spoke with was very complimentary about the service. �The staff are very supportive to myself and residents.�

Two people said that they were involved in the initial assessment of their needs before they came to live at the service. However all the people we spoke with said they could not remember being involved in any review or update of their care needs.

We identified some concerns around the lack of support for staff.