St Marks Court

St Mark’s Court is a care home providing personal and nursing care to up to a maximum of 60 people. The service provides support to older people including people who live with a dementia. At the time of our inspection there were 43 people using the service.

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

At our last inspection the provider had failed to robustly manage the risks relating to the health safety and welfare of people, including managing risks to people’s nutrition and pressure area care.

At this inspection improvements had been made and the service was no longer in breach of the regulation good governance as systems had improved to monitor the quality of service provision.

We have made a recommendation that the provider continues to make improvements to governance including menus, and as a result of people’s feedback to ensure person-centred care is provided.

Records now provided detailed guidance to assist staff to deliver care and support to meet people’s needs safely. Risks were assessed and mitigated to keep people safe. Staff recruitment was carried out safely and effectively.

An infection control system was in place. However, not all areas of the home were well-maintained or clean and there were signs of wear and tear.

We have made a recommendation about continuing with the programme of refurbishment in a timely manner, ensuring the environment is appropriately designed to meet all people’s needs and an appropriate standard of hygiene is maintained.

The provider was monitoring the use of PPE for effectiveness and people’s safely.

All people and relatives were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff, although, “very busy”, were kind and caring and supportive of people and their families. Their comments included, “All the staff are lovely” and “The staff are very friendly and extremely welcoming."

Staffing capacity was sufficient to ensure people's needs were met in a safe way. People's feedback was staff were "very busy."

We have made a recommendation the provider continues to keep staffing levels and staff deployment under review to ensure people receive timely and person-centred care.

Systems were in place for people to receive their medicines in a safe way.

There was evidence of collaborative working and communication with other professionals to help meet people's needs.

The staff team provided support discreetly and with compassion. People’s privacy was respected, and people were supported to maintain contact with relatives.

There was a cheerful atmosphere at the service. One relative commented, “The home has a very homely feeling.”

Staff spoke positively about working at the home and the people they cared for. Staff said the manager was very approachable and they were supported in their role.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 January 2022) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 3 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

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 Safe and Well-led which contain those requirements.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

St Mark’s Court is a residential care home providing personal, nursing and dementia care across three units. There were 38 people living at the service at the time of the inspection. The service can support up to 60 people.

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

The service was not always well-led. Audits had not always been effective in identifying inconsistencies with care planning, meaning people were at risk of receiving care that was less than good. Most staff were not confident with the electronic care planning system, however additional training was underway.

The service was not always safe. Some risk assessments lacked detail and were not always consistent. Staff did not always record risk-reducing actions, so it was at times unclear whether these were carried out or not.

The building was safe with regular maintenance checks in place.

There was a positive culture within the home and people and relatives gave good feedback about the care. People and their representatives were involved in decisions about the service. Staff had a good relationship with visiting professionals.

There were enough, suitably trained staff available to meet the needs of the people living at the service. Medicines were managed safely and audits were carried out. People were safeguarded from abuse. One person said, “I feel very safe living here.” Lessons had been learnt from incidents.

We were assured by the infection prevention and control practices within the home.

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.

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

Why we inspected

We received concerns in relation to the lack of understanding of the electronic care planning system and pressure area care. 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 changed from good to requires improvement. This is based on the findings at this inspection.

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

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 St Mark’s Court on our website at www.cqc.org.uk.

We found the following examples of good practice.

Systems were in place to help prevent people, staff and visitors from catching and spreading infection. Staff had closely considered how to support people to maintain relationships whilst keeping safe. For instance, dining tables had Perspex screens, which let people still sit together and chat over meals but reduced the potential to spread infections.

There was enough PPE, such as aprons, gloves and masks, which staff were seen to use. Staff had undertaken training in putting on and taking off PPE and the manager routinely checked staff compliance with the guidance.

Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme was in place.

People who used the service told us they found the staff were very supportive. The manager explained how the activity co-ordinator had been organising visits, including window visits and video calls, to help people maintain family connections.

The activity co-ordinator told us they were aware the people who used the service missed singers coming into the home. Therefore, the service had organised an event called ‘St Marks has talent,’ where staff and people performed and received awards. They had also arranged for singers to perform virtual entertainment for people’s birthdays.

The provider employed ‘speak and listen’ staff who spent time with people who may be more isolated.

We observed positive interactions between staff and people.

Further information is in the detailed findings below.

St Marks Court is a care home which provides nursing and residential care for up to 60 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 42 people using the service.

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

Since the last inspection the provider and registered manager had continued to make improvements to the operation of the service. Staff were deployed effectively, and this had led to a positive impact on people's quality of life. Staff discussed how the introduction of a floating staff member had supported them to fully meet people's needs and ensure people remained safe.

Staff were making a difference to people’s wellbeing by working well as a team, and by sharing the same values and principles.

Medicine management was being reviewed and measures had recently been put in place to reduce the potential for errors to occur.

A one-page assessment document had been fully introduced and these were detailed. The registered manager and provider recognised that having more information about people's life history would assist staff understand people's cultural differences and experiences.

At times support plans contained assessment information rather than clearly defining the interventions staff were to use. The evaluations and reviews had not assisted staff to critically consider if the interventions work and show how their dedicated and skilled work had led to very positive outcomes for people. The provider was in the process of reviewing the care documentation to see how this could be enhanced.

There was some variability in the quality of capacity assessments and ‘best interests’ decision records, which the registered manager was resolving.

The activity coordinators had been extremely effective in their role and had developed a wide range of events. They had made sure people had a life with meaning. The activities coordinators had secured a range of grants and been undertaking projects which had led to real community integration. Staff had recently started to put together ‘scrap’ books with people that contained photos and memories of their lives.

The registered manager and staff demonstrably showed people were valued and respected. Staff created a warm and friendly environment. Relatives and visiting professionals reported that staff were superb, fantastic, extremely friendly, kind and caring. Staff actively engaged people in discussions, and we heard lots of friendly banter.

We found staff were committed to delivering a service which was person-centred. 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.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. External professionals were involved in individuals care when necessary. The GP and community nurses visited at least once per week and routinely checked how people were feeling.

Staff had received a wide range of training and checks were made on the ongoing competency of staff. Appropriate checks were completed prior to people being employed to work at the service.

The cook had received a range of training around meeting people's nutritional needs. Staff were encouraging people who were under-weight to eat fortified foods. A range of menu choices were available.

The registered manager had acted on concerns and complaints and had taken steps to resolve these matters. They actively promoted equality and diversity within the home.

The service was well run. The senior managers and registered manager carried out lots of checks to make sure that the service was effective. The registered manager constantly looked for ways to improve the service. They continually researched information about best practice and ensured staff practice remained at the forefront in introducing new guidance.

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

Rating at last inspection

Requires improvement (report published 10 September 2019).

Why we inspected

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

Follow up

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

St Marks Court is a care home which provides nursing and residential care for up to 60 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 30 people using the service.

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

A registered manager had been in post for the last two months. The provider’s regional manager and quality team had supported them to identify shortfalls and to make positive improvements to the operation of the service. However, these changes were not fully embedded and further time was required for the provider and registered manager to be assured that these were effective.

To ensure people’s safety in the event of an emergency a range of improvements were needed around fire risk management. The registered manager confirmed they would organise this training and develop an evacuation plan.

The provider’s dependency tools did not assist staff to provide safe staffing levels. The regional manager and registered manager took this up with the quality manager and immediately increased the staffing levels. Despite this increase, we saw that on a morning the staff on the nursing unit could not support everyone to have a drink. The registered manager agreed to look at the deployment of staff during this time.

Staff were revisiting risk assessments, and these were in the process of being improved. Risk assessment for dehydration did not consider underlying physical conditions, which led to an inaccurate risk profile. The regional manager immediately discussed this with their quality team who reviewed the tool and supplied a new version that needed to be tested to determine if it was effective.

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. However, the policies and systems in the service did not support this practice, as the documentation was inaccurate and was confusing.

Staff completed monthly physical health checks but when this indicated a change or deterioration we could not establish what action was taken or understand the results. The registered manager undertook to revisit staff competency to use this tool.

The registered manager had reviewed medication practices and made improvements, but further work was needed. As required protocols were variable in content, and stock control needed to be reviewed for controlled medicines.

The staff were in the process of changing all 30 people's care records to mirror the new style records that were more informative. The registered manager had introduced new templates such as concise person profiles, pocket size cards detailing risks for individuals and communication plans. The registered manager had also introduced a system of using colour coded dots on people's door to assist staff see at a glance how much support people needed in the event of an emergency.

Equipment was appropriately maintained, and checks were routinely completed. A new treatment room with air conditioning had been created on the nursing unit. The service was clean and tidy.

Recruitment was effective, but the provider needs to ensure enough space was available for people to record their full employment history. Staff training, and supervision were being completed. The provider and registered manager constantly monitored the effectiveness of the courses. This oversight had led them to change the training provider and staff reported that the new courses were far more informative.

Tools were in place and staff ensured people were encouraged to eat a balanced diet. The cooks were very knowledgeable. The cook had received training around how to support people who were underweight or needed adapted diets. Staff were now closely monitoring food and fluid uptake for people and knew who was at risk of becoming dehydrated or losing weight.

Staff told us that the registered manager and regional manager were approachable and closely listened to their views. They were positive about how the service was now being operated and felt morale had significantly improved.

The provider had a system in place for overseeing the service and had identified gaps in practice and put action plans in place. However, the recent frequent changes to the manager and the regional manager being needed elsewhere had impeded progress in meeting these goals.

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

Rating at last inspection and update

Requires Improvement (report published 11 December 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance arrangements and meeting MCA principles. Although the service had started to improve in the Key Questions we reviewed and no breaches of regulation were identified further improvements were needed.

Why we inspected

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 Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Marks Court on our website at www.cqc.org.uk.

Follow up

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

St Marks Court is a ‘care home’. People in care homes receive accommodation, nursing and 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. St Marks Court is a care home which provides nursing and residential care for up to 60 people. Care is primarily provided for older people, some of whom have dementia. At the time of this inspection 50 people used the service.

We last inspected the service in September 2017 and found the service was not meeting our expectations. We rated St Mark’s Court as Requires improvement overall and in four domains. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment and good governance.

We found that the provider was failing to submit notifications, which is an offence and we issued a fixed penalty notice. The provider paid the £1250 fine and has subsequently sent in notifications.

The service has not had a registered manager since June 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. Over the last year the provider had recruited three managers and one person had applied to be the registered manager but left the service before the process was completed. At the beginning of September 2018, a new manager had started working at the service.

At the last inspection we highlighted concerns around how people were supported with their mobility. Staff needed to ensure that they adopted the correct moving and handling techniques. Moving and handling equipment needed to be appropriate for each individual and stored appropriately. Accidents and incidents were monitored but we found improvements were needed with how the information was analysed and used to assess risks of falls and injury. We found that the provider was changing the systems they used for monitoring the service and in the transition period the systems in place had not picked up the issues we identified.

At this inspection we found that although the provider had been working to resolve these issues and improvements had been made, the instability in the management had led to a continuation of issues.

We found that the provider was introducing new training programmes but not all staff were up to date with mandatory training. New staff had not received moving and handling training, the catering staff had not renewed food hygiene level two awards and the provider needed to ensure there were sufficient qualified first aiders to cover 24 hours every day. Staff had not completed regular supervision sessions but the new manager was re-introducing these.

There were not enough staff on the unit for people living with dementia during the mealtimes to ensure people ate sufficient food. Also, staff on this unit did not fully recognise when people were at risk of malnutrition or take proactive measures to encourage people to consume sufficient nutritious foods and maintain their weight. Catering staff were not always alerted to people’s dietary needs and had not been support to understand how to create foods that were suitable for people at risk of losing weight.

The regional manager discussed how they had recently reviewed staffing levels and these were to be increased both during the day and overnight. They were in the process of recruiting staff to fill these newly created vacancies. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The provider was planning to complete a full refurbishment of the service and some decorative works had commenced on the nursing unit. Priority needed to be given to refurbishment to the unit for people with dementia, as this was malodorous. The settees in lounges needed replacing, as these were sagging and low. We heard that since the new manager had started to work at the service repairs were being completed, for instance a bath that had been broken for over six months had been fixed.

Safeguarding and whistleblowing procedures were in place. Staff reported concerns but the previous manager had not dealt with these effectively. A complaints process was in place and the new manager was checking with relatives and the people that used the service that any issues raised had been acted upon. We found no records to show the previous managers had investigated incidents or what lessons had been learnt.

We reviewed the systems for the management of medicines. We found that people were administered medicines safely but the oversight of these needed to be improved. The treatment room temperatures exceeded 25°c, in part because one of the air conditioning units had been broken for a number of months and the other treatment cupboards were small. This meant that some items would be stored above the recommended temperature.

Staff understood the principles of the Mental Capacity Act 2005. We discussed how staff needed to demonstrate that decisions were made for people in their ‘best interests’ and complete effective capacity assessments.

The new manager and regional manager were taking steps to review the service to ensure that they were aware of all concerns, these had been thoroughly investigated and actions were taken to resolve them.

Staff knew the people they were supporting but the care records lacked information about people’s lives and were not always person-centred, as we could not establish basic information about how to support individuals. We discussed this with the regional manager who explained that the provider had identified these deficits in the care records and was in the process of improving them.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. Staff respected people’s privacy and dignity. We found a range of activities were available.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to the need for consent and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.

We last inspected the service on 6 May 2015 and found the service was meeting our expectations. We rated St Mark’s Court as ‘Good’ overall and all in five domains.

St Marks Court is a care home which provides nursing and residential care for up to 60 people. Care is primarily provided for older people, some of whom have dementia. At the time of this inspection 42 people were in receipt of care from the service.

The home has not had a registered manager since June 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had recruited a person to be the registered manager and they started working at the service in the middle of August 2017.

During our observations of care within the service, we identified concerns related to how people were supported with their mobility. Staff needed to ensure that they adopted the correct moving and handling techniques. Moving and handling equipment needed to be appropriate for each individual and stored appropriately. We raised concerns around specific practices and the quality manager informed us they would review this and submit safeguarding alerts immediately. We observed that equipment such as slings were stored in a pile on the floor, which was unhygienic. Also equipment such as wheelchairs were identified by numbers rather than the person’s name so it was difficult for staff to find the item for the individual who had been assessed to use it.

Accidents and incidents were monitored but we found improvements were needed around how the information was analysed and used to assess risks of falls and injury. We found that the provider was changing the systems they used for monitoring the service and in the transition period the systems in place had not picked up the issues we identified.

Safeguarding and whistleblowing procedures were in place. Staff reported concerns but needed to take ownership for reporting matters to the local safeguarding team. They also needed to ensure recommendations made by safeguarding teams were implemented, such as making sure people were supported to change their position in chairs regularly throughout the day.

A complaints process was in place and any concerns were investigated by the regional manager or the quality compliance team. However people told us that at times when they raised issues they received no feedback and action was not taken to rectify their concerns.

People’s care records were cumbersome, extremely difficult to navigate and we often found it difficult to get a sense of the person’s needs. The lack of a detailed written assessment had contributed to the difficulties around developing the care records as an effective working tool. Staff needed to improve the accuracy of their recording when monitoring peoples' fluid intake.

People told us they felt the care staff did a good job. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected.

We found a range of activities were available on the ground floor which people from elsewhere in the service accessed. When we visited a pet therapy session was taking place with a pony and the staff had been breeding chickens. The chickens were kept in the bar area of the home, which was away from the main areas of the service. They were reaching maturity so needed to be moved outside and despite staff best efforts, such as ensuring they were cleaned daily they were malodourous and this meant people were not accessing this area. There was a risk assessment in place, which highlighted and mitigated any risks around existing chest conditions were exacerbated by exposure to chicken feathers and the associated dust.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. Staff respected people’s privacy and dignity.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We carried out this inspection in response to concerns we had received about the care and welfare of people using the service. One relative told us, 'The staff are very good, but my father's named nurse who knew him very well, has left. There are now two nurses on every day, but that's just started and most are from and agency.' Other relative's comments included, 'Staff are very kind and seem to care for the people they look after. However, they seem very stressed and just seem to rush from person to person,' and, 'I approached one of the carers about my concerns and was told they could only deliver basic care.' A visiting health professional commented, 'There are no regular nurses who know people.'

People were cared for in an environment that was clean and hygienic. The building was clean, secure and other appropriate measures were in place to ensure the security of the premises. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. A member of the management team was available on call in case of emergencies.

We found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We also found that the service had not always taken steps to provide care in an environment that was adequately maintained. In addition, we found that there were not enough qualified, skilled and experienced staff to meet people's needs. 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 care and welfare of people who use the services, the safety and suitability of the premises and staffing at the home.

Is the service effective?

We carried out this inspection in response to concerns we had received about the care and welfare of people using the service. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. One person told us, 'The staff are very good and very obliging. They look after me well and they seem confident and competent in what they do.' One relative told us, 'Given the current staffing difficulties, I think my mum is very well cared for.' Another relative commented, 'The staff all seem really pleasant and very helpful. She always looks clean and well presented, but staff do not have time to spend with people.'

However, we found that staff did not always receive appropriate training and suitable appraisal and supervision arrangements were not fully in place. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff training, appraisal and supervision arrangements.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Our observations confirmed this. One person told us, 'The care is really good here, the staff are all lovely.' One relative told us, 'The staff are always very nice, pleasant and always speak. They are very good with the residents and their care and support is very good.' Another relative commented, 'Staff are very kind and seem to care for the people they look after.'

Relatives of people cared for on the nursing unit told us they were concerned about the standards and continuity of care provided. They were aware of recent staff changes, but felt they had not been kept well informed about what was happening in the home.

Is the service responsive?

People's needs were not always assessed before they moved into the home. We found in one instance, this had resulted in a person having no care plans for meeting their needs. Other people had care plans which set out how staff would support them with their physical and mental health and social needs. These included advice given by other health care professionals. However, care plans were not always routinely reviewed or updated in response to people's changing needs.

We saw the provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that three complaints had been received by the service within the 12 months. We also noted that five compliments had been received by the service within the last 12 months.

Is the service well-led?

The registered manager for the service had left and the service was being managed by an acting manager.

Staff had a good understanding of the ethos of the home and some quality assurance processes were in place. Relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. The provider undertook some audits and risk assessments to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The provider had in place systems to monitor the quality of the service people received. However, we found that they were not always effective, or currently undertaken on a regular basis. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to establishing effective quality monitoring systems.

Some relatives and staff told us they felt the quality of services provided at the home had deteriorated. They were concerned about changes in the staff team and leadership. One relative told us, 'X (the former manager) was lovely and really good; my mother got on with her very well and we are sorry to see her go. In an ideal world, they should have had a replacement manager in place to take over as she left.'

People told us they were happy with the care which was provided. One person said, 'This is a good home; I've been in a few, but I'm happy here." Another person said, "The staff are very good. They look after us well." We spoke with two members of staff. Staff were knowledgeable about people's care needs and what they should do to support them.

There were enough staff to meet people's needs and appropriate arrangements were in place to manage medicines.

There was an effective complaints system available and people were given information about how to make a complaint.

However we found that records had not been accurately maintained.