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Coundon Manor Care Home Requires improvement

Reports


Inspection carried out on 20 February 2018

During a routine inspection

This inspection took place on 20 February 2018 and was unannounced.

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

The maximum number of people the home can accommodate is 74. The home is a two storey building. People who lived with dementia were supported on the ground floor, and people who were being re-habilitated from hospital on short term contracts, and those living at the home who had more physical nursing needs were supported on the first floor.

At our last inspection the home was placed into Special Measures. This was because we had rated the key questions of 'safe,' ‘responsive’ and 'well-led' as inadequate. There were seven breaches of the Regulations. At that time we met with the provider and they provided us with an action plan. This showed what they would do and by when, to improve all areas of the service we had concerns with to at least 'good'. The provider liaised with us by updating the action plan informing us when they had achieved their aims and what outcomes continued to require improvements.

During this visit the provider had made a promising start to improving the service and the home was no longer in breach of the regulations, and no longer in special measures.

Because it had only been four months since our last visit we were aware the provider had not had a significant period of time to move the home forward and sustain improvements made. The provider also shared this view. They had also been made at a period of time when there were less people in the home than usual. This was because the provider had volunteered to stop admitting new people to the home until improvements were made.

At our previous inspection to the service, 70 people lived at Coundon Manor; during this visit 49 people lived at the home. Improvements were required to be sustained over a period of time once further people were admitted to the home.

The registered manager had been the registered manager at Coundon Manor since 2016. 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.

Staffing levels had increased, and there had been a reduction in the high number of agency staff used. New staff were still becoming familiar with the service and the needs of people who lived at the home. Staff were deployed in specific areas of the home to supervise people in order to promote people's safety and to reduce the risks of people falling.

Care records provided more detail about people, and risks related to people's health and well-being were now being appropriately assessed and acted on. New equipment had been bought to improve the responsiveness of care and to reduce people's risks.

The premises and equipment were clean.

The mealtime experience had improved and people who were at risk of malnutrition or dehydration were getting more support from staff to encourage them to eat and drink healthily. Checks were now being undertaken to identify when people had not eaten or drank so staff could provide further encouragement.

Staff now received better access to training and support. Many staff had completed the provider's accredited dementia training and dignity training, as well as the expected health and safety training. We saw improved responses from staff in relation to people with dementia, and in respecting people's dignity and privacy.

Medicines were mostly managed safely, and the provider had a good understanding of what improvements were required to manage medicines more safely and effectively. Staff recruitment procedure

Inspection carried out on 25 October 2017

During a routine inspection

This inspection visit took place on 12 September 2017 and 25 October and was unannounced. We initially visited the home to undertake a focused inspection on 12 September 2017. This was because the provider had been in breach of a number of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at our last inspection in March 2017 and we wanted to check if improvements had been made. Because we did not see sufficient improvement during this visit we changed the inspection to a comprehensive inspection and went back again on 25 October 2017 to ensure we looked at all the areas of care we regulated.

Coundon Manor is a nursing home which provides both permanent accommodation, and respite or temporary accommodation to people who require nursing care and specialist dementia care. The maximum number of people the home can accommodate is 74. At the time of our inspection visit, 70 people were staying at the home.

The home had a registered manager. 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.

When we visited the home in March 2017 we rated the overall service as 'Requires Improvement'; however the majority of our concerns related to the quality of care provided on the ground floor dementia unit. During this inspection we had concerns about the quality of care on both floors.

At this inspection we found the provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 18, Staffing. This was because the staffing levels for the units were the same as they were when we visited in March 2017. The provider had agreed to an increase in staff during the day time, but this had only just been approved and not fully implemented. No increases to night time staffing had been considered and staff were not always available at the times people needed them. People were still at risk because there were not enough staff to meet their needs and manage the risks associated with their care. We had concerns about the level of staff and staff deployment on both floors of the home. There continued to be a high level of staff leaving the provider’s employment at the service and high use of agency staff to cover for staff shortages. This did not promote continuity of care for people who lived there.

The provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 14, Meeting nutritional and hydration needs. During our first visit there had been some improvements such as changes in the structure of mealtimes. People who required support to eat in their rooms, had this support before people who had their meals in the dining rooms were provided with their meals. This gave staff more time to support people with meals. On our second visit this had been changed back to the original routine. Mealtimes were rushed and people at risk of malnutrition were not always receiving the additional food supplements they required. People who could not drink independently were not always getting enough fluid to keep them hydrated.

The provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 9, Person-centred care. The provider continued to have a high turn-over of staff at the home. This meant not all staff had received the 'creative minds' training to support them with dementia care. The home had to use a high number of agency staff and this meant people with dementia were supported by staff they did not know well. There were not enough staff to support people with more person centred activities.

People’s medicines were not always managed well, there were areas of the home and equipment

Inspection carried out on 14 March 2017

During a routine inspection

The inspection took place in the evening of Tuesday 14 March 2017, and during the day on Wednesday 15 March 2017. The inspection was unannounced on Tuesday 14 March, and we told the provider we would be back to complete the inspection on 15 March 2017. The service was rated as ‘requires improvement’ at the last inspection, but there were no breaches of the Regulations.

Coundon Manor is a nursing home which provides both permanent accommodation, and respite or temporary accommodation to people who require nursing care and dementia care. The maximum number of people the home can accommodate is 74. At the time of our visit, 69 people were using the service.

The service had a registered manager. 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.’

There were not enough staff on the dementia unit to keep people safe and to respond to people’s dementia care needs and the risks associated with these needs. There were enough staff on the first floor to keep people safe. Since our last inspection the service continued to have a high turnover of staff which meant there had been a high level of agency staff used, but this had reduced significantly in the last two months.

The provider understood their legal responsibilities to apply for deprivation of liberty safeguards for people who did not have capacity to make decisions and whose liberty was being restricted. Not all care staff had received training in the Mental Capacity Act or understood the importance of gaining people’s consent before care tasks were undertaken. It was not always clear why decisions had been taken in a person’s best interest when they lacked capacity.

Staff mostly had a caring approach towards people, but they did not have time to provide care centred on the needs of the person. Care was task focused on both floors of the home. People’s dignity and privacy was mostly respected.

The cook provided different meal options for people, but some people were not offered a choice and staff did not know how to support people who lived with dementia to make food choices. We were concerned that staff on both floors did not have the time to support and encourage people to eat their lunch and tea time meals.

Friends and relatives were welcomed to visit the home at any time during the day or evening, and could spend as long as they wished with the person they visited.

People’s medicines were mostly administered safely and their healthcare needs were met in a timely way.

Most staff had undertaken training to provide them with the knowledge and skills to work with people safely, and staff received management support with individual meetings and team meetings.

The registered manager responded to complaints in line with the organisation’s complaints’ policy and procedure. Most relatives and staff felt the registered manager listened and responded to their concerns.

The provider undertook their own quality checks of the service, and the registered manager undertook monthly audits to ensure people’s health and safety. The checks were rigorous in relation to health and safety issues and in ensuring records were maintained. They were less focused on the ‘lived’ experience of people who lived in the home.

The registered manager had notified us of incidents that affected the safety of people who lived at Coundon Manor. They had also fulfilled their legal responsibilities by completing and returning the Provider Information Return to the Care Quality Commission when requested.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 10 February 2016

During a routine inspection

This inspection took place on 10 and 11 February 2016. The inspection was unannounced.

Coundon Manor is a nursing home which provides nursing care for a maximum of 74 people. The home provides care on two floors. People whose primary care need is dementia, are mainly supported on the ground floor, and people with more complex nursing needs are mainly supported on the first floor. Sixty five people were living at the home at the time of our inspection.

The home had a new registered manager. They were appointed in August 2015 and registered with us in January 2016. 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 previous inspection on 1, 2 and 3 July 2015, we identified four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this inspection the home was put into special measures. We asked the provider to improve staffing arrangements; ensure people’s individual and social needs were met; improve the cleanliness of the home; ensure people received the food and fluids required to maintain their health; and improve their quality assurance systems. The provider sent us an action plan and monthly updates to tell us about the improvements they had implemented.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Overall, staff were available at the times people needed them. Since the last inspection staffing arrangements had been reviewed and additional staff were available to support people during busy periods. However, we had concerns that reduced staffing levels in the later afternoon and evening meant people might not have such a responsive service to their personal care needs as they did earlier in the day.

There had been significant improvements in the cleanliness of the home. An increase in housekeeping staff meant all areas of the home were clean and tidy.

There were improvements in meeting people’s social and individual needs. An increase in the number of hours provided to support an individual and group activity programme had benefited people’s social and emotional well-being.

In most cases, people received the food and fluids required to maintain their health. An increase in staffing to support meal times ensured that people who required assistance to eat, received the support necessary. Due to their health needs, some people required additional snacks and drinks, but records did not always confirm they had been given.

The home worked well with the dietician, GP, speech and language team, and other healthcare professionals to support people with their healthcare needs.

There had been improvements in the personal care provided to people, however there were still instances when people did not receive the personal care they had requested or required.

At our last visit many people who could use a call bell to call for assistance, did not have one in reach. During this visit, most people’s call bells were in reach and when people used them, staff responded quickly.

People and visitors were complimentary of the staff and the care provided at the home. We saw staff engaged well with people. People looked well presented with clean clothes and hair and people’s privacy and dignity was promoted. Relatives and friends were able to visit the home at any time during the day or evening.

Complaints were responded to appropriately. The registered manager ensured all complaints, both f

Inspection carried out on 1,2 and 3 July 2015

During a routine inspection

This inspection took place in the evening of 1 July 2015, and during the day on 2 and 3 July 2015. The inspection was unannounced. We carried out this inspection during the evening and daytime because of concerns raised by members of the public and staff about the level of care provided at the home.

Coundon Manor is a large nursing home which provides nursing care for a maximum of 74 people. The home provides care on two floors. People whose primary care need is dementia, are mainly supported on the ground floor, and people with more complex nursing needs are mainly supported on the first floor. Seventy three people were living at the home at the time of our inspection.

The home has a registered manager. 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.

There were not enough staff to meet people’s health and social care needs. The provider was trying to fill the gaps in the planned staff rota with agency and bank staff. The use of agency and bank staff to cover staff vacancies meant people were not provided with continuity of care by people who knew them well. The ‘staffing tool’ used by the provider to determine the number of staff required; did not provide sufficient staff to meet the needs of people, or take account of the size and layout of the building.

Staff were kind and most of them were attentive to people when they provided personal care. However, staff interaction with people was mostly when supporting people with care tasks. We saw little involvement between staff and people at any other time of the day. There were limited opportunities for people to be involved in social activities, particularly people with high dependency needs.

People who were independent received food and fluids which met their nutritional and hydration needs. People who were dependent on staff helping them with food and fluids did not always receive the support they needed to eat and drink. Drinks were not always placed in people’s reach. Staff did not always provide people with protective covers when eating, and people were left to sit in dirty clothes for the remainder of the day which compromised their dignity.

The personal care provided did not always meet people’s preferences or expectations. Most people only received a shower once a week and records showed that many were not supported to have a wash at night or their teeth cleaned. Care provided was task orientated and not tailored to the needs of each individual (person centred care).

There were numerous areas of the home that were not clean. Food debris or stains were found on chairs, equipment, carpets, tables and beds.

Call bells were not always in reach of people who could use them. At times people’s needs were not noticed because they were not able to ring for help. Those who did, received help promptly.

Care records identified risks relating to people’s care but staff had not always acted on the risks.

The registered manager had responded appropriately to formal complaints. However, some staff and relatives had raised a number of informal complaints and concerns, some of which they felt had not been adequately addressed. This information was contained in people’s care files and in staff files, but had not been used by the registered manager to identify and act on patterns of concern.

Relatives and friends were able to visit the home at any time in the day or evening.

The registered manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (permission needs to be sought when a person who does not have capacity has their liberty restricted). However, consent was not always gained from people who had capacity when their freedom was restricted.

There were mixed views from staff as to whether there was an open and transparent management culture. Quality assurance management systems had not identified the concerns we raised at the inspection. We had concerns that the home had a history of non-compliance with the regulations, and the concerns raised at this visit were similar to concerns raised in other inspections in the last few years.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 21 January 2015

During a routine inspection

This inspection took place on 21 January 2015. It was unannounced.

Coundon Manor Care home is a nursing home which provides nursing care to a maximum of 74 people. The home operates on two floors. On the day of our visit, 73 people lived at the home.

The registered manager identified in this report is no longer the manager of the home. 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 registered manager has left the service and a new manager has applied to be registered with the CQC.

The manager had staffed the home in line with the provider’s staffing tool. However, a high number of new admissions to Coundon Manor , an increase of new staff to the home, some of whom were inexperienced in care work, and un-planned staff absences, meant that staff were not always responsive to people’s needs and safety was sometimes compromised. Staff did not always have time to provide as much care and support as people wanted, and the diverse needs of some people had not been fully considered. We saw however that staff treated people with kindness and ensured people’s dignity was maintained.

An activity worker was available each day of the week to support people with their activities, hobbies and interests. However they did not have time to provide regular individualised activities to the high number of people living at the home. Care staff did not routinely have time to support people with hobbies or interests.

Staff understood how to protect people from abuse and avoidable harm. People told us they felt safe, although their relatives were concerned about staffing levels.

The provider adhered to the Mental Capacity Act 2005. Staff respected and acted upon people’s decisions. Where people did not have capacity to make informed decisions, ‘best interest’ decisions were taken on the person’s behalf.

The provider met the requirements of the Deprivation of Liberty Safeguards (DoLS). The provider had referred people to the local authority for an assessment where potential restrictions on people’s liberty had been identified. At the time of our visit, nobody living at Coundon Manor had been assessed as requiring a DoLS.

There were systems in place to ensure the premises and equipment were well maintained.

We saw people received a good choice of food and drink, and people’s individual food requirements were well catered for. People’s health needs were well met and they were referred to appropriate health care professionals when concerns about their care and well-being were identified.

The manager was working towards an open and transparent leadership culture after a challenging period which left staff feeling demoralised.

Inspection carried out on 11 November 2014

During an inspection to make sure that the improvements required had been made

We visited the home to follow up on concerns we had about the management of medicines at our last inspection in September 2014.

At our last inspection we found concerns with the administration, storage, disposal and recording of medicines, which might have resulted in people not being fully protected against the risks associated with medicines.

During this visit we found effective systems were in place that ensured medicines were managed safely. Staff were able to assure people that their medicines were stored safely and people were found to be receiving their medicines in accordance with the prescriber’s advice.

Inspection carried out on 9 September 2014

During an inspection to make sure that the improvements required had been made

When we visited Coundon Manor in June 2014, we identified some concerns around care and welfare of people, equipment, staffing, the management of medicines within the home and the systems in place to monitor the quality of service provided. Following our inspection, the provider sent us a plan setting out the actions the service was taking to ensure improvements in these areas.

On 9 September 2014 two inspectors visited the home and on 15 September a pharmacy inspector visited the home to check the actions had been implemented.

The registered manager referred to at the front of this report is not the current manager of the service. The registered manager has not yet cancelled their registration with the Care Quality Commission.

During our visit we spoke with the manager, deputy manager, operations manager, 10 staff, five visiting relatives and five people who used the service.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions.

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

Is the service safe?

We found sufficient staff to meet the needs of people during the day. Because of staff sickness, we could not determine from observation whether there was sufficient staff at night. The provider has agreed to monitor this and report their findings to us in the next six weeks.

We found some errors and omissions in medication management meant people were not always kept safe.

Is the service effective?

People were supported by staff who have the necessary skills and knowledge to meet their assessed needs.

Management had plans to promote good practice and develop the knowledge and skills of existing and new staff.

Is the service caring?

People were treated with kindness in their day to day care. Staff supported people to maintain their dignity, and were respectful when providing care.

Is the service responsive?

The manager had implemented systems which encouraged people to be involved in the planning and review of their care.

The service had an effective complaint's procedure.

Is the service well-led?

The new management team have been in post for a short period of time. During this time they have improved the quality of service provision, and introduced systems which more effectively monitor the quality of care provided.

Since our visit they have acted swiftly to address the new concerns we had regarding medication management.

Inspection carried out on 16 June 2014

During a routine inspection

This service was inspected by four inspectors including a pharmacist inspector and an inspection manager. The inspection focused on concerns we had received about the service. The inspection covered parts of the night and day shifts. This was to enable us to see how people were being cared for and supported across the whole day. It was also to enable us to talk with a wide range of staff, people who used the service and their relatives or friends. Many of the people who lived at Coundon Manor were not able to tell us about their experiences of the home. We spoke with six people who lived at the home, two relatives, five nurses, eleven care assistants, a cleaner and a kitchen assistant. We also spoke with management staff.

We looked at five outcomes to answer the following five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with were positive in their comments about the service but we found improvements were needed in the care and support being provided.

People were not always involved in their care. We saw people’s care records were not always accurate or sufficiently detailed to make sure people received the care they needed.

Staff had received or were booked onto training about the Mental Capacity Act. This was to improve their understanding of how to support people who lacked mental capacity to make decisions about their care and treatment. The manager told us further work was needed to check if any Deprivation of Liberty Safeguards (DoLS) applications needed to be made.

Effective systems were not in place to make sure staff learned from events such as accidents and incidents, complaints, concerns and investigations.

We found staff were not always knowledgeable about people’s needs. We were told by staff that they did not always have time to read care plans. We found the number of staff available to support people and the way staff were organised was not always effective to keep people safe.

There were ongoing problems with people’s medicines not being available. We were told this was primarily due to problems in communication between the doctor’s surgery and the supplying pharmacy. Although we acknowledged the problem involved a number of agencies, effective action had not been taken to resolve it. We found that people’s medicines were not always available to give to people as prescribed. This increased medicine safety concerns. We found appropriate arrangements were not in place to manage the risks associated with the unsafe use and management of medicines.

Is the service effective?

We saw there was a process to assess risks associated with people’s care. We found this process was not being managed consistently. We found in particular risks associated with people’s nutrition were not always effectively managed.

People had access to a range of health care professionals to support their care needs, some of which, visited the home.

We found some of the equipment needed to support people’s needs was not readily available.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. We saw some staff were kind and friendly in their approach. Others were task orientated and seemed rushed and unable to spend time with people. We spoke with a number of people who used the service. People told us they were satisfied with the care and support they received. One person told us, “I’m very comfortable and well looked after.”

Is the service responsive?

People were able to participate in social activities within the home and within the local community. One person told us, “They throw balls and do painting.” We saw social activities being undertaken on the day of our inspection.

There was not an effective system in place to manage complaints. This had been identified and the new management team were in the process of addressing complaints received.

We found systems and processes were not in place to analyse accidents and incidents to identify any preventative measures required.

We saw people were able to access help and support from other health and social care professionals when necessary.

Is the service well led?

At the time of our inspection the manager named on this report was no longer in post. A new manager had been employed and was to complete the CQC registration process.

We did not see there was an effective system to monitor the quality of care and services provided. We were told about plans in place to address this. These plans included the implementation of quality audits of the service.

We saw there was a new management team in place at the home. We saw actions were in progress to make improvements across the home. Staff were positive about the actions that the management team had taken since they had been in post.

Inspection carried out on 11 September 2013

During an inspection to make sure that the improvements required had been made

During this follow up inspection we specifically looked at staff access to training, appraisals and supervision. These were areas that we identified as needing improvement at our last inspection.

We found from talking with staff, the manager and reviewing records that arrangements were in place to support staff in developing their skills. Some staff had completed the required training and others had dates identified to complete this.

Inspection carried out on 14 May 2013

During a routine inspection

On the day of our inspection we spoke with five people living in the home and four relatives. We also spent a period of time observing those people unable to speak with us. This was so we could determine what it was like for people living in the home.

We found actions had been taken to address the compliance actions issued at our last inspection but further improvements were needed to address staff training, supervision and appraisals. People we spoke with about the staff told us: “Staff have been really helpful.” “Very helpful, very polite, very interested and there are always plenty of them around.”

We saw that people were involved in making decisions about their care. We received positive comments from people and relatives about the service. These included: “It’s very good.” “I find it quite comfortable.” “My impression so far is really good.”

We saw there were appropriate systems in place to manage any allegations of abuse. People told us they felt at ease to raise any concerns with staff if they needed to and staff knew what process to follow if they suspected abuse.

We saw that the service had systems in place to monitor the quality of care and services provided. Comments on completed surveys included: “One of the best homes I have visited for odour free areas.” “The home is clean and tidy and gives an excellent insight into the quality of staff at all levels.”

Inspection carried out on 10 December 2012

During a routine inspection

On the day of our visit we spoke with eight people living in the home, three relatives and a visiting GP. We also spent a period of time observing those people unable to speak with us. This was so we could determine what it was like for people living in the home.

We found that some people were involved in making decisions about their care to enable them to maintain some independence. We identified improvements were needed in the delivery and maintenance of care to keep people safe. Care records were not always up-to-date to make sure staff managed risks and delivered care that met people’s needs. Improvements were also needed to address people’s privacy and dignity.

Whilst we had concerns about care, people were positive in their comments about the home. They told us: “All very good.” “It’s smashing they are all friendly people.” They were also positive about the staff. Comments included: “Staff are ever so nice.” “They have been very kind to me.”

We observed that staff were rushed in their work and task orientated. We observed incidents of concern involving people living in the home which went un-noticed by staff. This was because staff were busy.

Quality monitoring was not being carried out on a regular basis to ensure people were receiving the quality of care and services they expected.