Archived: Bamford Grange Care Home

About the service

Bamford Grange Care Home is a care home providing personal and nursing care to up to 79 people. Bamford Grange Care Home provides care across separate five units over two floors. Units specialise in dementia care, general nursing and mental health. At the time of our inspection there were 54 people using the service and one unit was closed.

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

The home had a history of a change in home management and the last manager left their post before completing their registration with CQC. As a result, some areas of oversight of the service were affected. The home was being managed in the interim by two area support managers and the deputy manager. Staff and managers were helpful, supportive and transparent throughout the inspection.

Improvements had been made in the management of medicines. However, we have made a recommendation about additional checks to ensure paperwork is accurate and up to date in people’s medicines files. Staffing levels were appropriate on the day of our inspection and staff had been recruited safely. People’s individual risks had been assessed and plans were in place to reduce these risks. Environmental safety checks had been carried out. However, we have made a recommendation about the secure storage of potentially harmful substances.

Staff received a programme of induction and ongoing training. People were supported to access a wide range of health care professionals and people received timely care and treatment. People’s nutritional needs were assessed, and dietary requirements were met. However, we received mixed feedback about the food. 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.

People were supported by kind and caring staff. People were involved in decisions about their care and were treated with privacy, dignity and respect. One relative told us, “Staff are always kind and patient with him, they have a joke with him, and he loves this and interacts well with them. They always seem to ask him before they do anything, and they treat him with respect at all times.”

People’s communication needs were met. The home had new activity co-ordinators in post and people and staff were pleased they would be able to partake in the activity programmes. Visits were being fully facilitated and options were in place to continue visiting if a person needed to isolate.

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 27 April 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of one regulation. This service has now been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

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

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

You can read the report from our last inspection, by selecting the 'all reports' link for Bamford Grange Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to management oversight at this inspection. We have made two recommendations.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bamford Grange Care Home is a residential care home providing personal and nursing care to 70 people at the time of the inspection. The service can support up to 79 people.

Bamford Grange Care Home provides care across separate five units. Units specialise in dementia care, general nursing and mental health.

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

Medicines management was not always safe. Staffing levels were appropriate on the day of the inspection. Staff had recently been strategically assigned to units and were being moved between units less. Newly recruited staff were getting to know people. People told us they felt safe at Bamford Grange. The home was clean and staff wore the recommended personal protective equipment.

People did not always had access to regular activities. People were receiving support with some aspects of their personal care. However, oral healthcare delivery was an area that still required improvement. At the time of the inspection the provider was rolling out a new programme of activities. Complaints had been managed in line with the provider’s complaints policy.

There remained inconsistencies in how staff monitored and recorded care. However, the newly registered manager was making improvements at Bamford Grange Care Home and was implementing changes to many areas of care delivery. Most staff told us they felt more settled and were optimistic about the future. However, we did find some issues during the inspection that the home's quality systems had not identified.

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

Rating at last inspection

The last rating for this service was requires improvement (published 17 December 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had been made. However, the provider was still in breach of regulations in relation to person-centred care, governance and medicines management.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 October 2020. Three breaches of legal requirements were found, and we issued a warning notice to the provider. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing, person-centred care and governance.

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the safe, responsive and well-led key questions.

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 remained the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive 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 Bamford Grange Care Home on our website at www.cqc.org.uk.

Enforcement

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

We have identified breaches in relation to person-centred care, governance and medicines management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do continue to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bamford Grange Care Home is a care home providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 79 people.

Bamford Grange Care Home provides care across separate five units. Units specialise in dementia care, general nursing and mental ill health.

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

People did not always receive care which met their needs. Care plans did not always reflect people’s current needs. End of life wishes were not always captured. Monitoring records were inconsistent. The provider had failed again to demonstrate the required standard of governance. This is a breach of Regulation 17 (Good Governance) and Regulation 9 (Person-Centred Care).

Staff were not appropriately deployed to ensure that meant people’s care needs were met. This is a breach of Regulation 18 (Staffing).

Activities were taking place in parts of the building, but people cared for in bed were at risk of social isolation. We made a recommendation about activities.

There was a clear policy and system to manage infection control particularly in terms of the prevention of Covid-19. The inspector completed an infection control questionnaire on site. We made a recommendation about infection control.

The provider followed their complaints policy when dealing with complaints. One complaint had been escalated to the Local Government and Social Care Ombudsman who investigate complaints about adult social care settings.

Staff expressed a commitment to their caring roles. Most relatives told us they were happy with the care their loved ones received. Relatives told us that communication between themselves and their loved ones could be better supported by staff at the home. We made a recommendation about communication.

There had been some changes to the management team at Bamford Grange Care Home and new systems were being implemented to improve people’s experience of care.

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 5 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s care needs, staffing and infection control. A decision was made for us to inspect and examine those risks.

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

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

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 remained the same. This is based on the findings at this inspection.

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

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

Enforcement

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

We have identified continued breaches in relation to staffing, person-centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bamford Grange Care Home is a nursing and residential care home which provides nursing and personal care for up to 79 people, including older people, people with mental health support needs and people living with dementia. Accommodation is provided over five units, each of which has its own lounge and dining area. At the time of the inspection, 71 people were living at the home.

People’s experience of using this service:

Improvements were needed to how staff managed people’s medicines to ensure they received them safely. The provider’s staffing levels were not always achieved, which meant there were not always sufficient staff on duty to meet people’s needs. The manager made improvements to this shortly after our inspection. Staff understood how to protect people from the risk of abuse and how to report any concerns. People felt safe at the home. The provider followed safe processes when recruiting staff to ensure they were suitable to support people living at the home. Staff followed appropriate infection control procedures and we found the home clean. The provider completed regular checks of the home environment to ensure it was safe.

Staff did not always support people in a way which met their needs. Improvements were needed to the environment, to meet the needs of people living with dementia. We have made a recommendation about this. People felt staff had the skills to meet their needs. Staff were happy with the induction they received when they joined the service and received regular supervision. Most staff training was up to date and the manager told us outstanding training would be addressed shortly after the inspection. 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 supported people with their dietary and healthcare needs and contacted community professionals when they needed extra support.

People liked the staff who supported them and told us staff were kind and respectful. Staff considered people’s diversity and respected their right to privacy and dignity. They encouraged people to be as independent as they could be and involved them in decisions about their care. The service provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

Staff did not always document people’s hobbies and interests and there was a lack of activities and entertainment on most units at the home. People’s care documentation was not always personalised, and staff did not always provide care which reflected people’s preferences. People’s care needs were not always reviewed in line with the provider’s timescales and their care documentation was not always updated when their needs changed. Staff supported people to maintain relationships that were important to them and provided them with any support they needed with their communication needs. We have made recommendations about the need for the provider to improve how people's complaints are managed and ensure people's end of life care wishes are considered.

There had been three managers at the home in the previous 12 months and a new manager had started in post three days before the inspection. Management had regularly completed a variety of checks and audits of the service; however, the audits had not been effective in ensuring appropriate levels of safety and quality were maintained at the home. Necessary improvements had not always been made in a timely way and the home had a lengthy action plan in place, which had been developed internally in response to concerns and provider led audits. Staff worked in partnership with a variety of community agencies to ensure people received any additional support they needed. Some people, relatives and staff felt the management of the service needed to be improved.

Rating at last inspection:

At the last inspection the service was rated good (published 2 November 2018).

Why we inspected:

This inspection was prompted, in part, due to a number of safeguarding concerns raised about the home and concerns raised by the local authority. These related to management arrangements, staffing, medicines processes and the culture within the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

Enforcement

We have identified breaches in relation to the management of medicines, staffing, person-centred care and governance. Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan from the provider to understand what they will do to ensure improvements are made to medicines processes, staffing arrangements, person-centred care and governance arrangements. We will monitor the progress of improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

At our last inspection in May 2017 we found three breaches of regulations relating to the way safeguarding concerns were managed and followed up, a lack of regular supervision of staff and ineffective quality monitoring systems. At this inspection we found improvements had been made and the service was now meeting these requirements.

Bamford Grange 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.

Bamford Grange is a nursing care home in the Shaw Heath area of Stockport and can accommodate 79 people. The home is divided into five units each with a communal lounge and dining room. The home has an enclosed garden which is accessible from the on the ground floor.

People told us they felt safe in the home. Regular checks were made on the equipment and premises to ensure they were safe.

Risks to people were assessed and they were supported to do the things they chose in as safe a way as possible.

Sufficient, well trained staff were on duty. The home performed appropriate background checks on people before they were offered employment.

People’s medicines were stored and administered safely. Records relating to the administration of medicines were clearly written and regularly audited.

The home was clean and in a good state of repair. Staff were trained in infection control and during our inspection we observed staff following good infection control practice.

People’s needs were assessed and regularly reviewed to ensure they were receiving support in the way they chose and preferred, including where their culture of beliefs influenced the way they chose to receive support.

Staff were well trained and received regular reminders to keep their training updated. Regular supervisions were held with staff to provide them with support.

People were supported to eat and drink and were not rushed. A choice of meals was available people said they enjoyed the food. Where people required special diets, staff ensured they received appropriate meals.

Where people needed specialist support from other healthcare professions, they were referred promptly and we saw advice given by other professionals was followed by staff.

The home was acting under the principles of the Mental Capacity Act and people were asked for their consent before support was given. Where people lacked the capacity to make decisions for themselves, appropriate processes were in place to identify the person’s best interests.

People told us they felt treated with compassion and respect. We observed friendly, support interactions between staff and people living in the home during our inspection.

People were treated as individuals and were encouraged to be as independent as possible and to do the things they could for themselves. People’s privacy and dignity was respected.

Complaints were investigated thoroughly and where possible were discussed face to face to resolve issues as quickly as possible. People told us they felt able to speak up if they weren’t happy.

Processes were in place to provide care to people as they neared the end of their life if the person wished to continue to be supported in the home.

The home had a registered manager in post. The 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.

People living in the home, their relatives and staff and felt the registered manager had improved the home since they started and had promoted a more open culture.

The registered manager knew their responsibilities well and had a good oversight of the running of the home through a regular presence on the units and technology systems.

Management and staff in the home worked well with other agencies and welcomed their support and feedback.

The home had the report and ratings from the previous inspection on display both in the home and on their website.

We last inspected Bamford Grange Care Home in December 2016 and rated the service overall. We found the service was in breach of one of the regulations. This was in relation to formal staff supervision which had not consistently been taking place.

Prior to this inspection, we received some concerns about the way in which safeguarding matters were managed and the lack of consistent, responsive and proactive management and leadership of the service. Details were provided of incidents and concerns that had taken place since our last inspection of the service. These incidents included lack of timely responses to sharing safeguarding information with the local authority, lack of compliance with the safeguarding policy and lack of follow up on actions taken.

This inspection was to check improvements had been made following the last inspection, to check how the home managed safeguarding concerns, how the home was being led and to review the ratings.

During this inspection we identified one continuing breach and a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Bamford Grange Care Home is purpose built offering accommodation for up to 79 people. The home is set out in five units with all bedrooms being single with en-suite facilities.

The service had a registered manager in place. A registered manager is a person who has been 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.

During our inspection we found the atmosphere in the home to be unsettled with a number of care workers telling us about a divide between the registered manager and deputy manager.

Safeguarding matters were not always managed appropriately or in a timely manner. The local authority had raised a number of concerns and, at the time of the inspection, the matters had still not been satisfactorily resolved. We also found that staff training in safeguarding vulnerable adults had not taken place for all staff, with some staff requiring refresher training.

People living in the home and their relatives who we spoke with, said that they felt safe and well looked after.

Medicines were safely managed.

Some staff personnel files did not contain all the required details including a recent photograph of the person.

At the time of the inspection sufficient numbers of care staff and qualified nursing staff were available to support people and help meet their assessed needs.

Each person using the service had an up-to-date care plan, risk assessment and other associated documentation in place.

All areas of the home seen were found to be clean and tidy and we observed domestic staff carrying out routine daily cleaning duties.

We observed some good interaction communication between staff and people who used the service.

Systems were in place to monitor the quality of service people received. However due to the shortfalls we found during our inspection they require improvements.

The service was last inspected in July 2015 following which the service was rated as ‘requires improvement’. This inspection was carried out to check sufficient improvements had been made to the service.

Bamford Grange Care Home is purpose built offering accommodation for up to 79 people. The home is set out in four units with all bedrooms being single with en-suite facilities.

The service had a registered manager in place. A registered manager is a person who had been 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.

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

Formal staff supervision had not consistently been taking place. Supervision provides staff and their manager the opportunity to discuss staff development and performance and any other issues that staff may want to bring to the attention of their manager and vice versa.

We recommend that the provider takes appropriate action to ensure that quality monitoring systems are used effectively and identifies all areas where shortfalls are found and records all actions taken to resolve those shortfalls, including staff supervision.

Sufficient numbers of appropriately trained care staff and qualified nursing staff were available to support people and help meet their assessed needs.

Medicines were managed safely with those staff with the responsibility for administering medicines in the home receiving appropriate training in this topic.

Each person using the service had an up-to-date care plan, risk assessments and other associated documentation in place.

All areas of the home were found to be clean and tidy and we observed domestic staff carrying out routine daily cleaning duties.

We observed some good interaction and communication between staff and people who used the service.

We saw that the service had a written complaints policy and a procedure which was visible throughout the home.

We considered the evidence collected under this regulation and addressed the following questions, is the service safe and is the service effective?

Is the service safe?

We found that the registered manager and senior staff had taken appropriate steps to assess the needs of people requesting admission to the home. We found that risks to the health, safety and wellbeing of the individuals and others had been adequately assessed and an appropriate care plan had been put in place. This meant that the service provided safe and effective care and took reasonable action to minimise the risks associated with providing a caring service to people.

Is the service effective?

We found that two people who had recently been admitted to the home had an effective care plan in place that supported staff to meet their individual assessed needs.

We considered the evidence collected under this outcome and addressed the following questions, is the service safe and is the service effective?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We found that the home had not taken appropriate steps to assess the needs of a person admitted to the home. Risks to the health, safety and wellbeing of this person and others had not been adequately assessed and an appropriate care plan had not been put in place. This meant that the service did not provide safe and effective care or take reasonable steps to minimise the risks associated with providing this person with a service.

Is the service effective?

We found that a person who had recently been admitted to the home had to be transferred to another provider a short time later. This was because the service did not have an effective plan in place to meet this person's needs, which included staff having the appropriate skills to support this person.

We considered the evidence collected under the outcomes and addressed the following questions: 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. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people were treated with dignity and respect by staff. The people we spoke with who lived at the home or were visiting relatives, told us they had no concerns about people's safety or the care provided. One person told us 'I feel safe', 'it's lovely here', 'staff are very good'.

Following our inspection, we spoke with a GP who regularly visited people living at Bamford Grange Care Home. They told us they had no concerns about the care people received.

Although we found that people's needs were being met by the number of staff on duty, it was acknowledged by the managers who we spoke with, that there was a shortage in the pool of available staff, particularly nursing staff. The provider was in the process of recruiting new staff and also using agency staff where needed to cover shifts. There was some evidence that staffing numbers were having some impact at times on opportunities for staff to engage in activities with people who lived at the home and on staff morale.

Is the service effective?

People's care needs were assessed with them, and where appropriate their families were involved. People's care plans were person centred and generally provided clear guidance for staff in how to deliver people's care. We did find some examples where people's care records were not as complete as they could have been; however there was no indication that people were receiving poor care.

Staff told us they had access to appropriate information to guide them in supporting people and they demonstrated a good understanding of the needs of the people they worked with. The people we spoke with made generally positive comments about the staff and the care they or their relatives living at the home received. One relative told us 'I like the place, I'm impressed with it', 'she's cared for, she is attended to'.

Staff understood the importance of working with the other professionals involved in people's care and their responsibilities in accessing this support, including medical advice and treatment. Staff told us they had a good working relationship with local medical professionals. We also saw that staff were aware of what action to take when people needed medical attention, including in an emergency. Following our inspection, we spoke with a GP who regularly visited people living at Bamford Grange Care Home. They told us that the service made appropriate and timely referrals to them and that staff were aware of peoples' needs, care and treatment and provided a good 'handover' of information. They told us staff were available to assist them on their visits and they felt staff were well organised.

Staff felt that they received the appropriate training they needed to do their job. Staff also told us they felt supported and that the management team were approachable. We saw that staff received regular supervision sessions and annual appraisals.

Is the service caring?

We saw staff treating people with respect and warmth and the care we observed was provided in a sensitive, unhurried, personal way. The people we spoke with made positive comments about the care they or their relative received. A person we spoke with who used the service commented They're [staff] kind and gentle', 'They've helped me a great lot, they've helped me make my room nice'. A visiting relative told us '[Staff are] pleasant and tender when required'.

We were told that before people started using the service, they were encouraged to spend some time visiting the home, where they could enjoy a meal or an overnight stay to experience the environment. This was to help them to settle in.

Is the service responsive?

We saw that reviews of people's care were carried out and people's preferences and preferred routines considered.

Staff were aware of the importance of engaging medical practitioners and other professionals in people's care when required and were proactive in accessing this support to ensure people's changing needs were met.

Is the service well led?

There were effective systems in place to monitor the quality and the safety of the service that people received. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received.

Staff generally felt supported by the management team in place and there lines of accountability and support for staff. Staff showed a clear understanding of the protocols in place which guided their work. There was a complaints procedure in place and the people who used the service we spoke with, and staff, felt able to express their concerns to the management team.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. We focused our inspection on the sections of the home which provided care for people with dementia.

We found that the home had a relaxed, sociable and welcoming atmosphere. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were happy and content and we saw that they were treated with respect and enjoyed good relationships with staff.

We looked at the personal care files for four of the people who lived at the home and saw that improvements had been made in the way care plans were written. Records showed that each person's health and wellbeing was monitored closely and where appropriate staff had sought medical attention or advice and guidance from the person's health and social care professionals.

We found that improvements had been made in all outcomes areas and we observed staff carrying out their work with care, sensitivity and skill.

We carried out a follow up inspection on the 19 June 2013 and although we found some improvements had been made we could see that further action was required to protect the health, safety and welfare of people using the service.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. We focused our inspection on the sections of the home which provided care for people with dementia. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were treated with respect and were content with arrangements made for their care and support.

We found that improvements had been made in all outcomes areas inspected and we observed examples of individual staff carrying out their work with care, sensitivity and skill. However further improvements were needed on care and well fare, nutrition, quality monitoring and records to ensure all people living at the home received safe and appropriate care that met their needs and respected their rights.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. We focused our inspection on the sections of the home which provided care for people with dementia. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were treated with respect and were content with arrangements made for their care and support.

Visiting family members told us that they had seen some improvements but some family members told us that they remained concerned for the care and welfare of their relatives. They told us that staffing levels were still inadequate so there were times when their relatives lacked stimulation and their health and social care needs were not always met.

We observed examples of individual staff carrying out their work with care, sensitivity and skill but we found that the warning notices were not met in full so people remained at risk of receiving unsafe and inappropriate care.

We focused our inspection on the sections of the home which provided care for people with dementia. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were treated with respect and were content with arrangements made for their care and support, although one person told us that there was nothing to do.

Visiting family members told us that they had concerns about the standard of care provided and lacked confidence in the ability of the management team to address deficiencies in the planning and delivery of care. They told us that they had made complaints to managers but they had not been listened to so corrective action had not been taken and poor care was allowed to continue.

We found that improvements were needed to protect people from inappropriate or unsafe care, in six of the seven outcome areas we inspected including care and welfare, meeting nutritional needs, staffing, assessing and monitoring the quality of service provision, quality assurance complaints and record keeping.

We found that the home had a relaxed, sociable and welcoming atmosphere. We could see that the people were treated with respect and enjoyed good relationships with staff. However, there was a short period of time during the early afternoon when there was an inadequate number of staff on duty to offer people activities and the level of support they needed to take part in them.

People told us that they felt safe. We found that people were protected from abuse by robust safeguarding procedures which were effectively implemented.

We looked at the care records for a number of the people who used the service and could see that arrangements made for their care and support were centred on their individual needs and personal preferences. We found that there were areas where improvements were needed. These included assessment, care planning, staffing and records.