Hilltop Hall Nursing Home

Hilltop Hall Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older people. At the time of our inspection there were 38 people using the service. The care home accommodates people in one adapted building across 3 floors.

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

People were not always supported safely to receive their medicines. People were not always supported appropriately with their needs and action to mitigate individual risk was not always taken. Shortfalls in recruitment processes had not been fully addressed and systems to safely manage the use of agency staff were not being followed. People did not always feel there were enough staff to meet their needs.

The provider did not have enough oversight to ensure the shortfalls identified at previous inspections, and through their owns system of checks, were effectively addressed. Many of the issues identified at this inspection were identified and referenced within actions plans but the required action had not yet been made. The service had not had a registered manager in post for some time and there had been a high turnover of managers. The providers interim arrangements for oversight between management changes had been insufficient to drive the required improvement. Systems were in place to investigate concerns and respond under the duty of candour and staff worked in partnership with external services to meet people’s needs.

The home was generally clean and a plan to address environmental issues and improve infection control was in place. There were systems to ensure lessons were learnt from accidents and incidents but lack of detail and consistency in record keeping meant meaningful analysis was not always possible.

People were not suitably supported to eat and drink well and people with specialist dietary needs did not get choice. People told us the food provided was often cold. People did not always receive care in line with their individual needs. Care records were not always clear, accurate or detailed and did not always readily identify people’s needs and risk.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not effective to ensure good practice. The service was not working within the principles of the mental capacity act and people were not always asked for consent before they were supported. Staff were not consistently supported through regular training and appraisals and training requirements were not in line with best practice guidance. Staff worked with other agencies to meet people’s needs and appropriate referrals for specialist advice.

People and relatives generally felt able to raise concerns and there was evidence that these were investigated. People spoke highly about the activity team and were supported to access a range of activities both in groups and on a one to one basis.

People did not always feel staff were kind and caring and interactions observed during inspection ranged from positive chats from staff who knew people well to interactions where people did not receive the support or reassurance they needed. It was not always clear that people were supported to make decisions about their care and choice was not always promoted.

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 13 July 2023). 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 regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Hilltop Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, risk management, how the service ensured the need for consent to care was followed, person centred care, how people were supported to eat and drink, staffing levels, staff training and induction and the providers oversight of the safety and quality of the care provided.

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Hilltop Hall Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older people. At the time of our inspection there were 43 people using the service. The care home accommodates people in one adapted building across 3 floors.

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

There had been a lack of stability of management since our last inspection which had impacted on how effectively change and improvements had been progressed. Audits and checks were being completed although these were not always robust and had not identified and resolved some of the issues we found during the inspection. Where shortfalls had been identified and action taken, these were not always followed up to ensure they became embedded into practice. A service improvement plan was in place, and this was being progressed prior to, and during the inspection.

Medicines were not always safely managed and suitably robust assessments of staff competency in this area was not always in place. There were generally enough staff to meet people’s needs, but they were not always suitably deployed within the service. Records did not always demonstrate a robust recruitment process had been followed. Shortfalls in the environment had been identified and work was ongoing as part of a service improvement plan. The home was generally clean, and people felt safe. We found some improvements were needed to the recording and management of risk.

Staff completed a variety of training but further work to ensure staff on shift had the relevant knowledge, skills and competency was needed. Assessments were in place, but these were not always accurate, and records did not always demonstrate that the appropriate levels of care were being given. Work to improve the mealtime experience was being undertaken at the time of inspection and these improvements needed to be completed and embedded.

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 although records needed to be more robust in demonstrating how the service was working within the principles of the Mental Capacity Act.

The provider was making progress in providing personalised care and although care plans had improved, further work was needed and currently being completed to ensure these were personalised to include people’s wishes and preferences. Activities were available for people, but the records did not always demonstrate how people were supported fully to engage in their hobbies and interests. People and families felt able to raise concerns, but feedback from staff about this was mixed. Care plans were in place to support people who may require care at the end of life, but these needed to be personalised.

Staff were kind and caring and were seen to promote people’s independence and dignity as much as possible. People felt involved in making decisions about their care although records did not always reflect this.

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 29 June 2022). 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 requires improvement and in breach of regulations. The service has been rated requires improvement for the past three 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.

Enforcement and Recommendations

We have identified breaches in relation to how people’s medicines were managed; the need for further improvements to ensure people received care and support that was individualised, appropriate and met people’s needs; and the oversight of the service to drive improvements and ensure robust record keeping at this inspection.

At our last inspection we recommended that the provider refers to current guidance to prioritise meaningful individual activities for people cared for in bed. At this inspection we found some changes had been made but further improvements were needed.

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

About the service

Hilltop Hall Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older people. At the time of our inspection there were 40 people using the service. The care home accommodates people in one adapted building across 3 floors.

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

People were not always involved in planning their own care. Care plans did not always contain personal information to enable them to provide individualised care. There was an activity provision; however, people did not always receive meaningful interactions. We have made a further recommendation about people cared for in their room receiving meaningful activities that promotes their wellbeing.

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.

Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always actioned the concerns we found on inspection. We identified a repeated breach and a new breach of regulations. People’s care plans were not always accurate and reflective of people’s current care needs. The management team were helpful and quick to investigate and provide assurances when we fed back our findings during and after the inspection. Staff were complimentary about the manager and people gave positive feedback about the care provided by staff.

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 18 March 2021) and there was a breach of regulations. 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 regulations.

At our last inspection we recommended that the provider referred to current best practice to prioritise meaningful interaction for people cared for in bed. At this inspection we found further work was needed to develop this approach.

The service remains rated requires improvement. This service has been rated requires improvement for the last two 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.

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 remained requires improvement based on the findings of this inspection.

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

The provider was transparent and responsive throughout the inspection and took action to attempt to mitigate the risks we identified.

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

Enforcement

We have identified breaches in relation to person-centred care and governance of the service.

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 improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hilltop Hall Nursing Home is a residential care home providing personal and nursing care to 45 people at the time of the inspection. The service can support up to 54 people and is close to Stockport town centre.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were supported appropriately with their health needs. People were not always supported with the personal care as specified in their care plans. We have made a recommendation about activities for people cared for in bed.

The home was short staffed on the day of the inspection. The registered manager told us that this was an isolated incident and there were usually enough staff to meet people’s needs. Staff told us there were often not enough staff to meet people’s needs. We have made a recommendation about staffing.

We were assured that infection control practice at Hilltop Hall Nursing Home was in line with best practice guidance. Staff were wearing appropriate PPE and the home was clean.

Complaints had been dealt with in line with the home’s complaints policy with the exception of one complaint that was ongoing.

People told us they were supported to have contact with relatives during the pandemic. Relatives told us that other communication from the management team was minimal and it was difficult to get through on the telephone.

The provider has made assurances about improvements that they plan to make immediately at the home.

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

Rating at last inspection

The last rating for this service was Good (published 28 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and the management of complaints. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of responsive 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 coronavirus and other infection outbreaks effectively.

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 and 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 a breach in relation person-centred care at this inspection.

We have found evidence that the provider needs to make improvements. Please see the 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.

The overall rating for the service has changed from good to requires improvement. 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 Hilltop Hall Nursing Home on our website at www.cqc.org.uk.

Follow up

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

We will request an action plan for the provider to understand what they will do 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.

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

We last carried out a comprehensive inspection on 31 August and 1 September 2016. At this inspection we found the service to be in breach of the regulations relating to the management of medicines, recruitment practices, arrangements for the assessment of nursing residents prior to admission, the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS), staff training and quality assurance.

We returned to the service to carry out a focussed follow up inspection on 25 April 2017. Although we saw improvements had been made to arrangements for the assessment of residents in need of nursing care prior to admission, the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS) and staff training there were continuing breaches of medicines management, recruitment procedures and the management of the service. There was no registered manager in place at either of the above inspections and we were also concerned about the levels of agency staff being used at the home. The overall rating of the service was requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe and well led to at least good. At this inspection, we found that improvements had been made in all areas and plans were in place to make further improvements.

Hilltop Hall Nursing Home is situated close to Stockport town centre. The home provides nursing and personal care for up to 54 people. At the time of our inspection, 46 people were living at the home.

People who used the service had a diverse and wide age range of nursing and personal care needs. These included older people with age related health conditions, younger people with physical needs such as amputations and Multiple Sclerosis as well younger people who had a learning disability and/or mental health needs that may be challenging to others.

The service had a registered manager in place. The manager was registered with us on 17 August 2017 and had worked at the service since April 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present during most of this inspection.

At this inspection, we found that improvements had been made in relation to safe management of medicines and recruitment procedures. The numbers of agency staff being used by the service had significantly reduced.

The registered manager and deputy manager with support from the quality manager were more effectively managing the day-to-day operations of the service. The management team’s priority had been to reduce the use of agency staff and build a strong confident staff team to help provide consistent and safe care to people.

Staff had received training in safeguarding adults. Staff were confident that action would be taken by managers if they reported any abuse they witnessed or suspected.

Risk assessments were in place in relation to the environment and for people who used the service.

We found the home to be clean and tidy throughout and systems were in place to help control and protect people from infection.

The premises were spacious, well maintained and furnished to a good standard.

People gave mixed responses about the food provided. Plans were in place to improve the menu. We saw that people were offered a choice of food and were encouraged by staff to eat as much as possible.

People had access to a wide range of healthcare professionals who understood their needs.

The atmosphere at the home was relaxed and calm. Interactions between people who used the service and staff were seen to be warm, frequent and friendly.

Improvements had been made to people’s care records; however records were still being closely monitored by managers in line with quality assurance procedures. This was to ensure consistency and good practice was being sustained.

We saw that there were activities for people to join in. We were told that there were plans in place to further improve activities to include people going to activities outside the home and for people with dementia.

The service had a complaints policy and procedure in place.

The service had a manager in place who was registered with us and a deputy manager who were working hard to make improvements at the home. Staff spoke positively about working at the home.

At our last inspection on 31 August and 1 September 2016, we found six breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person centred care, need for consent, fit and proper persons employed, staffing and good governance.

Following the inspection the provider sent us a plan of the actions they intended to carry out to become compliant with the relevant regulations. This inspection was carried out to check that the provider had met the breaches in the regulations. This report only covers our findings in relation to this topic. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for ‘Hilltop Hall Nursing Home’ on our website at www.cqc.org.uk.

Hilltop Hall is a care home situated close to Stockport town centre. The home is on a main bus route with a bus stop outside. There is ample parking for visitors' cars.

The home provides nursing and personal care for up to 54 people. At the time of our inspection, 48 people were living at the home. People who used the service had a wide range of needs, which included older people and some people who had a learning disability and mental health needs.

The service continued not to have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Because there is no registered manager, we automatically limit the rating of the well led section of this report to requires improvement. Following our inspection we were formally notified that the acting manager had left the service and the operations support manager was to register with us as the manager of the service.

At our last inspection we found six breaches in the Regulations relating to the management of medicines, recruitment practices, arrangements for the assessment of nursing residents prior to admission, the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS), staff training and quality assurance.

At this inspection, we found that a number of improvements had been made, however the home remained in breach of three of the regulations in relation to the management of medicines, recruitment practices and quality assurance.

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

We also found that the following improvements had been made.

The deputy manager who was a qualified nurse was now undertaking pre-admission nursing assessments for people moving into the home.

We saw that applications for deprivation of liberty safeguards (DoLS) were being sent to the local authority DoLS team for consideration for authorisation. There was some evidence that the service was chasing the local authorities concerned for authorisation, however further work could be done to improve the recording system.

We saw that improvement had been made in the numbers of staff completing basic training.

The nurses were receiving clinical supervision from the deputy manager who was a qualified Registered General Nurse (RGN) and Registered Mental health Nurse (RMN). More recently care staff had started to receive more regular supervision.

Hilltop Hall is a care home situated close to Stockport town centre. The home is on a main bus route with a bus stop outside. There is ample parking for visitors' cars.

The home provides nursing and personal care for up to 54 people. At the time of our inspection, 28 people were living at the home. People who used the service had a wide range of needs, which included older people and some people who had a learning disability and mental health needs.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found six breaches in the Regulations relating to the management of medicines, recruitment practices, arrangements for the assessment of nursing residents prior to admission, the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS), staff training and quality assurance.

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

Medicines were not always managed safely. This was because the administration of medicines was not always as prescribed. We also checked controlled drugs within the service. We found the cupboard used to store them did not comply with the law

Recruitment processes and systems in place within the service were not robust enough to ensure vulnerable people were protected against the risk of unsuitable people working within the service.

The acting manager, who was not suitably qualified to undertake the task, was carrying out assessments undertaken prior to admission for people who required nursing care.

We were concerned that the service had only started to make applications for the authorisation of the deprivation of liberty to the local authority in February 2016. We were told that 12 applications had been made but none had been authorised by the local authority. Records relating to the submission of DoLS applications were seen to be incomplete so we could not be sure how many or when the applications had been made.

Although staff told us that they received regular basic training from the service the records we saw did not support this. We saw that staff had not received regular supervision, which included the clinical supervision of all the nursing staff team.

The home had numerous quality assurance systems in place that showed areas were improvements were needed which in some cases remained outstanding. Not all the shortfalls we found had been identified in the services quality assurance systems particularly medication and recruitment.

Staff we spoke with us told us that they had received training and understood their reporting responsibilities in relation to safeguarding and whistleblowing on the poor practice of colleagues. Staff told us they were confident that action would be taken by the provider should they raise any concerns. We saw that in relation to a recent incident that this was the case.

Risk assessments were in place in relation to the environment and for people who used the service.

We found the home to be clean and tidy throughout and systems were in place to help control and protect people from infection. The premises were spacious, well maintained and furnished to a good standard. Plans were in place to undertake decoration in some communal areas of the home.

People gave mixed responses to the food provided. We saw that people were offered a choice of food and encouraged to eat as much as possible.

People had access to healthcare professionals.

The atmosphere at the home was relaxed and the atmosphere was calm. Interactions between people who used the service and staff were seen to be warm, frequent and friendly.

Improvements were being made in relation to people’s care records.

We saw that there were activities for people to join in. We were told that there were plans in place to further improve activities to include people going to activities outside the home.

The service had a complaints policy and procedure in place.

Due to a safeguarding allegation currently still under investigation the provider had put in place 24 hour management cover. This will continue until the investigation is concluded.

Is the service safe?

We saw that people were treated with respect and dignity by the staff. People we spoke with and some of the visitors to the home told us staff respected their privacy and dignity and supported them in a way that suited their individual needs and personal preferences.

The environment was clean, tidy and systems were in place to prevent, detect and control the spread of infections.

For the areas we looked at during this inspection visit we saw that staff had received appropriate training to ensure they had the knowledge, skills and experience to meet the assessed needs of people living at the home. This meant that people living at Hilltop Hall Nursing Home could be confident that their needs were being met by fully trained staff.

Systems were in place to make sure that managers and staff learned from events such as incidents, complaints, and safeguarding events. This reduced the risks to people and helped the service to continually improve.

We saw that policies and procedures were in place to support staff in delivering safe and effective care.

Management systems were in place to monitor and audit aspects of practice such as checks on care plans, medication audits, falls, hospital admissions, infection control and safeguarding people.

During our inspection visit we looked at the premises which were fit for purpose and we saw there were protocols in place to manage the ongoing maintenance of the home.

Is the service effective?

People living at Hilltop Hall Nursing Home had a care file that included assessments of their individual needs and risks. The care plan had been developed to meet those assessed needs. The assessments and care plans were reviewed on a monthly basis and updated accordingly.

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Prior to people being admitted into the home, where possible, a member of staff visited the person to carry out an assessment of their needs. This meant that people could feel confident that the service could meet their individual and personal care needs when they moved into the home. Where possible people could spend some time at the home having lunch and meeting staff and other people living at the home before a decision was made about moving in. We were told that relatives were encouraged to call in and look around the home at any time without having to make an appointment.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and preferences. We saw that staff were kind and sensitive in their approach to people and responded promptly to peoples requests or need for assistance.

We observed that people looked well cared for and were appropriately dressed.

Staff spoken with were all positive regarding the care that was delivered. Some comments included: 'It's a fantastic atmosphere here,' 'I would be quite happy to come here,' 'It's so lovely here' and 'We have a great staff team, the staff here are lovely and kind.'

Some of the comments we received from people living at the home were: 'I have everything I need,' 'I like having my hair and nails done' and 'The girls here are nice people.'

Visitors spoken with confirmed they were always welcomed by accommodating, friendly and supportive staff. One visitor said 'I can't say anything bad about this home.'

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example, we saw evidence of visits from the GP, the district nurse, the chiropodist, the optician and the speech and language therapist. This meant that people using the service received co-ordinated care and support.

The service had systems in place to ensure that people were regularly consulted about their views and ideas on how the home should be run. This was done by means of regular informal chats with people and satisfaction surveys. We saw evidence of these surveys being carried out on a regular basis, following which an analysis of the findings would be undertaken by the directors and an action plan would be implemented if appropriate.

Is the service well led?

The service worked well with other services to make sure people living in the home received appropriate care and assessment from the right professionals in a timely way.

When we looked at documentation we saw that there were good systems in place to audit and monitor care practices in the home. These actions helped to ensure that people received a good quality of service at all times.

When we spoke with staff they spoke highly of the support they received from the manager and the senior staff. They told us they received regular supervision and training. They also told us they had regular staff meetings and if they had any problem they would go straight to the home manager who was always available and approachable.

We found that some improvements had been made. We saw that people were receiving regular health monitoring. We spoke with four members of staff who were able to describe the care that people needed and the audit systems that were in place to ensure that this was carried out. We also spoke with four people who lived at the home. They expressed no concerns and were complimentary of the staff.

Following the inspection we spoke with two relatives. We also spoke with the registered manager, who was not present on the day of the inspection.

We looked at the home's care documentation and saw that some improvements had been made within the records that the home used.

During out visit we spoke with a director of the service, the registered manager and members of staff.

We spoke with three family members who used the service. They all told us that the home involved them in their relatives care and they were regularly consulted.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We also spoke with six people who lived in the home and all told us they thought that the home was good.

We looked at a selection of care records. We noted in two records that there was a lack of health monitoring to ensure that people's needs were being assessed and care planned appropriately.

We found although the service had some quality assurance systems in place, some were being developed.

We viewed training records and found that there was training provided to enable people to deliver safe and effective care.

We found the lack of consistent recording systems means that there is a risk that information may not be kept up to date and people are not protected against the risks of unsafe or inappropriate care and treatment.