Cherry Tree Lodge

Cherry Tree Lodge provides accommodation and personal care for up to 72 people, some who are living with dementia and some who are very frail and have physical support needs. The service consists of 4 separate units over 2 floors. There were 53 people living in the home on the day of our inspection visit.

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

Since our last inspection the provider had appointed a new management team who were committed to improving standards of care at Cherry Tree Lodge. Action had been taken to ensure audit systems operated effectively and the provider's policies and procedures were being followed. Where audits and quality assurance checks had identified improvements were needed, these had been incorporated into a home development plan which was monitored by the provider.

Staff had received further training so they could be more effective in responding to risk and had increased confidence to challenge poor practice. Staff told us managers were visible in the home and they felt able to raise concerns and make suggestions knowing they would be listened to. Relatives spoke of improved communication within the service and how changes implemented had resulted in positive outcomes for people.

There were enough staff to keep people safe and deliver support in accordance with people’s care plans. Staff understood their role in keeping people safe and safeguarding concerns had been reported to the local safeguarding team for external investigation. Risks to people's health and well-being had been identified and care plans contained guidance for staff on how to mitigate those risks. People received their medicines as prescribed.

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 encouraged people to engage in group activities they enjoyed, and community events were planned to enable people, relatives and friends to enjoy time together. Initiatives were being implemented to enable staff to spend more time with people, but these were not fully embedded within the home.

Managers understood their responsibilities under the duty of candour and relatives confirmed they were informed when things went wrong. Learning was shared with the staff team and there was a proactive approach to supporting staff practice when it fell below expected standards.

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 16 December 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We previously carried out a targeted inspection of this service on 15 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding and the good governance of the service.

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

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Tree Lodge on our website at www.cqc.org.uk.

Follow up

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

Cherry Tree Lodge provides accommodation and personal care for up to 72 people, some who are living with dementia and some who are very frail and have physical support needs. The service consists of four separate units over two floors. There were 63 people living in the home on the day of our inspection visit.

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

People did not consistently receive safe care. Risks associated with people's care were not always identified, managed or mitigated. Systems and processes to protect people from the risks of harm or abuse were not always effective.

The provider’s systems were not robust enough to ensure action was taken in response to risk. Senior staff did not always have the competence or confidence to carry out the responsibilities of their role effectively.

Some improvements were identified in infection control practices to ensure they always reflected the most up to date guidance.

The provider has produced an action plan with tight timescales and managerial oversight to improve standards and practice at the home.

Rating at last inspection

The last rating for this service was requires improvement (13 September 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service sustained serious harm. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about risk management within the service and the recording and reporting of accidents and incidents to ensure people were safeguarded from the risks of abuse. This targeted inspection examined 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 COVID-19 and other infection outbreaks effectively.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Therefore, the overall rating for the home remains requires improvement.

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

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 identified breaches in relation to the risks associated with people's care to ensure they were safeguarded from the risk of harm, and in the management of the service.

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

Follow up

We requested an action plan from the provider to understand what they will do to immediately 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.

Cherry Tree Lodge provides accommodation and personal care for up to 72 people, some who are living with dementia and some who are very frail and have physical support needs. The service consists of four separate units over two floors. There were 46 people living in the home on the day of our inspection visit.

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

The provider had appointed a new management team since our last inspection visit who had worked hard to make changes and drive forward improvements. A service improvement plan (SIP) was under constant review and further improvements were planned to take place. However, the improvements needed to be embedded into the culture of the home and after a period of managerial changes, staff needed to be confident in the stability of the new management team.

The management of risk in the home had improved because staff had a better understanding of how to complete risk assessment tools. Overall, plans were in place to inform staff how to manage identified risks. However, some health risks had not been planned for and records did not always reflect reduction measures were being effectively followed.

There were enough staff on duty to meet people's needs. Whilst concerns were shared about a recent reduction in staff numbers, managers were confident staffing levels were safe because people’s risks and healthcare needs had been effectively assessed. Staff had received training and support, so they were more confident in their abilities to provide safe and effective care. Staff understood their responsibilities to protect people from abuse or discrimination.

Relationships with other healthcare professionals who had contact with the service had improved, which helped support people’s health and wellbeing. People received their medicines as prescribed and mealtime experiences had improved to encourage people to eat and drink well.

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.

The provider had acted to improve staff morale and to give staff time to be caring and compassionate towards those in their care. Work was underway to ensure people had opportunities to engage in activities and occupation that was meaningful to them and prevent people becoming socially isolated.

People were supported by staff to maintain their personal lifestyle choices.

People, staff, relatives and visiting healthcare professionals spoke of a more open management team who were responsive to any issues or concerns. The manager understood their regulatory responsibilities and had informed us of significant events at the service since taking on the management role.

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 inadequate (published 21 March 2019).

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People's experience of using this service:

•Systems to identify people's individual safety risks and to promote people's safety were inadequate.

•Good governance of the service had not been maintained because too often there had been inconsistency in the management team which meant there was a lack of responsibility to identify the shortfalls we found, including risks to people's safety and welfare.

•The provider's quality assurance systems were not effective in identifying, responding and maintaining a good standard of service that people deserved.

•No or limited action had been taken when quality assurance checks identified people could be exposed to unnecessary risk, such as potential skin damage because risk assessment tools were not being completed accurately or staff were not recording care interventions to manage identified risks.

•There were not enough sufficiently-skilled, senior staff to review everyone’s risk assessments to ensure effective preventative measures were in place for people.

•Staff had not had the training or support they needed to assist them in accurately identify emerging risks so support could be sought from community healthcare professionals.

•Community healthcare professionals raised concerns about the timeliness of referrals and the accuracy of the information they were given when a referral was made.

•On the first day of our inspection visit there were not enough staff with the appropriate skills, experience and knowledge of people’s individual needs to provide safe and effective care. Staff were not always available in communal areas so people could get assistance when needed. On the second day, staffing numbers had increased but there was still a reliance on agency or very new senior staff.

•Overall, people received their medicines as prescribed but improvements were required in the management of prescribed medicines applied directly to people’s skin.

•People’s dietary needs, preferences, likes and any allergies, were assessed and recorded when they moved into the home. However, people on modified diets did not always get a choice of what they wanted to eat and there was a lack of fortified snacks for those people identified as being at risk of losing weight.

•Improvements were needed to ensure people were supported to enjoy a wider range of activities on the individual units which reflected their interests, and enhanced their lives.

•Overall staff worked within the principles of the MCA in their interactions with people.

•Most staff were caring in their approach, but the main interaction with people was focussed on when they offered support or completed a care task.

•People's privacy and dignity was not always upheld.

•Improvements were required in the oversight and management of staff’s practice to ensure people received a quality service.

Following our inspection, we notified relevant stakeholders such as the Local Authority Quality Team about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2014 - Person centred-care

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing

Rating at last inspection: Requires Improvement. The last report for Cherry Tree Loge was published on 6 March 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The provider had failed to improve on the previous ‘requires improvement’ rating and the quality and safety of the service had declined further. At this inspection the rating is now Inadequate overall.

Enforcement: Please see the ‘action we have told provider to take’ section towards the end of the report. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor progress made against the provider's action plan and any regulatory action as an outcome of this full inspection report.

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.

At the last comprehensive inspection on 6 December 2016, the service was rated as ‘Good’ overall, but we found a breach of Regulation 17, good governance under Well led. We completed a follow up inspection in June 2017 to review the area of Well Led and found sufficient improvements had been made, so the provider was no longer in breach, but the rating remained ‘Requires Improvement’ in Well Led. This was because there was no registered manager in post and audit systems still required improvement.

This inspection visit was a comprehensive inspection and we checked to make sure improvements had been made in Well Led to a least ‘Good’. Whilst some improvements had been made, we found some improvements were still needed in audit systems because the provider had not identified some of the improvements we found, and there continued to be no registered manager.

A requirement of the service’s registration is that they have 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was no registered manager in post. The last registered manager left the service in March 2017. Since then, two managers have managed this service but had not registered with us and have since left this service. A new manager was appointed to the home in December 2017 and was in the process of applying to become the registered manager at the home.

The Lawns is a care home registered to provide care to 76 people. People in care homes receive accommodation and nursing and/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. At the time of our inspection visit, 59 people lived at the home on 4 January 2018 and when we returned on 11 January 2018, 58 people lived at the home. Some people at the home were living with dementia. People are supported across two floors and both floors support people living with dementia.

People told us they felt safe at the home, because they felt safe with the staff who supported them. However, since June 2017 some people’s personal, valuable and sentimental items had gone missing. Police and safeguarding had been involved regarding the potential thefts but we could not be confident the provider had taken necessary steps to protect people from financial and emotional abuse.

The provider used recognised risk assessment tools to identify any risks to people’s health and wellbeing. Staff knew how to support people to reduce identified risks to people. However, further checks were needed to ensure people’s records provided staff with the necessary information to keep people safe, especially when people’s needs or behaviours changed.

People told us their needs were met because they were supported and cared for when needed. People were complimentary of the staff and said staff were kind, caring and considerate in their approach. People spoke positively about the friendliness and willingness of staff to help them.

People told us they had a choice of meals and could eat in the dining room or their own bedroom, according to their individual preference.

People’s privacy and dignity was respected and staff knew how to maintain this to prevent people feeling uncomfortable. Staff promoted people’s choices and independence which gave people a sense of worth and ownership in how their care was delivered.

The home was clean, free of odour and staff wore personal protective equipment (PPE) at the necessary times. Regular monitoring ensured standards of cleanliness were maintained and from our observations of staff, they followed good infection control methods.

People told us they would raise any concerns or complaints and they knew how to do this and the expected timescales regarding a response. People and staff felt the newly appointed manager meant they had increased confidence if they raised a concern, they would be listened to and action taken, although some people and relatives were still getting to know the new manager.

There were enough trained and skilled staff who were available to provide people’s care and support at times people preferred.

Medicines were administered safely and people received their medicines as prescribed. Time critical medicines were given at the required times, instructions ensured staff provided medicines ‘as and when required’ safely.

At this inspection we found some improvements had been made to the provider’s systems of checks and governance. Systems and processes had been introduced by the newly appointed manager to monitor the quality of the service. However, these improvements needed to become embedded in every day practice to be consistently effective.

The manager told us they were committed to improve the service and wanted people’s experiences to be positive and to have confidence in them. The manager gave us a commitment that actions would be taken swiftly to give consistency to the service. Recent improvements had been made, including closer working and improved relationships with other healthcare professionals and looking at ways to introduce the local community into the home.

A previous manager had submitted a Provider Information return (PIR) to us, the new manager and the provider understood their legal responsibility to notify of us of important and serious incidents. The provider displayed a copy of their previous inspection rating.

There was a breach of one of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Lawns on our website at www.cqc.org.uk.

At our previous inspection in December 2016, we gave the home a rating of 'Good’. However, we

found the provider was in breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s quality assurance systems and management of the home was not effective in identifying and implementing improvements. Constant managerial changes has had a destabilising effect on driving and sustaining improvements. At this inspection, we found some improvements had been made. This meant the provider was no longer in breach of the regulation although further improvements were still required to ensure the governance of the home supported a good quality and well managed service.

The overall rating of Good, which was awarded following the CQC's previous inspection of 1 and 6 December 2016, was not correctly displayed. We discussed this with the manager and regional care director who displayed the correct rating poster whilst we were in the home.

The home is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. At the time of this inspection the home did not have a registered manager in post. A manager had been appointed in April 2017 and was in the process of registering with us.

Some staff said the number of managerial changes ‘were tiring’ and felt changes were made because it was another manager, rather than for the good of the service. Staff felt the previous manager was not supportive and said they did not feel comfortable raising suggestions or giving feedback. This time, staff were complimentary about the new manager and said the team was becoming more cohesive, but they wanted a period of stability for the people using the service and for them. The manager said recent changes in staff personnel had taken place and those changes meant staff morale had improved which was supported by what the regional care director told us.

Improvements to the quality assurance systems were being made but when checks were delegated to others, there was no effective system to follow up on these improvements. We found some checks were being made without understanding and questioning, if they were required. The regional care director agreed to relook at their quality assurance processes and focus more closely on how their audits increasing the quality of service provided.

The Lawns is a residential home which provides care to older people including some people who are living with dementia. The Lawns s registered to provide care for up to 76 people. At the time of our inspection there were 54 people living at the home.

This home was last inspected in December 2015 and was rated as ‘requires improvement’. We found a breach of the regulations relating to the governance of the home. At this inspection we found improvements had been made, although we found some improvements where still required in the management and governance within the home. The provider had not always followed their action plan to ensure improvement actions were taken and sustained.

A lack of consistent management of the home, meant some of the quality assurance systems were not thorough or regularly checked. When some monitoring or management checks were delegated to others, improvements did not show what action, if any, had been taken to improve the delivery of service. We could not be confident statutory notifications involving serious incidents and safeguarding concerns had been sent to us.

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 and associated Regulations about how the service is run.

People and relatives were complimentary about the care and support they received. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were supported to make their own decisions where possible and care was given in line with their expressed wishes.

Care plans contained accurate and relevant information for staff to help them provide the individual care people needed, although some care information required updating, such as people’s assessed dependencies which determined the levels of care needed.

People’s care and support was provided by a staff team who were knowledgeable, trained and knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at The Lawns and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. However, we found two examples of potential safeguarding incidents that the provider had not reported to the relevant authorities.

Potential risks were considered positively so that people did things they enjoyed. People were encouraged to maintain relationships and kept in touch with those people who were important to them.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

There were enough staff to support people and the permanent staff team were being supported by high agency staff hours whilst the provider continued to recruit to fill all vacancies. The senior management and registered manager needed to better understand what tasks staff did, to help ensure people continued to receive a prompt and effective service.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

Some people were supported to pursue various hobbies and leisure activities but others felt staff did not always spend time with them to do the things they enjoyed.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the provider, registered manager and staff were available and approachable.

We found a 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 the report.

We set compliance actions in relation to care and welfare and staffing. We received a report from the area manager that told us what they intended to do to achieve compliance.

We followed up on these areas of non compliance by undertaking an inspection on 23 September 2014.This inspection was completed by two inspectors over one day. During our visit we spoke with seven people who lived in the home and three visiting relatives. We also spoke with the area manager, acting deputy manager and the care staff on duty. We also looked at seven sets of care records for people and other records as appropriate. The evidence we collected helped us to answer the key question five key questions; is the service safe, effective, caring, responsive and well led?

We found that the areas of non compliance identified at the previous inspection with regards to care and welfare had been met but the service remained non compliant in staffing. We also found non compliance with medicines at this visit.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People and relatives we spoke with told us they were happy with the care and support they or their family member received. We were told, "I like it here, I'm well looked after" and " Mum's care is good, it's nice to be able to see things getting better."

We identified concerns around a lack of clear protocols for staff to follow for medicines prescribed on an 'as and when' basis and an inaccurate record of 'as and when' medicines in stock.

Is the service effective?

We saw care records for people had been reviewed and were being regularly evaluated following our visit in May 2014. We noted a couple of concerns with care plans and staff awareness in one suite which we raised with the area manager.

Is the service responsive?

People's medicines were generally managed safely for them. We found concerns with some people not being able to take their prescribed medicines when they wanted them. For example, we were told, "There is one medicine I take that I need to have early in the morning. I need to take it early in the day so that the effects wear off. If I don't do this, it really affects the rest of my day and I can't do the things I want to do. I have asked the staff to give me the medicine at 07.00 but it doesn't always happen.'

The information we received from the provider regarding staffing levels in the home told us that the levels of staff were determined by a dependency tool used by the provider and were appropriate to meet the needs of the people. Our findings during this visit demonstrated that whilst some people felt there were enough staff to meet their needs, this was not always the experience for other people. For example people told us they had to wait for long periods of time when they required support or assistance. One person told us, "I have had to wait an unreasonable amount of time when I have called for staff to support me."

Is the service well led?

The area manager and acting deputy manager took on board to the concerns raised and assured us that they would follow up and investigate issues as necessary.

Shortly before our inspection another home in the local area owned by the provider closed for redevelopment. All of the residents and staff from this service moved as a group in to the extension that has just been built at The Lawns. This increased the number of people the Lawns could accommodate 35 from to 76.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

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

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. The records we read showed that the home was cleaned daily. We found the environment smart and tidy with no unpleasant odours. The people we spoke with told us they felt safe in the home. One of the people told us, 'It has a nice, new look, it's always clean.'

There were not enough staff on duty to meet the needs of the people living at the home and keep them safe.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing, first aid training for staff, regular fire drills and a call alarm that people could use to call for assistance.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

Some people told us they were happy with the care they received and felt their identified needs were being met. One of the people we spoke with said, 'They provide everything I need.' Other people were not satisfied with the care they received. One person told us, 'We are very disappointed because we are not doing what we did at XXXX (previous merged service)'

We found that some of the care plans we looked at were not robust and reflective of people's needs. We saw care plans were regularly updated, however this was not always reflective of people's changing needs.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, "The staff are great' and 'The staff are very, very nice and good to you.'

Is the service responsive?

Where appropriate, the service shared information with other social and health care professionals. This ensured care was delivered to people safely when they transferred from other services.

People were asked what they liked to do by the service during needs assessments and the service acted in accordance with their requirements. People had been supported to pursue activities they enjoyed.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw people were regularly asked what they thought about the service and the manager took action to resolve any issues. People told us that the management had consulted with them before implementing changes to the service provided and their views had been taken into consideration. For example, changes were made to menus following discussions with people who used the service.

People who lived at the home told us, 'I am happy here' and 'The care staff are very good.'

We saw staff were kind and attentive when delivering care to people. We saw people were supported and encouraged to maintain their independence.

We looked at four people's care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with two staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely and were given the opportunity to meet with the manager on a one to one basis.

We found the service was well led and had systems in place to monitor the quality of service being provided.