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Chiltern Grange Care Home Good

Reports


Inspection carried out on 15 January 2018

During a routine inspection

This unannounced inspection took place on the 15 and 16 January 2018. Chiltern 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.

At the time of the inspection there were 44 people living in the home. Chiltern Grange Care Home can accommodate 75 people across three separate floors, each of which have separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we completed our previous inspection on 23 and 24 April 2017 we found concerns relating to end of life care documentation. At this time this topic area was included under the key question of “Is the service caring?” We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of “Is the service responsive? Therefore, for this inspection, we have inspected this key question and also the previous key question of “Is the service caring?” to make sure all areas are inspected to validate the ratings.

During our previous inspection on 23 and 24 April 2017 we found a number of breaches of regulations. These included Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 and Regulation 19 of the Care Quality Commission (Registration) Regulations 2009. Following the last inspection, we spoke with the provider and asked them to complete an action plan to show what they would do and by when to improve all the key questions to at least good.

During this inspection we found improvements had been made to all the areas that we previously reported as required improvement. During this inspection we found records were up to date, accurate and appropriate. Records related to risks had clearly identified the risk and the methods used to minimise risk. Standards of infection control were high with clear policies and procedures in place to minimise the spread of infection. The management of risks in relation to fire, health and safety and risks related to the provision of care were clearly recorded.

We observed and records demonstrated that improvements had been made to the administration of medicines. During this inspection we found medicines were administered in line with the prescribed times. Records were kept up to date and audits had proved effective in ensuring people received their medicines correctly.

Improvements had been made in the way staff were deployed. Through our observations and records of staff rotas we could see there were sufficient numbers of staff to ensure people’s needs were met.

Systems were in place to ensure the risk of employing unsuitable staff was minimised.

During our previous inspection in April 2017 we found the provider had failed to comply with the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). During this inspection we found this had improved and the provider was now compliant with the requirements of the Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice.

We observed food was presented in an attractive way to encourage people to eat and maintain good health. People’s dietary needs were identified and understood by staff who were involved in the preparation and delivery of food. People told us t

Inspection carried out on 23 April 2017

During a routine inspection

This unannounced inspection took place on the 23 and 24 April 2017. Chiltern Grange Care Home is a registered care home that provides residential and nursing care to young adults, older people and people living with dementia. The home is registered to accommodate 75 people. At the time of the inspection there were 42 people living in the home. The home has three floors including the ground floor with lifts and stairs to all floors.

During the previous inspection in May 2016 we found breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.This was because people were not protected against the risks associated with the proper and safe management of medicines. Care related documents were not always up to date or accurately reflected people’s needs. During this inspection we found continued breaches of these regulations and further areas of concern.

The home had been without a registered manager since June 2015. Although there had been a number of managers in place since this time, none had completed the registration process with the Care Quality Commission (CQC). At the time of the inspection a new manager was in post. They had started employment at the home on the 6 March 2017. They intended to register with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We had concerns about the safety of the service, For example, people living with dementia did not always have supervision from staff.

Records related to care were not always up to date and accurate. Care plans did not clearly document changes in people’s needs. Risk assessments were not always completed correctly. This placed people at risk of receiving inappropriate and unsafe care.

Staff recruitment was undertaken in such a way as to minimise the risk of employing staff who might be unsuitable to work with the people living in the home. Checks were made on the suitability and previous conduct of applicants.

Training, supervision and appraisals were provided to staff to encourage good practice and equip them with the skills and knowledge necessary to carry out their roles. Staff told us they felt supported in their role and they had received sufficient training to carry out their role competently.

The home was clean and odour free. The environment was comfortable and well maintained. Health and safety checks were completed to ensure the safety of the building and the wellbeing of the people living in the home, staff and visitors.

Staff did not understand the Mental Capacity Act 2005 (MCA) and how it applied to their role. Records did not demonstrate where decisions were being made on behalf of people who lacked the mental capacity to make their own decisions. The best interest process had not been followed. Mental capacity assessments were not always decision specific and these had not always been reviewed. People were not supported to have maximum choice and control of their lives. The policies and systems in the service did not support this practice. However, staff did support people in the least restrictive way possible. Where restrictions were in place to protect people’s welfare, appropriate applications had been made to the local authority for authorisation.

Staff were caring, considerate and treated people with respect. We observed positive interactions between staff and people. People spoke optimistically about their relationships with staff.

We had concerns that personal information was not always stored in a secure way, which preserved the confidentiality of information. Records related to Do Not Attempt Resuscitation forms were not always completed correctly or accurately. People’s preferences

Inspection carried out on 23 May 2016

During a routine inspection

This unannounced inspection took place on 23 and 24 May 2016. During our last inspection in October 2015 we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the CQC (Registration) Regulations 2009. During this inspection we found improvements had been made in all areas apart from the administration of medicines and care plans which required further improvements.

A requirement of registration is the necessity of a registered manager to be in place in the home. There was no registered manager in place, however a new manager had commenced employment in the home two weeks prior to the inspection. It was their intention to register with the commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We previously inspected the service in October 2015 We found that people did not consistently receive safe care and treatment, in relation to medicines, record keeping, staff training, support for staff and notifying the commission of events in the home. The provider sent us an action plan, to tell us what action they were taking to improve the service.

Over all people spoke positively about the care and support they received in the home. Their only criticism was in relation to agency staff. This was because they felt the agency staff did not know what their individual needs were. The home had relied heavily on agency staff due to a high staff vacancy rate. This situation had improved recently due to a new intake of permanent staff.

The home has also been through many changes of management over the last couple of years, however a new manager is now in place and people and staff appear to have confidence in their ability to improve the service on offer.

Staff knew how to protect people against the risk of abuse, and the whistleblowing policy was up to date and accessible to staff.

We found a number of concerns related to the administration of medicines to people living on the ground floor. There were incomplete records of stock balances, and for one person with epilepsy there was no seizure chart. Another person’s pain chart had not been reviewed until the day of the inspection. One person’s medicine had not been signed as given and stocks of medicines did not tally with the expected recorded amount. Records on the other two floors were accurate and up to date.

The provider had a tool to assess the number of staff required on each floor to meet people’s needs. People and one staff member told us there were insufficient staff members on the ground floor. During our inspection we found there appeared to be enough staff available to meet people's needs. We have made a recommendation about reviewing the staff numbers on the ground floor.

Appropriate checks were made in relation to the recruitment of staff, to ensure where possible only candidates safe to work with people were employed.

Improvements had been made to the assessments of risk to people’s health and safety since the last inspection. This included Legionella, fire, control of substances hazardous to health (COSHH).

During our last inspection we had concerns regarding the lack of training and support for staff. This had improved. We found staff were encouraged to attend appropriate training to enhance their skills and knowledge. Further work was underway to ensure all staff received appropriate training and support.

Mental capacity assessments were appropriately completed and where appropriate applications had been made to the local authority for Deprivation of Liberty Safeguards (DoLS).

During our last inspection we had concerns about the lack of support for people with their eating and drinking. During this inspection we f

Inspection carried out on 26 & 27 October 2015

During a routine inspection

This unannounced inspection took place on the 26 and 27 October 2015. The home is registered to provide nursing or personal care for up to 75 young and older people including people who live with dementia. At the time of the inspection there were 58 people living in the home. The home is required to have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Previously the home had been inspected in July 2015, this was a focussed inspection to see if the home had made improvements in the areas of Safe, Effective and Responsive. It was rated as good in these areas.

At the time of the inspection there was a new manager who had commenced employment with the provider four weeks prior to the inspection. They intended to become the registered manager.

During this inspection we found that infection control audits had been completed but there were no action plans in place to address the points of concern found in the audit. Legionella testing was not up to date and actions required to ensure the safety of the home in relation to legionella had not been completed.

The home was clean and well maintained. People had their own rooms and en-suite facilities. They were able to personalise their rooms with their own belongings.

People told us they felt safe living in the home, however, the manager was not aware of how to respond to allegations of abuse in such a way as to protect evidence. The home’s whistleblowing policy did not ensure staff had clear information of how to report concerns outside of the home and where possible, their identity would be protected. The safeguarding policy made no reference to the multi-agency agreement and the local authorities expectations of how safeguarding concerns should be addressed in the home.

Some aspects of the administration of medicines was not safe for example, signing the medication administration record (MAR) prior to administering medicine to people. We also observed prescribed fluid thickeners were being shared between people, rather than each person receiving their own. This is not in line with the guidance from the Nursing and Midwifery Council (NMC).

Training and supervision had not always been carried out for all staff. We noted that according to the records, three staff members who were carrying out the administration of medicines had not received training to administer medicines to people and their competency had not been assessed. Regular supervision of staff did not always take place this meant the provider could not demonstrate they had monitored and supported staff in relation to the duties they were employed to perform

Checks were undertaken to ensure new employees were safe to work with people. Where agency staff were used, the agency provided the home with a profile showing that appropriate checks had been completed and their knowledge regarding policies and procedures was up to date.

People told us there were not enough staff; however on the day of the inspection we saw there were sufficient numbers of staff to provide the care and support necessary. A significant percentage of the staff in the home were agency staff, as there were approximately nine staff vacancies at the time of the inspection.

The requirements of the Mental Capacity Act 2005 were understood by some staff, and where required the home had made applications regarding the deprivation of liberty safeguards. We could see no documentation to show how staff acted in people’s best interest when it came to making serious decisions that would affect people’s lives.

Care records were not always completed accurately or updated appropriately. This meant monitoring of people’s health and care needs was not effective.

We saw some positive interactions and strong relationships between some staff and people who lived in the home. However, we also saw poor communication between staff and people, and where two people who needed extra support with their food did not receive this from staff.

Records showed complaints were not always followed through in line with the home’s procedure and the new regulations.

People participated in activities such as puzzles, board games, arts and crafts, sing-along and painting but plans were in place to improve the quality and the quantity of activities.

The frequent change in management over the last 14 months meant there had been no consistency in the management approach. There had also been a large turnover of care and nursing staff. The Care Quality Commission (CQC) had not always been informed about changes in the home that legally they are required to do.

We found a number of 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 the report.

Inspection carried out on 10 and 14 July 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of Chiltern Grange Care Home on the 4 & 11 December 2014 and 07 January 2015. We found accurate records had not always been maintained to ensure people were protected against the risks of receiving care or treatment that was inappropriate or unsafe. Robust recruitment procedures were not followed and Deprivation of Liberty Safeguards (DoLS) were not being implemented effectively or consistently within the service. DoLS aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. It ensures the service only deprives someone of their liberty in a safe and correct way and this is only done when it is in the best interest of the person and there is no other way to look after them. We also made recommendations around monitoring the nurses’ relevant qualifications, training and continued professional development to inform further training needs. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and submitted an action plan informing us they would be compliant by 30 April 2015.

We undertook this focused inspection to check that they now met legal requirements. The inspection took place on 10 & 14 July 2014 and the inspection team consisted of one inspector. 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 (Chiltern Grange Care Home) on our website at www.cqc.org.uk.

Chiltern Grange Care Home provides care for up to 75 people who live with dementia, older people and people who require nursing support. Accommodation was arranged over three floors. The ground floor accommodated people with residential needs, the first floor dementia care needs and the second floor nursing care needs. At the time of our visit 61 people were using the service.

During this visit there was no registered manager in post. The previous registered manager had left their post in June 2015. We were informed the service were in the process of recruiting a manager who would subsequently be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In the meantime the residential care manager, nursing manager, heads of departments and staff were supported by the Operations director, the regional manager and a project manager.

During this inspection, we found the provider had made improvements and followed most of their plan which they had told us would be completed by 30 April 2015. We found all legal requirements had been met.

The provider had made considerable improvements to ensure Deprivation of Liberty Safeguards were implemented consistently and in line with the Mental Capacity Act and related codes of practice. This meant people’s care and support was provided in their best interests and in line with current legislation.

Robust recruitment procedures were now in place for all agency staff who worked in the home and a profile of each was held on file. Similarly all staff files contained an employment history with any gaps explained and an up to date photograph. This meant procedures were followed to ensure the safe recruitment of staff.

Improvements to people’s records had been made so they reflected the care they had been provided.

Training had been sourced to update staff’s knowledge on pressure area care. This was to ensure all staff working in the home had the knowledge and skills to care and support people with pressure area care needs effectively. Advice and support of an independent tissue viability nurse consultant (TVN) had been sourced. Support from the community dietitian ensured all staff working in the home had a good knowledge of how to meet people’s pressure area care needs and maintain a healthy well balanced diet. Documentation within people’s care files had improved and where people had been assessed as having pressure area care needs we saw appropriate monitoring documentation was in use.

Improvements had been made to ensure people’s records were personalised according to their individual needs. People’s life histories had now been completed which provided staff with a picture of the person’s biography, their hobbies and interests, their working lives, important dates such as anniversaries and birthdays and family connections. People and/or their representatives had been involved in the care planning and review processes and signed documentation to show they consented and agreed to the care and support detailed in their care plans.

The service had made considerable improvement since the last inspection to ensure they were working in line with the required regulations. The provider had utilised outside resources to ensure staff received appropriate training and support to fulfil their roles safely, effectively and responsively.

Inspection carried out on 04 &11 December 2014 & 07 January 2015

During a routine inspection

Chiltern Grange Care Home is based in Stokenchurch and is registered to provide care for up to 75 people who live with dementia, older people and people who require nursing support. On the day of our inspection there were 53 people living in the home. Accommodation was arranged over three floors. The ground floor accommodated people with residential needs, the first floor dementia care needs and the second floor nursing care needs.

Chiltern Grange Care Home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 05 August 2014 and was found to be in breach of Regulation 13, the management of medicines. This was because people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We set a compliance action for the provider to take action to improve medication practices.

During this inspection, we found medicine practices had improved. Peoples allergies were now recorded to ensure medicines did not directly affect people’s conditions. There was now clear guidelines in place to ensure people who received ‘as required’ medicines were done so safely. Medication Administration Records (MAR) now corresponded with administered medicines. Where people were able to self administer their medicines, this was done so in a safe and independent manner. Staff had received further training in the management of medicines and had undertaken competency checks.

Risk assessments were in place where it was identified people were at potential risk, however clear documentation was not always available on the management of risk, especially so where people required nursing support. Record keeping was not always accurate and some records such as turning charts had been completed before the task had been undertaken. There were shortfalls in regards to clear pressure management guidelines.

Although the service had a robust recruitment policy in place this was not always followed in practice. They did not ensure themselves that relevant checks had been undertaken for the agency staff they used, did not always gain a full employment history or gain an up to date photograph.

People told us they felt safe living at Chiltern Grange . Staff were knowlegable on how to identify suspected abuse and how to escalate it further to the correct people. We found improvements to staffing levels to ensure people’s needs were met in a timely manner. Robust recruitment checks were not always in place to ensure the suitability of staff when working with vulnerable people.

There were shortfalls in regular supervision, however the service identified this issue and put a robust plan in place to ensure staff were supported to undertake their roles effectively. Training was in place for staff to ensure their development, however the service heavily relied on nurses professional registrations to demonstrate their competence rather than specific training provided within the service.

There was a policy and procedure in place in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The MCA is a law about making decisions on what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom. Whilst there was a policy and procedure in place DoLS were not being implemented effectively or consistently within the service.

There had been concerns raised prior to this inspection regarding peoples nutritional and hydration needs. We found the service had actioned these issues and a new chef was now in place. People were complimentary about the food. Where required, appropriate documentation and guidelines were in place which showed how people’s nutritional and hydration needs should be managed. Where people required access to healthcare professionals, this was undertaken and recorded including the outcomes of appointments.

People and relatives told us the service and staff were caring. We observed good examples of caring practice, and practices that promoted people’s dignity and privacy. Where people required the support of an advocate, this was provided. Where people were receiving end of life care, this was done with dignity and compassion. The care provided was personalised to meet people’s individual needs within a warm atmosphere. Staff understood the needs of the people living in the home and provided care and support with kindness and compassion.

Before people moved into Chiltern Grange, an assessment of their needs was undertaken. Care plans had been completed which explained how people wished to be supported, however some elements of care planning was not recorded, paticulary for people with nursing needs.

Activities were provided within the home, and trips out were also undertaken. We found a variety of activities available for people who used the service including visits from a hairdresser, a chiropodist and talks from local groups such as the Alzheimers society and local Women’s Institute. The service had a clear complaints policy in place.

Staff and people told us they felt management were approachable and felt improvements had been made in regards to leadership. Management had identified that there were shortfalls in aspects of the service and had begun to make arrangements and action plans to address these shortfalls. Management undertook audits to ensure the quality of the service and to identify where improvement was required. Where accidents and incidents had occurred, these had been thoroughly investigated to assess any trends or patterns.

We have made a recommendation that copies of the nurses relevant qualifications, training and continued professional development are kept on file and used to inform further training needs.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 5 August 2014

During an inspection looking at part of the service

This inspection was a follow up to our last inspection in April 2014. This inspection was carried out by a pharmacist inspector to assess what the provider had done in response to the action we had told them to take with regards to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with medicines. We found that there had been some improvements made to the way medicines were handled and managed in the service since our previous inspection but there were still actions that the provider needed to take to ensure that people received their medicines safely.

You can see our judgements on the front page of this report.

Inspection carried out on 9, 11 April 2014

During a routine inspection

The inspection team was made up of one inspector who visited the service over two days and a pharmacist inspector who accompanied the inspector on the first day of the inspection.

We looked at five outcomes during this inspection and set out to answer these key questions: Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our observations during the inspection and discussion with people using the service, their relatives, the staff supporting them and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

People told us they felt safe and knew who to speak to if they had concerns. One person said ''I feel safe here and the staff are very good.''

People told us they were treated with dignity and respect by the staff. One person told us they were offered privacy as they had a lock on their door and staff always knocked before entering. They said when staff helped them with their shower they always kept the doors closed and drew the curtains.

Systems were in place which ensured staff and management learnt from events such as accidents, incidents and any outbreaks of infections. The provider audited these events on a monthly basis and documented any actions to be taken. This helped them to improve the service and outcomes for people who used it.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). We saw documentation in one person's file which showed these procedures were being followed. An appropriate referral to the Local Authority had been made and approved. This showed the provider had identified when people could potentially be deprived of their liberty and understood when an application should be made and how to submit one.

There were guidelines in place for staff to follow when completing risk assessments. These had not always been followed. For example, in two cases risk assessments in respect of pressure area care, use of bed rails and falls were incomplete. This meant people could potentially be placed at risk.

People were not protected against the risks associated with medicines because the provider did not have arrangements in place to manage them. Appropriate arrangements were not in place for the safe and timely administration of medicines or the recording of the administration of medication. There were no minimum or maximum temperatures recorded for the medication refrigerators to ensure the correct temperature had been maintained. Whilst the majority of administration records were printed, where they had been handwritten, they had not all been checked for accuracy. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

The provider had safe and thorough recruitment procedures in place to ensure only suitable people worked with people who lived in the home.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs prior to them moving into the home. They told us they were involved in the process as well as family members. This enabled the home to access any necessary equipment prior to them moving in and to write an initial care plan with details of people's preferences and wishes. We saw people had signed documentation stating they had been involved in the care planning process and consented to the care and support detailed within them. We found the care and support provided reflected their needs detailed in their care plans and were regularly updated where those needs changed. We saw signed documentation in people's files to evidence they consented to the care and support detailed in them.

A relative was very pleased with the services provided and told us ''I can sleep peacefully and know he's being looked after properly...has improved tremendously since being here.''

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required. This showed staff worked jointly with other health care professionals to meet people's needs in the most appropriate way.

People were provided with a daily programme of activities and entertainment each morning and afternoon which they could take part in if they wished. This included weekends. There was also a visiting hairdresser and chiropodist where people could book appointments if they wished. This ensured people were supported to meet their social and leisure needs.

It was evident through discussions with people living in the home, our observations and speaking with staff that they had a good understanding of people's needs and knew them well.

Is the service responsive?

People knew how to make a complaint or raise any concerns if they were unhappy. We saw the complaints procedure displayed in the home which detailed who to direct any concern to and the timescales in which complaints would be responded to. We looked at the complaints log and found complaints had been documented and included any actions taken in response to them. This showed the organisation responded to people's concerns and took actions to improve outcomes for people who used the service. One person told us ''I have raised concerns and they've been dealt with appropriately.''

Is the service caring?

People said they were happy with the care and support and their needs were met well. One person said ''They look after me well, I am very satisfied. They sometimes help me with my showering and always offer me privacy; they keep the doors closed and close the curtains... I am happy, I don't think you could improve on the care or service.''

We observed staff were gentle and patient with people and provided assistance to those who required help. Staff were respectful when they spoke with people and did not hurry them but enabled them to answer at their own pace.

We observed lunch and saw people were offered choice in what they ate. One person who previously asked for risotto asked to an alternative on the menu. Their chosen alternative was provided.

Is the service well led?

People's opinions were regularly sought. This was by way of surveys, care reviews and regular monitoring. We saw documentation and minutes of monthly resident's meetings. These enabled them to provide suggestions of ways to improve the running of the home. The meetings were chaired by a person who lived in the home which showed people were given the opportunity to take part in the monitoring process.

There were a range of audits and systems in place to monitor the quality of service. The results of the audits were collated and where any shortfalls were found an action plan was put in place to address them.

Inspection carried out on 14, 19 June 2013

During a routine inspection

We found people were treated with dignity and respect. We joined people in the dining room during lunch time. We observed staff offering people choices of food and people were enabled to eat their meal at their own pace.

People and their relatives had the opportunity to visit the home before they moved in to ensure it met their needs and expectations. One relative told us ''I bought my mother here and X assessed her needs. We sat with X and went through the admissions procedure. Her care plan is an evolving plan.....the staff all know everything about her so the information has been passed on. We had lunch, looked around and chose her room.''

Care plans were in place and provided evidence that any risks to the safe delivery of care had been assessed. This ensured the safety and welfare of the person receiving care and the carers supporting them. They contained guidelines for staff but they were generally brief and there were inconsistencies in completing monitoring forms. People and their relatives confirmed they were involved in the care planning and review process

People said they felt safe and staff looked after them well. They knew who to speak to if they had concerns.

Daily activities were provided to those who wished to take part. They were provided in groups and as a one to one session for those who were either nursed in bed or who preferred a one to one setting. The activities included trips out into the community as well as in house activities.