Wayside Care Home

Wayside Care Home is a care home that provides nursing and personal care for up to 31 people within 1 large, adapted building. It provides care to people requiring general nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 24 people were living at the home.

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

Improvements in the recording of people’s care and medication documentation had been embedded since our last inspection. The provider and registered manager were now fulfilling their regulatory responsibility to promptly notify the Care Quality Commission (CQC) when Deprivation of Liberty Safeguards had been authorised.

The home was clean, although some communal areas looked worn. There were plans in place to ensure continual improvements to the home environment were made, including redecoration.

Processes were in place to safeguard people and protect them from harm and abuse. People were supported to take their medicines as prescribed by staff who were trained in medication management and were assessed as competent to administer.

There were adequate numbers of safely recruited staff to care and support people. The provider used agency staff to cover any shortfalls in staffing levels. The registered manager pre booked agency staff in advance to ensure consistency of the same agency staff as much as possible. Risks to people had been assessed, monitored, and reviewed. People were supported to maintain a healthy and balanced diet and were given choices. Staff understood people’s dietary needs. Staff knew how to recognise and respond to signs of ill health and ensured people were supported to access the health care they needed.

People were supported by staff who helped them to be as independent as they could be. People were encouraged to maintain relationships with those important to them and to engage in activities they wanted to.

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 a complaints policy in place. People and relatives were aware how to raise any concerns.

The registered manager and senior management team carried out regular audits and checks to monitor the quality of the service and care provided. Areas for improvement were identified and responded to so the service was continuously learning and developing. People and their relatives’ views were sought and considered to help drive through improvements. Staff worked in partnership with other health and social care professionals to ensure people’s needs were met.

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

Rating at last inspection

The last rating for this service was requires improvement (published 27 April 2023) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about the management of complaints. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wayside Care Home 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.

Wayside Care Home is a care home that provides nursing and personal care for up to 31 people within 1 large, adapted building. It provides care to people requiring general nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 21 people were living at the home.

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

People's care and support had been enhanced by the provider and management team working together to make improvements since our last inspection. Work was continuing to drive through further improvements required as identified at this inspection. This included some elements of care and medication documentation.

The provider had appointed a new manager who had already identified areas for improvement. They understood time was needed to embed and sustain these improvements.

The provider had not consistently fulfilled their regulatory responsibility to promptly notify the Care Quality Commission when Deprivation of Liberty Safeguards had been authorised.

People were protected from abuse. People and relatives were confident people had support from staff who knew their safety needs well. People were assisted to have the medicines they needed to remain well by staff who had been trained to do this. Systems were in place to reduce the likelihood of the spread of infection.

There were sufficient staff to meet people's care and support needs without rushing. Staff were safely recruited. Staff worked well together in a mutually supportive way and communicated effectively.

Improvements had been made to ensure any gaps in staff training were identified and action taken. Staff demonstrated the appropriate skills and knowledge to support people in an individualised, respectful, and compassionate manner; people told us this and our observations confirmed it.

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 in the service supported this practice. However, the associated records did not consistently reflect this and therefore the provider needs to ensure this is achieved.

People were provided with food and drink of good quality which they enjoyed and met their individual needs and preferences. Staff worked closely with local social and healthcare services to ensure people had access to any specialist support they required.

The home environment and facilities were being redecorated on an ongoing basis to reflect people’s requirements. People liked their own rooms and they furnished these with personal items, to make these homely.

People's needs had been assessed and met on an individual basis. Relatives were welcomed into the home and included in their family member’s care.

The provider and manager were open and responsive to making ongoing improvements and achieving good quality care. Incidents and complaints were analysed, and learning was shared with staff.

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

Rating at last inspection

The last rating for this service was requires improvement (published 10 February 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to elements of people’s personal care, care monitoring documentation and the cleanliness of home environment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 effective and well-led sections of this full report.

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

Enforcement

We have identified a breach as the Care Quality Commission had not always been promptly informed prior to our inspection when the supervisory body had authorised DoLS.

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

Wayside Care Home is a care home that provides nursing and personal care for up to 31 people within one large adapted building. It provides care to people requiring general nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 14 people were living at the home.

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

People received their medicines as prescribed however, there was room for improvement in relation to some of the documentation for staff to follow when administering people’s medicines.

Staff training had been moved to a new provider and staff were in the process of refreshing their training to ensure they were fully up-to date. Gaps in training were known to management for them to action and resolve.

Management and provider oversight required further strengthening to identify and improve the effectiveness of the quality monitoring systems.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People's needs were assessed, and care was planned and provided to meet people's needs. People had a nutritious diet, and they enjoyed the food offered. Staff ensured people had enough to drink to meet their individual needs.

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 6 August 2019).

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about care and treatment people were receiving. A decision was made for us to inspect and examine those risks.

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

Follow up

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

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

Wayside Care Home is a care home that provides nursing and personal care for up to 31 people within one large adapted building. It provides care to people requiring general nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 11 people were living at the home.

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

The provider and manager had worked together to make improvements since our last inspection. Work was continuing to drive through further improvements identified at this inspection. The manager understood time was needed to embed improvements and sustain these.

Staff practices to manage the risks associated with infection prevention and control needed to be strengthened further in some areas. Staff told us they had access to enough equipment to support their practices in reducing the risks of cross infections.

The provider’s arrangements to undertake regular checks on all safety aspects of the home environment needed to be completed on a more regular basis; so, any actions required were undertaken in a timely manner. Fire safety practices with one specific piece equipment needed to be undertaken by all staff which the manager was already aware of.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. People received their medicines regularly and systems were in place for the safe management and supply of medicines.

Sufficient, knowledgeable staff were available to meet people's needs and the manager understood when more people move into the home staffing arrangements will need to be focused on. People told us when they needed assistance, staff responded promptly so people’s safety needs were not compromised.

People's needs were assessed, and care was planned and provided to meet people's needs. Care was provided by staff with training and the manager understood this needed to be provided on a regular basis. People had a nutritious diet, and they enjoyed the food offered. Staff ensured people had enough to drink to meet their individual needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were cared for by staff who were kind. Staff were considerate towards people they cared for. People and relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

Staff were responsive to people's needs and wishes and were knowledgeable about each person. Care records were being further improved to ensure they were personalised to each person’s needs. Relatives confirmed staff knew their family members well.

The manager was continuing to support people in having opportunities to have fun to follow their interests. People had access to some entertainment they enjoyed and there were ongoing improvements to recreational activities.

People felt their concerns would be listened to and action taken to improve the service as a result.

As part of the manager and provider’s oversight of the service they were following an action plan to drive through further improvements and strengthen the effectiveness of quality monitoring systems.

We found the service met the requirements for good in three areas and requires improvement in two other areas. 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 (inspection report published on 10 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the service's previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any information of concern is received, we may inspect sooner.

Wayside Care 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. Wayside Care Home is registered to provide accommodation with nursing and personal care for adults for a maximum of 31 people. There were 17 people living at the home on the day of the inspection.

This is the second time the service has been rated Requires Improvement. For services rated Requires Improvement (RI) on one or more occasions, we will take proportionate action to help encourage prompt improvement. You can see what action we asked the provider to take at the back of the full version of this report.

There was no registered manager in post. A manager had been recruited band told us they would be making an application to CQC to be registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There had been a lack of leadership and direction for staff, with no oversight of clinical risks or key issues for people's care. Systems and processes for monitoring the quality of the care provision were inconsistent and there was no robust management of the service. At the time of the inspection there was a new management team in place. They had produced an action plan for improving all aspects of the service. However, it was too soon for us to assess the impact of this upon people's care.

People’s care plans were not accurate and had not had up to date information about their current needs. Information was difficult to find or contradictory. Risk assessments were being completed; however, these were not always being followed or had been completed incorrectly to mitigate risks to people using the service. The knowledge staff had about people had not been recorded to ensure there was consistent care for people.

Staff had not been provided with training that reflected the needs of people who lived at the home. The training information showed that staffs knowledge had not been regularly updated. People had not always been involved in the planning of their care and records of their care were not accurate.

People had not always been supported to maintain their hobbies and interests that supported their needs. The provider had not been able to review any concerns raised as no records had been kept. Information was not available for the provider to improve the service.

People told us they felt safe and free from the potential risk of abuse. Staff told us about how they supported people’s safety. People told us they liked the staff and felt they knew how to look after them and were included in day to day decisions about their care and support. People were supported to eat and drink enough to keep them healthy. People received their medicines as prescribed and at the correct time. People told us and we saw their privacy and dignity were respected and staff were kind to them. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

We found breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. 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.

The provider of Wayside Care Home is registered to provide accommodation for up to 31 people with personal and nursing care needs who may have physical disabilities or people with dementia. At the time of this inspection 24 people lived at the home.

At our previous inspection on 9 November 2015 the registered provider's overall rating was 'good.'

There was a registered manager in post and they were present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had experienced challenges in recruiting staff and managing individual unplanned staff absences from work. This had impacted upon the registered manager’s available time as they had worked on staff rotas to ensure there were sufficient staff on duty and they recruited to vacant posts. The registered manager was aware of where staffing numbers may decrease due to unplanned staff absences so these could be covered to maintain people’s safety.

People’s care and risk management plans had not been updated to reflect people’s specific needs including any changes to these so people received consistent support to keep them safe. This was important as people relied upon staff to support them with their needs and new staff and agency staff would not have all the information required to provide safe care.

People’s safety from avoidable harm was not consistently upheld. People received their medication as prescribed but staff practices did not ensure that medicines were stored safely. Staff did not always ensure sluice and fire doors were closed to reduce potential hazards which could impact on people’s safety.

People felt safe living at the home and staff treated them well. Staff knew how to recognise abuse and were clear about their responsibilities to report safety concerns to the registered manager. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible; they were safe to work with the people who lived there.

People’s individual needs were assessed alongside the arrangements to ensure there were sufficient staff in order to maintain people’s safety and reduce identified risks. Staff were timely in how they responded to people’s needs to support their safety but did not always have sufficient time to consistently plan recreational activities.

People were supported by staff who had received training however staff had not consistently received opportunities to refresh their previous training. People were not always effectively supported by staff who used their skills and knowledge in practice to improve people’s sense of wellbeing.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible. However, we found there were inconsistencies in how staff supported people to consent to their everyday care before staff provided this.

People were provided with meal choices and received assistance to eat and drink with aids to support their levels of independence. Where people required their drinks to be monitored due to risks of dehydration the records were not always totalled so any actions of people not drinking sufficient amounts action could be taken in a timely way. People’s health care needs were met and monitored by staff who had access to various health care professionals.

Staff relationships with people were caring and supportive. However, staffing arrangements had impacted upon the time staff invested into providing care which was not always led by tasks staff needed to do. Staff practices were inconsistent in applying their knowledge when communicating with people to reflect people were always kept at the heart of the care provided. People were supported to maintain their dignity, privacy and relationships which were important to them.

People’s particular needs were not consistently responded to so people’s care experiences were enhanced by staff practices. Staff did not consistently have all the information they required within people’s care plans to support them in providing and delivering responsive care.

People believed the registered manager was approachable and were comfortable in raising any concerns they had. The registered provider's procedures showed the registered manager had acted upon any raised and used these as an opportunity to drive through improvements.

The registered provider had failed to display their current inspection rating which is a legal requirement to show people had access to the ratings to inform their judgments about services.

The registered provider had not taken steps to ensure the systems used to monitor and check the quality and safety of services provided were consistently effective and supported improvements.

We found 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.

The provider of Wayside Care Home is registered to provide accommodation for up to 31 people with personal and nursing care needs who may have physical disabilities or people with dementia. Bedrooms, bathrooms and toilets are situated over three floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 28 people lived at the home.

There was a registered manager in post and they were present during our inspection. 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.

While we saw positive communications where staff showed consideration for the feelings of people in a kind way we also heard a staff member used uncaring approaches when they assisted a person with their needs. The registered manager took appropriate action to reduce the risks of this happening again.

People were involved in identifying their needs and preferences which staff respected. We saw on one occasion where a staff member did not involve a person to establish their meal preferences which was challenged by another staff member to ensure this person’s preferences were respected.

Staff did not ensure information about people’s medicines were consistently stored securely to respect their rights to confidentiality. This was because people’s medicine administration records were left on top of medicine trolleys in communal areas.

People felt safe living at the home and risks to their safety had been identified. This included staff monitoring and reviewing risks to people and consulting with external professionals so that risks were consistently reduced. We saw the monitoring procedures used by staff for recording people’s drinks and food was not always completed with all food and fluid amounts. Although this had not impacted upon people’s needs and or heightened risks of dehydration or malnutrition at the time of our inspection. However, the registered manager showed they listened and took immediate action.

Staff were knew how to recognise and report incidents of potential abuse or harm to people as a result of an injury. There were procedures in place so that staff had information to support them in recording accidents and these were overseen by the registered manager so that they could manage the action taken to reduce the risks of these happening again.

We saw procedures were followed to recruit suitable staff to provide care and support to people who lived at the home and prevent unsuitable staff from being employed. There were arrangements in place to make sure there were enough staff of the right skill mix on duty both day and night. These management arrangements were regularly reviewed by the registered manager and provider who took action when staff had shared their views about more staff being required at certain times, such as, lunchtime.

We found staff did follow the procedures for the safe administration of people’s medicines. Staff had signed records to confirm people had received their medicines as prescribed and we saw medicines were dispensed for one person at a time to reduce the risk of mistakes being made.

People were supported by staff who were aware of how to support people’s rights and seek their consent. The registered manager had fulfilled their responsibilities in making sure where people might have restrictions in place they received care and were safe as these were lawfully applied in people’s best interests.

Staff had support and training to ensure they had the skills to meet people’s needs. The registered manager supported staff to further improve their knowledge as people’s individual needs changed and new people came to live at the home. This included the registered manager sharing further learning around dementia care to enable staff to effectively support people with dementia.

People told us they enjoyed the meals and we saw staff had the knowledge about people’s nutritional and hydration needs. This made sure people received the support they needed to eat and drink enough to remain nourished and hydrated. People’s health was supported by access to appropriate external healthcare professionals.

We heard examples where staff went the extra mile in their caring role, such as, a staff member making blankets for people who liked these and used them on the day of our inspection. People were positive about the way staff supported them to meet their daily routines and how staff knew how best to support them in meeting their needs. This included staff making sure people’s wellbeing was enhanced by having support to follow their interests and opportunities to take part in social events. The registered manager had recruited a lead staff member to arrange and coordinate fun and interesting things for people to do so that continual improvements were made.

People knew how to make a complaint and were confident these would be listened to and acted upon. The registered manager and provider had responded to a relative’s complaint which had been raised with them. In doing so they had learnt lessons about how to make sure their response was always done in a caring manner as their response at the time did not reflect this had happened.

People described the registered manager as friendly and approachable. Staff felt supported by the registered manager who used a range of methods to support staff in continually reflecting on and improving their practices. This included making sure where actions were identified, such as, removing the key from the medicine trolley, improvements were made. The registered manager and provider were open and responsive to making further improvements so that people consistently received good standards of care and treatment.

The manager of Wayside Care Home was in the process of submitting an application for registered manager status to the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We observed the care and support that people received to meet their different needs over the course of the day. We also looked at a sample of care plans for three people who lived at the home and various management records. These records were used to review, monitor and record the improvements made to the quality of care and support that people received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

People who lived at the home and their relatives told us that they felt safe and staff responded to their needs with minimum delays. One person told us, 'I feel safe and comfortable here' and a relative said, 'Absolutely safe, no concerns about how staff treat her.'

There was a focus on people's safety and we saw that staff assessed, identified and had taken action to reduce risks so that people were protected as much as possible from harm. This included the improvements that had been made to medicine arrangements and practices so that people received their medicine in the right way and the right time as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. We found that there were proper policies and procedures in place. We saw that consideration of the Mental Capacity Act was evidenced in care plans where people gave their consent to their care and treatment. We also found that the manager and staff were aware when levels of intervention or supervision may represent a deprivation of a person's liberty.

Staff personnel records showed the manager had carried out checks before staff started work at the home to ensure they were fit to work in health and social care.

Is the service effective?

People told us they were happy with the care they received and that their needs were met by staff. One person told us, 'They (the staff) always help me when I need it. What more could I ask for, I am happy here.'

Each person had a range of care plans in place that provided information about how people preferred their care and support. The plans also included information about people's health needs and interests. One relative told us, 'Staff are committed and my dad gets the continuity of care that he needs.'

When we spoke with staff they were able to tell us the care and support people needed which showed they understood their needs.

We saw that staff had the most up to date information about people's needs. This included daily handovers that supported staff to deliver effective and consistent care and treatment to people.

Is the service caring?

People, who lived at the home and relatives that we spoke with, told us that they thought staff were very caring and respected people's privacy. During the day we saw staff treated people in a kind and caring way. One relative told us, 'They (the staff) are kind and always respectful when they talk to you.'

People were supported by kind and attentive staff. We saw that staff encouraged people to be as independent as possible and to make their own decisions. One member of staff told us, 'We try to keep people as independent as they can be and do as much for themselves as they possibly can.'

Is the service responsive?

Staff worked in partnership with other professionals that supported people to receive appropriate care, treatment and support to meet their different health and social care needs.

We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

During our inspection we saw that there was evidence of unplanned engagements with people and staff chatting to each other. We also saw people had their nails done if they wished to. The manager was reviewing the planned activities for people to ensure that these continued to be improved upon.

People told us that staff listened to their views and supported them to keep in touch with people who were important to them by way of visits which we saw at the time of our inspection. The manager showed us that they were doing their best to make improvements to people's quality of life.

Is the service well led?

The manager sought the views of the people who lived at the home and their relatives during regular meetings. The manager listened to people and had identified actions they would take to resolve any issues and/or suggestions people made. This helped to support people to receive a good quality service at all times.

Staff told us they were able to speak with the manager about any concerns they had. They felt that the manager was always approachable and supported by them.

The provider had an effective quality assurance system in place and identified actions had led to improvements in the service that people received. The manager carried out a regular programme of audits and checks to make sure the quality of the service was maintained.

Where investigations had been required, for example in response to accidents, incidents or safeguarding concerns, the manager had completed a detailed investigation. This included information such as the actions that had been taken to resolve them.

When we carried out our inspection care and support was provided to 28 people.

We spoke with the manager, who at the time of our inspection was not registered with the Care Quality Commission. We also spoke with the deputy manager. We spoke with one person who visited the service. We spoke with some people who used the service.

We found that commodes were clean and ready for use. Therefore the risk of cross infection was reduced.

Although improvements had been made in the management of medicines we found areas where improvement was needed. Improvements were needed to ensure that people who used the service always received their medicines as prescribed to ensure their health and welfare needs were met.

We found that improvements had been made in relation to monitoring the quality of the service provided. However, further improvements were needed to ensure that people received appropriate care and support.

At the time of our inspection there was no registered manager at Wayside Care Home.

We spoke with the provider, the nurse on duty who was the deputy manager and some care workers. We spoke with people who used the service and a visitor. One person commented: 'People are well looked after here'.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner.

From our observations we saw that people were provided care to met their individual care needs. We saw equipment in use to prevent people getting sore.

During our inspection we saw that some equipment was not sufficiently clean to prevent the risk of cross infection.

We found that appropriate arrangements were not in place to ensure the safe use and management of medicines.

We found that arrangements were in place for checking the suitability of staff.

The provider confirmed that systems for monitoring the quality of the service were not in place and were in need of developing.