Maples Care Home

Maples Care Home is a care home set over three floors and provides residential, nursing and dementia care and support for up to 75 older people. At the time of our inspection, 61 people were using the service.

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

Risks were not always assessed, identified and/or updated and risk management plans were not always in place to manage risks safely. Records were not always completed and monitored in line with people's individual needs. Medicines were not always safely managed. Staff were not always available when needed. Accidents and incidents were not analysed and learning from this was not disseminated to staff.

People were not always supported to eat and drink when required. Staff training was not up to date, with no training provided for Epilepsy. Supervisions and appraisals were not carried out in line with the provider’s supervision policy. People’s privacy and dignity was not always respected. People were supported to have maximum choice and control of their lives. People's needs were not always met by the design and decoration of the home. We have made a recommendation about sourcing designs and decoration that would be conducive to people who live with dementia.

People and/or their relatives were not always involved in planning their care needs. Complaints were not managed in line with the provider’s complaints policy. People’s communication needs were not always met. People’s end of life wishes, were not always documented. There was a lack of activities on offer to stimulate people. Systems in place were not effective to assess and monitor the quality of the service provided. Feedback was sought from people, their relatives and staff to improve on the quality of the service provided.

Assessments were carried out prior to people joining the service to ensure their needs could be met. People were protected from the risk of infection. The service worked in partnership with key organisations and health and social care professionals when required.

Rating at last inspection and update

The last rating for this service was Good (published 23 December 2020). At this inspection we found the provider was in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

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

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

Enforcement

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

Follow-up

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

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

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Maples Care Home is a care home set over three floors and provides residential, nursing and dementia care and support for up to 75 older people. At the time of our inspection, 51 people were using the service and the top floor was not in use to provide any regulated activities.

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

The service had improved on their records management practices; however, some records were not always updated as regularly as required. The service had systems in place to assess and monitor the quality and safety of the service and to continuously learn to drive improvements but did not identify the issues we found with records management.

People's care and support needs were met. Relatives and professionals were complimentary about the service. Relatives told us their loved ones were safe and were happy living at the home. People were protected from the risk of avoidable harm, abuse and neglect. People were supported by sufficient numbers staff to ensure their needs were safely met and the service followed appropriate recruitment practices. Medicines were managed safely, and staff followed appropriate infection control practices to prevent or minimise the spread of diseases.

People's needs were met by the design, decoration and adaptation of the home. People were supported to eat and drink sufficient amounts for their health and wellbeing and to access healthcare services. People's needs were regularly assessed and care and support was planned to meet their individual needs. Staff were supported through induction, training and supervision to ensure they had the knowledge and skills required for their roles.

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

People were supported by staff that were kind, caring and respectful of them and their end of life wishes. People were involved in making decisions about their care and support needs and their views were taken into consideration when planning their care. People's privacy and dignity was maintained, their independence promoted, and their diverse and cultural needs respected.

People were supported to develop and maintain relationships important to them and participate in activities that interest them. People's communication needs had been assessed and met and Relatives told us they knew how to make a complaint if they were unhappy.

The management team demonstrated a commitment to provide high quality care and knew they had to be honest, transparent and open when things went wrong. Feedback was sought from people, their relatives and staff to improve on the quality of the service provided. The service worked in partnership with key organisations and health and social care professionals to deliver an effective service. Staff knew of their individual roles and responsibilities, they told us they felt supported in their role and were happy working at the service.

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 inadequate (published 23 January 2020). 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.

This service has been in Special Measures since 23 January 2020. 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. 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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate 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 Maples Care Home on our website at www.cqc.org.uk.

Follow-up

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

Maples Care Home is a care home set over three floors and provides residential care and support, nursing care and dementia care for up to 75 older people. At the time of our inspection, 66 people were using the service.

People's experience of using this service

Risks to people were not always assessed, reviewed and the provider did not always have appropriate risk management plans to guide staff on how risks should be minimised.

There were not enough staff available to meet people’s needs in a timely manner. Staff did not always monitor and assess people’s behaviour by completing behaviour charts so appropriate action could be taken to minimise risks associated with behaviours that can challenge the service. People were at risk of developing pressure sores, because pressure mattresses were not always set correctly. Where people were at risk of malnutrition, food charts were not always completed and prompt referrals were not made to health professionals for additional support where this was required to ensure people maintained a healthy weight . There was not appropriate signage within the home to help people orientate themselves.

Staff were not always kind and caring, and the provider's systems and processes did not support them to consistently display their caring values. Staff training was up to date. Information was available to people in a format to meet their individual communication needs when required. The service was not currently supporting people who had end of life care needs, but relevant information was not recorded in their care plans so this were available when people developed these needs. People were not always supported to eat a healthy and well-balanced diet. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection.

People said they felt safe and that their needs were met. People were protected against the risk of infection. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Assessments of people’s needs were carried out prior to them moving to the home to ensure their needs could be met. Staff were supported through induction and supervisions. People had access to a variety of healthcare professionals when required to maintain good health. The provider worked in partnership with key organisations to ensure people's individual needs were planned. Medicines were safely managed. Systems and processes were in place to order medicines to ensure they remained in stock and people could receive them as prescribed. People's rights were upheld with the effective use of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Their needs were not accurately assessed, understood and communicated.

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 of the service was requires improvement (published on 30 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations and the rating has deteriorated to inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, premises, staffing and good governance.

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 ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider.

Special Measures

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

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

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was 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.

At our last inspection on 11 October 2017, improvements were needed to the range and frequency of activities provided by the home. At this inspection we found that this was still an issue, as frequent activities were not being carried out.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were breaches of legal requirement because analysis in relation to accidents and incidents was not fully carried out to look for patterns or trends to reduce these risks and learning was not disseminated to staff. There were no pictorial menus and written menus were not provided in a large font that people could read easily. The home’s electronic care planning system was not always effective because during our inspection, the home’s internet connection was frequently lost throughout the day. We found that care files did not have back up paper care plans and risk management plans for staff to refer to. The provider had systems in place to monitor the quality and safety of the home, however, these were not always robust nor effective because they had failed to identify and address the issues we found during this inspection. Areas of improvement identified in the annual relatives’ survey 2017 remained areas of improvement identified at this inspection. They had not been rectified in a timely way. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were also needed because we observed that people had to wait long periods of time for their lunch. There was limited staff interaction with people and staff seemed to be task focused. We observed that some staff were not always caring when communicating with people or assisting them.

People told us that they felt safe, and there were safeguarding procedures in place to protect people from the risk of abuse. Risks were assessed and identified and appropriate risk management plans were in place. Medicines were safely managed and people were protected from the risk of infection. There were enough staff deployed to meet people’s needs and the provider followed safe recruitment practices.

Staff completed an induction when they started work and were supported through a programme of regular training and supervisions to enable them to effectively carry out their roles. People's needs were assessed prior to moving into the home to ensure their needs could be met. 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 in the service supported this practice. Staff told us they asked for people’s consent before offering them support. People were supported to have enough to eat and drink. People had access to healthcare professionals when required to maintain good health and the service worked with them to ensure people received the support they needed. The service met people's needs by suitable adaptation and design of the premises, with appropriately adapted bathrooms to manage people’s needs effectively.

People told us staff respected their privacy and dignity and that they had been consulted about their daily care and support needs. People were supported to be independent wherever possible. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People’s care plans were reviewed on a regular basis and were reflective of their individual care needs. People were aware of the home’s complaints procedures and knew how to raise a complaint. People's diverse needs in terms of religion, sexuality and culture were recorded and they were supported to meet their individual needs if required. Where appropriate people had their end of life care wishes recorded in care plans.

Regular staff and residents' meetings were held where feedback was sought from people. Staff were complimentary about the manager and the home. The provider worked in partnership with the local authority and other external agencies to ensure people’s needs were planned and met. The manager was knowledgeable about the requirements of a registered manager and their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. The philosophy of the home was to promote people’s dignity and provide person-centred care and meet people’s emotional and well-being needs.

Maples Care Home is a large nursing home which provides long term residential care and support, nursing care, dementia care and respite services for up to 75 older people. 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. There were three separate units at Maples, with separate facilities. Two of the units specialise in providing care to people living with dementia. At the time of our inspection there were 66 people living at the home.

At this inspection on 11 and 12 October 2017, we found improvements had been made to all the areas previously identified but there was still room for improvement with the range and frequency of the activities provided to ensure people’s individual needs were met. There were high levels of agency staff at this inspection and some people and some of their relatives told us this meant that their preferences and wishes in respect of their care were not always consistently met. However, the provider and registered manager had a robust induction for agency staff and had recruited a number of new staff who were due to start work in the near future. They told us they tried to use the same agency staff whenever possible.

There was a registered manager in place who had managed the home since October 2017. 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.

People told us they were safe and well looked after. Staff were aware of the possible signs of abuse and neglect and what to do if they had a concern. The registered manager had reported any safeguarding concerns and the local authority said the home had worked with them in an open and transparent way. Risks to people were identified and guidance in place to reduce the risk of them occurring. Risks in relation to equipment and the premises were assessed and managed and there were plans to deal with emergencies. Medicines were safely managed.

We received some mixed feedback about staffing levels. We found from our observations there were sufficient numbers of staff to meet people’s needs.

People told us staff were kind and caring. We saw people felt comfortable with staff and there was evidence of good relationships between most staff and people at the home. 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 in the service support this practice. People’s needs in relation to their disabilities, race, sexual orientation, religion and gender were recognised and supported appropriately. Staff told us they received sufficient training and support to know how to meet people’s needs.

People’s nutritional needs were met and a range of health professionals were available to support their health needs. People and their relatives told us they were treated with dignity and respect and that they were involved in their care planning. People’s care plans were personalised accurate and reviewed regularly.

People’s views were sought through regular residents and relatives meetings and surveys. Complaints were managed appropriately. Systems were in place to assess and monitor the quality of the service and to monitor risk and these operated effectively. The provider monitored the service through regular visits.

Maples Care Home is a large home which provides long term residential care and support, nursing care, dementia care and respite services for up to 75 older people.

Since the last inspection there had been some unavoidable changes in the management team at the home. The previous registered manager had left the home in July 2016. A new manager had been appointed and started work at the end of October 2016. They were in the process of registering as manager 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. The deputy manager had also left and a new deputy manager had just started at the home.

We found there were some areas for improvement in some key questions as a result of the lack of stable management there had been. These included ensuring some care records and risk assessments were consistent and up to date, the recording of some best interest decisions and the provision of suitable activities to stimulate people and meet their needs for socialisation. Staff had received regular training but supervision had not always been provided to staff in line with the provider’s requirements. However, the new manager had already drawn up an action plan that had identified all the areas for improvement we found and had started work on completing this plan at the time of the inspection.

Medicines were stored and administered safely. We have made a recommendation to the provider about the safe management of ‘as required’ medicines and the arrangements for the administration of medicines covertly where this is appropriate.

People told us they felt safe and well looked after at the home. Staff were aware of how to raise any safeguarding issues. There were safe recruitment procedures in place. People and their relatives told us there were not enough staff at all times to meet people’s needs. During the days of our inspection however we found there were enough staff to meet people’s needs. The manager told us they felt problems arose when staff were not effectively deployed and they were working to address this issue. We will monitor progress with this at our next inspection.

People gave us mixed feedback about the food but said they had enough to eat and drink. Nutritional risk was monitored and plans were in place to reduce risk. People had access to a suitable range of health care professionals and staff made appropriate referrals when needed to meet people’s needs. Staff sought consent from people when offering them support. The service acted to comply with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), where people had been assessed as lacking capacity to make certain decisions about their care and treatment.

People told us they were well looked after and comfortable. People were involved in making decisions about their care and treatment. Staff knew people‘s preferences and respected people’s dignity. There was a calm atmosphere at the home. Relatives and visitors appeared relaxed and said they felt welcome. There was a complaints system readily available and responses had been made in line with the provider’s policy. Annual surveys and relatives and residents meetings were held to capture people’s experiences of care and views about the home and the care provided.

There were systems to monitor the quality of the service which had identified the areas for improvement we found and action needed as a result of audits was recorded and completed.

Some people and their relatives expressed their disappointment at the unavoidable changes in management there had been. Most people and their relatives felt the new manager was making improvements, for others it was too early to be sure. We found the new manager had taken action to address issues they had found promptly and had made a number of changes. They were open to feedback; they had started to build relationships with local professionals and had ideas about how they wanted the home to develop. They were well supported by the regional operations managers. Staff were positive about the impact of the new manager and felt they were working better as a team.

After the comprehensive inspection, the provider sent us an action plan to say what they would do to meet legal requirements in relation to this breach. We undertook this unannounced focused inspection on 24 June 2016 to check that they had followed their action plan and to confirm that they now met legal requirements.

At this focused inspection we looked at aspects of the key question ‘Is the service responsive?’ This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Maples Care Home’ on our website at www.cqc.org.uk.

Maples Care Home is a large residential home which provides long term residential care and support, nursing care, dementia care and respite services for up to 75 people.

There was no registered manager in place. The current manager had been employed since February 2016 and was in the process of applying to become 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.

At this inspection we found that people’s care records were accurate and reflected their current needs and preferences to guide new and unfamiliar staff. There was a system to audit and check that care plans remained accurate and reflected any changes to people’s needs.

While improvements have been made and legal requirements are met, we have not been able to review the rating for this key question; to improve the rating to ‘Good.’ This was because at the previous inspection we found, although the provider met legal requirements, some improvements were needed in the provision of activities to meet people’s needs for stimulation and social interaction. We did not inspect this area at this inspection but we will review our rating for the key question ‘Is the service responsive?’ at the next comprehensive inspection.

We carried out this inspection on 27 and 28 January 2016 in line with our special measures policy. We checked what progress had been made in respect of addressing the breaches identified at the August inspection and also carried out a comprehensive ratings inspection.

At this inspection the home was providing nursing or residential care and support to 37 people. There was a manager but no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There had been two changes of manager since the last inspection and the service had been managed by the provider’s Head of Operations on a temporary basis since the end of October 2015 while a new manager was recruited. A new permanent manager had been successfully recruited and was due to start in February 2016.

At this inspection we found considerable improvements had been made in each key question, although we identified a breach of regulations in respect of records of people’s care not always being up to date or accurate. You can see the action we have asked the provider to take at the back of the full version of the report.

There were some areas which required improvement. Staff awareness about how to evacuate people in an emergency was not consistent. ‘As required’ medicines guidance lacked detail to guide staff and pain relief assessments on one floor were not reviewed with appropriate frequency. People gave us mixed feedback about activities and relatives of two people told us they experienced some inconsistency with the way their preferences about their care were met.

People using the service said they felt safe and that staff treated them well. The warning notice we had served had been fully complied with. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. People’s medicines were managed appropriately and they received them as prescribed by health care professionals. Risks to people were identified and monitored. There were enough staff to meet people’s needs and the provider conducted appropriate recruitment checks before staff started work.

Staff received adequate training and support to carry out their roles. They asked people for their consent before they provided care and demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and the Deprivation of Liberty Safeguards (DoLS).

People and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people. People were supported to have a balanced diet.

Regular residents and relatives meetings were held where people were able to talk to the manager about the home and things that were important to them. People and their relatives knew about the home’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

People told us there had been improvements at the home following the arrival of the new owner and manager. Audits were carried out to identify any improvements that were needed. The manager demonstrated leadership skills in changing the culture of the service and working openly and proactively with the local authority and health professionals to improve the care provided. They had identified the areas they needed to improve on. Staff said they enjoyed working at the home. They told us they wanted to provide a caring good quality service and they felt confident they were heading in the right direction under the current manager and the new team that had been appointed. The manager explained it had taken some time to recruit the right staff and management team to take the home forward.

In view of the significant improvements made in each key question the home is no longer in special measures. The conditions imposed on its registration at the August 2015 inspection have also been lifted.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were thirty eight people living at the home. We looked at the personal care and treatment records of people who use the service, observed how people were being supported and the interactions they had with staff, talked with people who use the service and their family members and spoke with members of staff.

Is the service caring?

People expressed their views and were involved in making decisions about their care and treatment. People who use the service were given appropriate information and understood the care and support choices available to them. People using the service told us they were involved in the planning of their care and had been given choices about their support and how it was provided. One person told us, 'I like living here. The staff are very patient and support me with anything I need." One visiting relative we spoke with told us 'I am very much involved with my loved one's care. The staff include me when decisions are made, reviews are conducted and when changes to the care plan is required." People we spoke with confirmed that their wishes and choices were respected by members of staff.

Staff members we spoke with were knowledgeable about people's health and social care needs and how best they can support people to meet their needs. We saw that staff were patient and responded promptly to people's requests for support. One member of staff we spoke with told us, "I'm very happy in my job and enjoy supporting people. We treat each person as an individual and always respect their wishes." Another member of staff said, 'We have a keyworker system in place and this allows us to become familiar with people's needs."

Is the service responsive?

We saw that people using the service were supported in a way that promoted their choice and independence. People's care and support plans were made clear where people were able to manage their own care needs. For example, we saw records to show that one person was able to manage some of their personal care needs. Other support plans identified where people were able to choose their own clothes and arrange their own social activities. One person commented, 'Staff know me well. They are aware of what I can do and how I like things to be done."

People using the service and visiting relatives told us they had visited the home before making a decision about whether they wanted to move in. One person told us, 'I visited the home several times to see if it was suitable for my loved one. We are very happy with the care being given so far and I have absolutely no concerns about the staff or the home." We looked at a sample of peoples care plans and records. These confirmed that people's needs had been assessed prior to receiving support. Assessing and obtaining information about people's needs in advance supported staff to develop people's care plans effectively. Care plans took account of people's strengths, needs, abilities, likes and dislikes and the support they required to enhance their independence.

Is the service safe?

During our tour of the home we noted that many parts of the building were only accessible to staff members. The home used an electronic tag system which allowed members of staff access to all areas of the building. This system ensured the safety of people using the service by limiting access to stairs, lifts and doorways particularly on the dementia floor where some people were at risk of leaving the building. There were arrangements in place to deal with foreseeable emergencies. People using the service had a personal evacuation plan in place which measured the support people required in the event they needed to be evacuated from the premises.

The home had clear procedures on the safeguarding of vulnerable adults from the risk of abuse including how to recognise types of abuse and what action to take. The registered manager showed us the provider's safeguarding adults from abuse policy and procedure and told us this was used in line with the "London Multi Agencies Procedures on Safeguarding Adults from Abuse." The registered manager also showed us the local authority's procedure for reporting abuse and the contact information they had with details of who to contact within the local authority should they have any concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been made and approved. People who use services are only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards. Proper policies and procedures were in place to provide staff with guidance about legal requirements. Relevant staff have been trained to understand when an application should be made, and how to submit one .

Is the service effective?

We observed members of staff speaking with people using the service and their visiting relatives in a dignified and respectful manner. We observed that people's bedroom doors were closed when personal care was provided and saw that staff members knocked on people's doors before entering. We observed that people using the service were well groomed and appropriately dressed. This demonstrated that people's dignity and privacy was maintained.

People were provided with a choice of suitable and nutritious food and drink. Some people using the service were able to make meal choices independently. Other people using the service required support from staff to choose their meals. We observed staff supported people to make choices from the menus that were displayed on each of the tables within the dining room. Where people were unable to make a choice, staff used their knowledge of people's likes and dislikes to make decisions for them. People were provided with an alternative choice of meal if they did not like the day's menu.

Is the service well-led?

Members of staff we spoke with confirmed that recruitment checks were made and that they had an induction period that consisted of training and shadowing other members of staff. Records we examined confirmed that induction training consisted of mandatory areas such as infection control, safeguarding vulnerable adults, Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and the management of medication.

The provider took account of complaints and comments to improve the service. We noted there were three complaints of a minor nature recorded in April 2014 which had been addressed promptly. We observed that the home's complaint policy was displayed within the reception area of the home and people using the service had also been provided with a copy for reference.

We looked at the provider's analysis report for the staff questionnaire that had been conducted in April 2014. Results showed that 81% of staff members were happy with the training provided and 75% of staff were happy with the way the home was being run. We spoke with the registered manager who told us that the home had developed a residents and relative's questionnaire which they plan to conduct in August 2014. Residents and relatives meetings were held on a frequent basis at the home.