Archived: Colebrook Manor

Colebrook Manor provides nursing care and support for older people. The service is registered to accommodate 49 people in one adapted building. The service supports people who are living with dementia, nursing or residential care needs. At the time of our inspection there were 22 people living at the service.

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

The provider had made some improvements in the service. For example, staffing arrangements. However, the provider had failed to act upon known areas of concern to improve the quality of care and safety for people at Colebrook Manor. This had exposed people to on-going poor care and risk of avoidable harm.

There were ineffective systems in place to assess, monitor and improve the quality and safety of the service. People were not protected from the spread of infection. The provider was adhering to government guidelines for working safely in care homes during the COVID- 19 pandemic. However people were not always protected from the risk of infection, because the premises were not always clean and well maintained.

Medicines were managed safely, and people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff knew how to identify and report any concerns. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going.

People told us staff were caring. Staff did all they could to promote independence and we saw examples of this taking place.

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 02 November 2021)

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 some improvements had been made however we found the provider remained in breach of regulations.

The last rating for this service was inadequate. The service is now rated requires improvement. This service has not achieved a rating of good for the last two consecutive inspections. This service has been in Special Measures since 02 November 2021.

During this inspection the provider demonstrated some improvements have been made. However, the service is still rated as inadequate in the well-led key question. Therefore, this service is still in Special Measures.

Why we inspected

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

We undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 changed from Inadequate to Requires improvement. 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.

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

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, leadership and governance and person centred care.

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

Follow up

We will continue to work with the local authority to ensure people's safety. The provider has taken the decision to deregister this service.

Colebrook Manor is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

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

People living at Colebrook Manor did not receive a safe, effective and well led service. The registered provider had failed to ensure that monitoring and governance systems and processes were established and operating effectively to maintain people's safety and welfare.

The service did not have effective and consistent managerial and operational leadership. Staff were committed to providing good care, however, staff did not always receive adequate and effective support to ensure they could carry out their roles to the best of their abilities.

People told us they felt safe and staff were kind and caring. However, our observations and findings showed that people were at risk of receiving unsafe care.

People were not protected from the spread of infection. The provider had failed to ensure government guidelines for working safely in care homes during the COVID- 19 pandemic were implemented and adhered to.

Risks to people's health and welfare had not always been assessed and detailed guidance was not always available for staff to refer to. Monitoring records were not always fully completed.

Pressure relieving equipment in place such as, pressure relieving mattresses, were not always set correctly which put people at risk of skin damage.

Medicines were not managed or stored safely. People had not always received their medicines when required or received them correctly. Where people were prescribed medicines given 'as required', guidance for staff was not always in place. This increased the risk people's medicines may not be given safely or effectively.

The provider did not demonstrate there were always safe staffing levels, this meant people were not always receiving care and support when they needed it.

The provider had failed to ensure staff had the required competencies or knowledge to meet people's needs safely. Staff had not received training to meet the specialist needs of people they supported.

Effective processes were not in place to monitor staff performance, provide feedback or listen to staff concerns. Staff had not had regular supervision, appraisal or team meetings.

People did not always have access to specialist diets in line with their support needs. Concerns were raised with us about the quality, variety and consistency of modified texture diets. The mealtime experience within the service was inconsistent.

Staff did not fully understand their roles and responsibilities under 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; the policies and systems in the service did not support this practice.

People did not live in a service that was properly maintained. We saw some furniture was worn and stained, paint had chipped or worn off doors and skirting revealing bare wood and the carpeting in communal areas looked dirty and heavily stained. People told us their furniture, such as chairs, were broken and they were unable to use them.

People told us they felt safe and staff were kind and caring. At the time of the inspection it was not clear what systems and processes were in place to keep people safe from abuse. However, staff had received safeguarding training and knew what they would do if they thought someone was being abused. We made a recommendation to the provider about reviewing their processes in place to ensure they were robust.

Whilst recruitment checks were in place, full employment histories were not always recorded or corroborated. We made a recommendation about this.

Following the inspection, the provider took immediate action to make improvements, and developed an action plan based on our feedback and their own observations. Prior to the inspection the providers had taken action to strengthen the leadership at the service and had employed a strong management team to support the service.

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

Why we inspected

The inspection was prompted due to concerns received about the provision of basic services; such as hot water, the quality of care, staffing, infection prevention and control, medicines management and governance and leadership at the service. 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.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and staff training, person-centred care, consent to care, the environment people live in and governance systems and processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

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 time frame, 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 of their registration.

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

Colebrook Manor is a care home that is registered to accommodate up to 48 people who required nursing or residential care. The service supported people of different ages who may have physical disabilities and conditions such as dementia, acquired brain injuries and mental health needs. At the time of the inspection 41 people were living at the service. A respite service was offered to people who may require a short term stay, or for people considering a move into a residential setting. The service also supported a local initiative with the NHS to provide assessment and short-term crisis intervention and rehabilitation to help prevent and minimise hospital admissions.

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

The home used an electronic medicines administration system to record when medicines were given to people. Not all nurses were trained or able to access this system. Some nurses recorded medicines administration on paper records. Although we found no negative impact on people in relation to medicines, the inconsistency in recording could increase the risks of mistakes being made. We have made a recommendation about the management of medicines. Immediately following the inspection, the registered provider sent us assurances that they had an action plan in place to address these concerns as as a matter of priority

People told us they felt safe living at Colebrook Manor. Risks associated with people’s health, care and lifestyle were understood by staff and managed well. Staff were employed in sufficient numbers and had the skills needed to provide safe care. People were protected from discrimination and abuse because staff understood how to safeguard people. Systems were in place to ensure the environment was safe, clean and well maintained.

Staff had a good understanding of people’s needs and were trained and supported to deliver skilled, effective care. People’s healthcare needs were met, and people were provided with a balanced, nutritious diet. The registered manager and staff worked across other agencies to ensure people received effective care. Regular reviews with health and social care professionals took place. Feedback from healthcare professionals involved with the service were very positive. They said the registered manager and staff were very responsive ensuring good outcomes for people.

People were supported to have maximum choice and control over 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.

There was a relaxed and welcoming atmosphere between people and staff. Staff knew people well, and were kind, caring and attentive. People and their relatives said they felt listened to and made to feel part of a family. People told us their privacy and dignity was respected and they did not feel discriminated against in relation to their needs or lifestyle choices. People were supported to maintain and regain their independence. Some people had been able to return home after a period of rehabilitation at Colebrook Manor.

The registered manager had worked hard to ensure concerns raised at previous inspections had been addressed and continued to improve. People and relatives were very positive about the management of the service and said they had seen a lot of improvement. Regular audits were undertaken by the provider and registered manager, and both had attended forums to discuss on-going improvement and compliance with the regulations.

Rating at last inspection

We inspected the service in September 2017 and at that time rated the service as Requires Improvement. At the inspection in 2017 the provider was in breach of regulations and we found the service was not always safe or well-led. The provider sent an action plan telling us how they would address the concerns and meet the regulations. Following the 2017 inspection we took enforcement action and placed a condition on the providers registration for them to send us monthly reports detailing their plan to improve and meet the regulations. We inspected the service again in July 2018 and found improvements had been made and the service was no longer in breach of the regulations. We rated the service as Requires Improvement in July 2018 as the provider still needed to evidence these improvements had been embedded and sustained into the running of the service.

This was a planned inspection based on the previous rating. At this inspection we found the provider had continued to make improvements and improvements had been embedded in the running and culture of the service. We have rated the service as Good overall. We did find some improvements were still needed in relation to medicines. We have made a recommendation about the management of some medicines.

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

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

Colebrook Manor is a care home that can accommodate up to 40 people that require nursing or residential care. At the time of the inspection 33 people were living at the 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.

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

When we completed our previous inspection on 12 September 2017 we found concerns relating to people’s end of life care recordings. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area was included under the key question of Responsive. Therefore, for this inspection, we have inspected this key question and also the previous key question of Caring to make sure all areas are inspected to validate the ratings.

During the last comprehensive inspection in September 2017 we found the areas of safe, caring, effective and responsive required improvement and well led was rated as inadequate with breaches of Regulation. We took enforcement action by imposing positive conditions on the provider’s registration. This meant they needed to send us a monthly action plan of the progress of meeting the regulations.

At that inspection we found that people could not be confident that risks to their health and safety had been fully assessed and recorded, or that safe systems were in place to monitor the risks. We also found people's health, safety and well-being may be at risk due to lack of maintenance in some areas of the home at that time. Some aspects of medicine administration were not fully safe. Some staff had not received training on safeguarding procedures People's end of life care was not fully planned with them. Care plans did not fully reflect people's needs or wishes. People were at risk because the provider's systems to monitor the quality of the service were not fully effective and had failed to identify or address areas where improvements were needed. At that time the leadership, governance and culture did not ensure staff had sufficient information to ensure people's needs were fully met and staff were not well supported to enable them to consistently and safely deliver good quality care.

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate in any of the key questions.

This inspection in July 2018 was a comprehensive inspection that looked at all areas of the service again to check the service had addressed the concerns from September 2017. We found people's care at Colebrook Manor had significantly improved in all areas. The service has been therefore rated as Good in effective, caring and responsive. There remained a rating of Requires Improvement in the responsive and well-led sections of the report. This is due to the need for the provider and house manager to demonstrate they can sustain the positive changes that have been made.

The registered manager and provider had put new systems in place to oversee the running of the service and check its quality. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff and professionals said the management team were approachable and had made many improvements since the last inspection. Staff said the management team were involved in the day to day running of the service.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the management team to help ensure its ongoing quality and safety. The provider’s governance framework helped monitor the management and leadership of the service.

The manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People were safe at the service. People, who were able to, said they felt safe living at the service. One person said; “They have nice staff here and I feel safe.” Staff said people were safe; “We check people all the time and make sure they are safe.” Healthcare professionals commented that the registered manager had put processes in place to care for people’s individual needs and, “staff dealt with this safely.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. Robust systems were now in place to assess risks and ensure measures were put in place to further reduce those risks to protect people.

People received their medicines safely by suitably trained staff. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff agreed there were sufficient staff to keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People lived in an environment that was clean and hygienic. Parts of the environment had been refurbished, taking into account people’s needs.

People received care from a staff team who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

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. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People's capacity to make important decisions about their lives had been assessed in accordance with the Mental Capacity Act 2005 (MCA). The provider and staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and met them. People were not all able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans in their best interests. People’s preferences were sought and respected. Care plans held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service was responsive to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

People had access to organised and informal activities which provided them with mental and social stimulation. We found some aspects of this that could be improved however the registered manager was already looking into this.

People’s end of life wishes were documented. People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives.

All significant events and incidences were documented and analysed. The evaluation and analysis of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from other agencies and the staff team.

Further information is in the detailed findings below.

Colebrook Manor is a care home that can accommodate up to 48 people who require nursing or residential care. There were 39 people receiving care at the time of this inspection. A few weeks before this inspection took place the registered manager resigned. A new manager had been appointed in mid-August 2017 and they had submitted an application to register, but this process had not yet been completed. 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.

This inspection was brought forward because we received some concerns and complaints about the service and we wanted to make sure people were receiving safe care. The concerns related to staffing levels, moving and handling procedures, procedures to be followed after a fall or serious injury, and behaviour and attitude of individual staff members. During this inspection we were assured that the concerns and complaints had been taken seriously by the new manager and their staff team, and actions had been put in place to address them and prevent recurrence. While we found no evidence of people being harmed by poor practice at the time of this inspection, we found a number of concerns which meant there was a risk of harm in the future. The providers had failed to implement robust systems to monitor and improve the quality of the service. They had not been pro-active in identifying issues, or dealing with issues promptly when they arose. This meant concerns and complaints may have been avoided if robust systems had been in place.

People could not be confident their personal care and health needs had been fully assessed, or that the staff had up to date information and knowledge on how to meet their health needs effectively. Before people moved into the home information was received from the local authority or hospital which outlined their needs. This information was used as the basis of a care plan for each person. However, care records were not always updated when people’s needs changed and they were not reviewed on a regular basis in order to ensure that information was reflective of people's current needs.

Risks to people’s health and safety had not been fully assessed, and staff did not have sufficient information to ensure the risks were minimised. People who lived with epilepsy did not have risk assessments detailing how to minimise risks from their condition. Where people were at risk of pressure ulcers, pressure mattresses had been put in place but we found three were incorrectly set. Staff had not been given information on the correct mattress settings, and there were no systems in place to monitor the mattresses. While we found no evidence that people had suffered harm at the time of this inspection due to poor risk assessment systems, there was a risk they may suffer harm in the future.

Systems to monitor the maintenance of the home were not fully effective. The overall appearance of the home was bright, clean and comfortable. A new wing had been opened on the first floor since our last inspection and this area appeared bright, modern, comfortable and spacious. However, there were some maintenance problems in some other areas of the home which may compromise people’s health and safety and affected the appearance of those areas. We also found a number of other maintenance issues around the home which had not been picked up through regular monitoring of the accommodation, and there were no plans in place to show when these would be addressed.

People’s capacity to make important decisions about their lives had not been fully assessed in accordance with the Mental Capacity Act 2005 (MCA). Staff were not always working within the principles of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff told us most people would be able to consent to basic care and treatment, such as washing and dressing. However, there were people who lived in Colebrook Manor who would not always be able to give consent to personal care. This was not reflected in the initial mental capacity assessment or reflected in the care documentation.

People were not fully protected from the risks of abuse. Staff assured us they were confident they would recognise abuse and would not hesitate to report any concerns to the manager. However, the training records showed a significant number of staff had not received training or updates on safeguarding vulnerable adults. This meant staff may not always recognise poor practice or potential abuse, and may fail to report their concerns. Some people had asked the home to hold amounts of cash on their behalf to pay for personal items such as toiletries and hairdressing. While we found all purchases had been recorded, there were no checks or audits carried out on the records to ensure the money had been correctly recorded, and safely managed.

Staff did not receive regular individual supervision. This meant any areas of poor performance had not been picked up and addressed through formal management processes. Most staff had received training and updates on a core set of training topics, but the provider did not have an effective system to review training needs and plan future training to ensure staff were competent to meet people’s needs. The lack of regular formal supervision meant staff did not have a regular opportunity to review their individual training needs with their line manager and consider any further training they may need.

Overall we found medicines were stored and administered safely. However, we found some minor issues which highlighted the need for further training, and improve systems for monitoring medicine administration systems.

People’s dietary needs were met. Staff were aware of each person’s individual dietary needs and the care and kitchen staff worked closely together to ensure people were offered meals they enjoyed. The menus offered people a choice of main meals, and the chef was always willing to provide an alternative of the person’s choice if they did not want any of the meals offered on the menus. Staff were attentive at meal times and ensured people received the assistance they needed to make mealtimes an enjoyable occasion.

People living in the home, relatives, staff and visitors spoke positively about the care people received and we found the atmosphere in the home was cheerful and welcoming. There was a stable staff team. Staffing numbers had recently been increased which meant staff were not rushed and had sufficient time to give people quality time, for example by sitting and chatting with them, and doing activities. We found new staff had been carefully recruited. Checks and references had been taken up before new staff began working in the home.

The home employed a full time and two part time activities organisers, and between them they ensured each person’s social needs were met. They consulted with people to find out what they wanted to do, and put in place a programme of activities to suit each person, both on an individual and group basis. Outings were organised, entertainers visited the home, and staff accompanied people for walks and shopping trips. Staff organised quizzes and games. Comments from people included, “Staff come and spend time with me”, “They have a band that comes in and entertainers. They get everyone going” and “All staff are very friendly and come in and have coffee with people.”

People told us they were happy living in the home. We heard many example of praise for the staff team, and we observed staff offering care and support to people in a compassionate and caring way. Comments included, “It’s great. Here I’ve got the carers and nurses on tap. I also like the company, hear voices and people moving around”, “It’s a happy place” and “I don’t think there is anywhere else I’d like to settle”.

There were systems in place to ensure people knew how to raise a complaint or make a comment. A relative told us “If we find anything we want changed, we do say.” A person living in the home told us if they had any complaints they would not hesitate to speak to the new manager and said “She is very good.” The new manager had taken complaints raised with them seriously, investigated them fully and ensured actions were taken to prevent recurrence. However, a book placed in the entrance hallway for people and visitors to make comments had not been checked, and actions not taken to address issues. The manager has reviewed the use of this book to ensure all comments and concerns are addressed promptly in future.

Action we have asked the provider to take for one breach of regulation can be seen at the back of the report.

For all other breaches of Regulations the details are within the key questions and full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We met seven people who used the service and spoke to them about the number of staff on duty. We met and spoke with the deputy manager and seven staff members who were on duty.

On the day we visited we could not substantiate the concerns which were about staffing levels. We saw there were sufficient staff on duty to support people at their own pace.

The care workers that we saw working with people were kindly and respectful. We spoke with people who received care. They told us that the nurses and care staff supported them well and said "'When I ring the bell they are usually there pretty quickly' and another said, 'I don't have to wait long for help'.

They staff we spoke with told us about the work they carried out at the home. They were passionate about the work they did. One told us "I enjoy working here, even when it is busy it is still nice'. Another told us they worked well as a team and covered some vacant shifts to help out. We saw care workers were well organised.

We considered all the evidence we had gathered under the outcome we inspected.

We considered our inspection findings to answer the question:

' Is the service safe?

This is a summary of what we found-

Is the service safe?

We found sufficient staff on duty to meet people's needs. We spoke to seven people who used the service and they were all happy with the care provided. They said they were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home and people were able to say they felt safe living at Revelstoke. One staff member said, 'I think we have enough staff on duty'.

We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. People we spoke with told us 'we are well looked after.' Another said 'I can do whatever I want.'

The care plans we looked at were personal to the individual and gave staff information to follow. This made sure that people received care and support which met their individual needs.

There were suitable safe storage facilities for medication and we observed staff administering medicines competently and safely.

The new provider was keeping people informed of changes taking place and monitoring the service.