Orchard Manor Care Home

We found the following examples of good practice.

¿ Relatives spoke positively about the home and comments included; "Staff are always kind and caring. They know [Name] really well and fully meet their needs", "Staff keep in regular contact about [Name] and I am welcome to call anytime", "Full PPE is supplied and worn during visiting, staff wear PPE including mask" and "Staff interactions have always been caring and natural."

¿ A relative spoke positively about the end of life care their relative had received during the pandemic. Their comments included; "The end of life care was superb. Staff wore full PPE at all times when caring for [Name]. Any issues were promptly addressed. The management team were very responsive."

¿ Relatives told us they had previously participated in garden visits and inside visits with screens in place. They said these were pre booked and well managed.

¿ The service had received many compliments during the pandemic. Some quotes included; "What an amazing job you do", "All care is delivered professionally, with kindness and dedication" and "We commend you for your courageous work during the pandemic."

¿ All visitors were asked to complete a health screening form, have their temperature checked and were provided with face masks to wear throughout their visit. Full personal protective equipment (PPE) was available for all visitors along with access to handwashing facilities and hand sanitiser.

¿ The service had increased the cleaning schedules and routines to reduce the risks of cross infection. The environment was very clean and hygienic.

¿ We observed staff to be wearing the correct personal protective equipment (PPE) throughout the inspection.

¿ People and staff were taking part in regular COVID19 testing.

¿ People had individual risk assessments in place that reflected their specific needs in relation to COVID19.

¿ Staff had all received training to meet the requirements of their role and for the management of COVID19.

Further information is in the detailed findings below.

Orchard Manor is a residential care home providing personal and nursing care to 89 people aged 65 and over at the time of the inspection. The service can support up to 93 people. It accommodates all people across two separate wings, each of which has separate adapted facilities.

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

We have made a recommendation. It is a legal requirement that we are notified of certain events with the service. Due to a misunderstanding, the deaths of people and altercations between people who used the service involving physical assault had not always been reported to us.

Staff were clear about the types of abuse that could occur and how to raise these. The registered provider followed local procedures reporting ‘low level’ incidents to the local authority each month.

People told us that they felt safe with the staff team and had no concerns about living within Orchard Manor. They told us that the staff team were “Very kind” and that they had been given “A new lease of life” since coming to live there. They commented that the staff team made sure that their living environment was clean and that they always received medication on time and it was “never missed”.

Appropriate numbers of staff were available to meet the needs of people. Some people required one to one support at different times of the day and night. While staff were available to those requiring one to one support; we observed one member of staff leaving the person’s room for brief periods on two occasions. We raised this with the registered manager who dealt with the situation and confirmed it was usual practice for staff to seek other staff to cover their absence.

The environment was well maintained, clean and hygienic. We raised issues with the registered manager in respect of security of the building at night and access to areas that could present a risk to people. These were addressed during our visit.

Medication was appropriately stored, recorded, audited and medication was administered in a person- centred way. The process for recruiting new staff was robust.

The views of people who used the service and their families were sought in order to assess and monitor the quality of the service.

The service worked effectively with other agencies

Rating at last inspection

The last rating for this service was Good (published 30 June 2018).

Why we inspected

We received concerns in relation to the management of medication, staffing levels, arrangements for the safe transferring of people and staff practice. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

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

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

Orchard a Manor 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. Orchard Manor accommodates 93 people in one building which is divided into two distinct units: Maple and Willow. At the time of our visit, 85 people were living at Orchard Manor.

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

We previously carried out an unannounced comprehensive inspection of this service on 12 June 2017. At that inspection we rated the service as requires improvement as a track record of a sustained quality of care was required at that time. No breaches in regulations were identified at our last visit.

Initially we found that the premises were not always safe. A cleaner’s cupboard containing chemicals, a sluice room and rooms used for storing equipment were not locked. Staff were observed entering these rooms and then leaving them unsecured. This could potentially pose a risk to people who used the service. Subsequent evidence was provided to us by the registered provider outlining the action taken to ensure people were not at risk of harm.

In addition to this, we found initially that information was not always stored securely. This related to the security of personal, sensitive information relating to people who used the service. Cupboards containing sensitive information located in one communal area were not locked. In addition to this, some confidential information had been left on a desktop. Evidence given to us subsequently by the registered provider outlining the action to ensure that all personal information was kept secure.

Prior to our visit, we received complaints about the service which would suggest that people did not receive positive outcomes. We did not see any evidence during this visit to confirm the concerns raised in the complaints. We referred the complaints to safeguarding prior to our visit and the outcome of the investigations was not available at the time of writing this report.

We observed that the was a delay in serving some people their meals and also an instance where a member of staff feeding a resident had to leave few times without explanation to attend to other tasks in the dining room. This was not a reflection on staffing levels which were maintained to reflect the needs of people who used the service. The registered provider subsequently made arrangements to ensure that mealtimes were enjoyable for all.

People told us that they felt safe and that there was always staff around to attend to their needs. They also told us that they received their medicines when required.

Staff were aware of safeguarding procedures and how to raise concerns. They had received training in this and outlined the types of abuse that could occur. Responses to taking action in the event of safeguarding concerns were not consistent and could compromise any police investigations.

Equipment and other systems in the building were regularly serviced to ensure that they were safe for people to use. The decoration of some areas was beginning to experience wear and tear and the registered provider was aware of this. The premises were clean and hygienic.

New staff coming to work at Orchard Manor were recruited robustly with checks carried out to ensure that they were suitable to work with vulnerable adults.

Risk assessments were in place outlining the hazards faced by people from the environment, risks faced in the support they received as well as risks faced by malnutrition or pressure ulcers, for example. Emergency plans to aid the safe evacuation of people in an emergency were in place and reviewed regularly.

Medicines were robustly managed. Audits were in place to ensure that stocks never ran out and that people received the medicines they required. Staff had received training in medication administration. Medication was given to people in a supportive manner. Consideration had been given to enabling some people to partially self-administer their medication as an aid to encouraging independence.

The registered manager had measures in place to look at lessons learned. This was done in response to specific incidents within the service and whether these could have been responded to in a different and more effective manner.

Staff received the training they required to meet the needs of people. This related to mandatory health and safety topics as well as training in dementia care and safeguarding. Nursing staff were provided with training in clinical issues such as catheter care and tissue viability. Staff received supervision to support them in their role.

The registered provider worked within the principles of the Mental Capacity Act 2005. Applications had been made to the local authority identifying those people who required safeguards to partially deprive them of their liberty in line with their best interests and safety. There was evidence that people’s capacity had been assessed and that a best interests process had been followed to ensure that staff practice was mindful of people’s limitations.

The health needs of people were promoted with health professionals being routinely involved in dealing with health issues as well as routine health checks.

The registered provider had sought to plan the environment in such a way that orientated people so that they could find their way around. Whilst steps had been taken to orientate people within the building, we recommend that the registered provider refers to good practice guidance to ensure that the environment is fully dementia friendly. The inclusion of staff workstations and desks in communal lounges and dining rooms potentially intruded on people’s personal space, howver, subsequent steps had been taken to ensure that workstations had been located elsewhere and did not impact on communal space.

Staff adopted a caring approach when supporting people. Their approach was kind, friendly and informative. When people were distressed; staff adopted a patient and reassuring approach to assist people. Staff described how they would promote the privacy and dignity of people in their care practice. We observed this being adhered to.

The communication needs of people were taken into account. Effective arrangements to communicate with people with sensory limitations were in place. Advocacy was supported within the service with information signposting to local advocacy services available.

Information in relation to activities was incoherent and not necessarily accessible to those who used the service. Two activities coordinators were employed by the registered provider. No specific activities were observed during our visit although evidence was provided to us subsequently to confirm that activities had taken place. Activities coordinators had an extended role in assisting at lunchtime.

Assessments for those coming to live at Orchard Manor covered all their main needs. Care plans were person centred indicating people’s personal preferences. Social care plans were in place.

A complaints procedure was in place. Compliments were displayed in the communal areas.

A range of audits were carried out by the registered provider to check on the quality of the service provided. These included walkarounds undertaken by senior staff. These had not always been effective given that, for example, inconsistencies in the mealtime experience and issues with the safety of the building had not always been identified.

People connected with the service such as health professionals, people who used the service and their families were given the opportunity to comment on the quality of support provided.

Staff commented that the registered manager was supportive and approachable and understood the needs of people. The registered manager was aware of their responsibilities as a registered person. This extended to notifying CQC of specific incidents and displaying the current CQC rating.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane. It is on a bus route from Chester City Centre. There are 93 bedrooms in total divided into two units: One unit provides general nursing and personal care and the other unit provides nursing and personal care for older people with memory impairment. All the rooms are single and most have en-suite facilities. There are also several lounges and dining rooms.

At the time of this inspection visit there were 77 people living at Orchard Manor Care Home. They were supported by a staff team of 125.

There was a registered manager employed to work at the service and they have been registered with the Commission for three months. 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 the last inspection on 8, 21 and 23 November 2016 we found that a number of improvements were needed in relation to people not being protected from the risk of unsafe, restrictive care and treatment. Medicines management was not robust and people were not protected from the risk of inadequate nutrition and hydration. People were not always supported or treated in a dignified way and consent to care and treatment was not always sought. People were not protected from the risk of receiving inadequate care as the quality assurance systems were not effective. Staff did not always receive appropriate support, supervision, induction or training. We asked the registered provider to take action to address these areas.

After the inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches identified. This inspection found that sufficient improvements had been made.

Staff were able to describe the care and support they provided to people as they knew them well. Care plans and risk assessments had improved. Care plans were person centred, reviewed regularly and were up to date. Risk assessments had been reviewed and reflected people’s current needs. Daily notes were completed in detail and reflected what care and support people received. Notes relating to the night time were highlighted as needing improvement at the last inspection. Although this had improved further requirement was needed and a recommendation was made regarding this. Information relating to nutrition and hydration in supplementary records was not always accurate and analysed. A recommendation was made regarding this.

People were provided with a choice of meals. On the whole people were satisfied with the meals provided. People made positive comments about new ‘dementia café’. However, the mealtime experience required further improvements to be made.

Support for the staff team had improved. Staff received supervision and induction and staff told us the management team were more engaged with them and the people who used the service. Staff recruitment was robust. Staff had access to a range of training and refresher training was up to date. Concerns were raised during this inspection that some people required restraint to assist with personal care and that staff had not received breakaway training to ensure this was completed appropriately. This was discussed with the registered manager who said staff would receive appropriate training.

People spoke highly of staff and said that they were caring and hard working. People and their family members said they were happy with the service and had seen improvements since last year. People told us that staff treated them with kindness and respect. They told us staff were mindful of their privacy and dignity and encouraged them to maintain their independence.

The registered provider had established a number of quality assurance audits since our last inspection. These monitored the health, safety and welfare of the people who lived at Orchard Manor. Where action was needed this was overseen by the registered manager to ensure it was completed in a timely manner.

Staff handover sessions were detailed and informative. Each person was reviewed and information included if they had a settled or unsettled night, medication administered and other general concerns and information.

Improvements had been made relating to medicines management and medication administration and this was now safe.

People were safe. Staff understood what was meant by abuse and the different forms this could take. Staff knew and felt confident in being able to report to the relevant people any concerns they may have. Staff confirmed that they had received training in safeguarding people from abuse.

The cleanliness of the service was satisfactory and there was evidence of continual cleaning throughout the inspection visit. Improvements had been made to the environment, however some of the environment would benefit from further improvement such as areas used by people living with dementia and to the refurbishment of some bathrooms. The general atmosphere throughout the inspection days was calm, relaxed and welcoming.

Staff had improved their understanding of their responsibilities under the Mental Capacity Act 2005 (MCA 2005) and associated legislation. Care records had improved and showed how people could be supported in decision making processes. Mental capacity assessments had been completed and best interest meetings had taken place.

People and family members told us that they had no concerns or complaints about the service. They were aware of and had access to the registered provider’s complaints policy and would speak to staff if they had any concerns.

CQC were notified as required about incidents and events which occurred at the service.

Before our inspection we received concerns in relation to low staffing levels and the right mix of staff being available particularly during the night. We were also informed that people had been locked in their bedrooms overnight; staff had been told to undertake tasks which they did not feel confident to do such as administer medication to a person or assist with nursing procedures for which training had not been received; lack of training specifically in fire awareness and evacuation procedures. Other concerns included restrictions on the use of incontinence products. Members of the public had also raised concerns about the poor care people were receiving and anxieties regarding people's safety. This information was shared with the local authority safeguarding team who responded to our concerns and undertook an early morning visit to the service.

Following the concerns raised we carried out an unannounced comprehensive inspection which included a night visit. The first two days were unannounced, 8 and 21 November 2016 followed by an announced visit on 23 November 2016.

The last inspection was undertaken in April 2016 and the service was rated as requires improvement. Breaches of regulations were made with regard to management of medication; cleanliness of equipment, care plans not up to date and ineffective audit systems. An action plan was received from the registered provider and they stated they would be compliant by 31 October 2016.

Orchard Manor is a care home for older people, set in large grounds off Acres Lane. There are 93 bedrooms in total divided into two units: Maple unit has 48 rooms over three floors. Two floors provide care and support for people living with general nursing requirements and dementia care needs and one floor offered residential care. Willow unit has 45 bedrooms over two floors both of which provide care and support for people with nursing requirements and dementia care needs.

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

During our visits we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and relatives told us that the registered provider used a lot of agency staff and that staff were always very busy and rushed off their feet. Some people said the staff were okay and others said staff were very nice.

Although there were enough staff working within the home, we found that the deployment of some of the staff and their level of knowledge to support the needs of people who lived at Orchard Manor was not sufficient to meet people's needs.

Risks to people’s health and safety were not always identified. Some people required the use of bedrails to ensure that they were safe whilst in bed. There were risk assessments in place for the use of these in some but not all of the care plans. However, the documentation failed to demonstrate why they had to be used or what risks were to be mitigated. We identified the possible entrapment risk of a person using their own headboard and noted that this had not been risk assessed. This meant that people could be left at risk of harm or injury.

We found that medicines were not managed safely. We found that four people were not given the right dose of medicine on some days and medicine administration was not always recorded accurately. Staff did not carry out adequate checks to make sure medicines stored in refrigerators were kept at the right temperature.

Checks on pressure relieving equipment were not robust. We found that out of four mattress settings one was set too high and one set too low. The other two mattresses checked showed one had a dial that had no information to indicate if the setting was correct and the other had an on/off switch. Records indicated that these were not set correctly. If equipment is not set correctly this could be detrimental to a person’s skin integrity.

People told us they were not happy with the food. They said the food was ‘horrible’, ‘abominable’ and ‘food is bland and tasteless’. Other people said the food is variable and some meals were nice. We saw that people waited up to 45 minutes at the table before they were served their meal and we found that the dining experience did not promote a positive experience for people.

Care plans did not always record people’s needs and preferences or not always reflect how people wished to be supported. Food and fluid charts were not accurately recorded to show what people had consumed on a daily basis. However care plans did contain information about people’s wishes with regard to end of life care and staff were aware of decisions made with the GP and people who were supported. Appropriate referrals to other healthcare professionals had been made where concerns had been identified in regard to people’s health.

The quality assurance systems in place were not effective and did not identify, assess or monitor the quality, care and facilities provided to people who used the service. Issues we found during our inspection had not been identified or addressed by the registered provider or registered manager.

Fire safety management within the home required reviewing. The fire risk assessment identified concerns in August 2016 which had not been addressed. We saw no evidence of evacuation training for staff to ensure people would be appropriately supported in the event of a fire. Some doors were propped open with wedges or items of furniture. We have raised our concerns with the fire authority and they have responded to our concerns and carried out a visit.

During the last inspection we raised concerns about the lack of training and awareness of the staff team about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). We found that staff had still not received this training. Staff were able to talk to us about what they understood by mental capacity, that it is related to specific decisions and that it could be variable. Staff also were able to explain how, on occasion, they had to make decisions for someone and ensure that these were in their best interest. However, we found that the ‘best interest’ principle was not always put into practice or evidenced within care plans and risk assessments effectively.

Staff attended annual training sessions in areas such as moving and handling, infection control, health and safety and safeguarding.

The service was clean and free from offensive odours.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review, and if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

Orchard Manor is a care home for older people, set in large grounds off Acres Lane, near Chester. It is on a bus route from Chester City Centre. There are 93 bedrooms in total divided into five units: Two of the units provide general nursing and personal care and three of the units provide nursing and personal care for older people with memory impairment. All the rooms are single and most have access to en-suite facilities. There are also several shared lounge spaces and dining rooms.

At the time of this inspection visit there were 85 people living at Orchard Manor Care Home. They were supported by a team of 125 staff which consisted of nursing, care and support staff.

There was a registered manager employed to work at the service and they had been registered for 18 months. 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.

During our inspection 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.

We had concerns regarding the cleanliness of some of the equipment and the premises; We found that some areas of the home and pieces of equipment were not clean. For example handrails on corridors were chipped and damaged and walls had dried drinks splashed up them. Toilets and commode seats were dirty on the underside and fridges were unclean and food was not labelled. This meant that people could be at risk of infection or living in an unclean environment.

We saw that medication administration was not safe. Systems were not in place to ensure people received their PRN (when required) medication at appropriate intervals and times, allergy information was not included in the medication record sheets, and temperature checks on medication stock rooms and fridges were not always completed and appropriate guidance was not always followed. This meant that people could not always be confident that medication was accurately administered and processes followed.

We found that care plans contained information about the support people required, however this was not always up to date or accurately followed by staff. Information regarding pressure area care was not accurate, up to date or reviewed. This meant that people were at risk of further deterioration of pressure areas due to a lack of information and monitoring controls.

Although the registered provider did have a quality assurance system in place this had not identified any of the concerns we raised which meant that shortfalls in the service provision were not identified or addressed.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “The staff are lovely”, “The staff are caring and always help me” and “The staff are very good.”

People said they enjoyed the meals. Comments included “The food is good”, “The food is very good” and “The food is good quality and I get a choice of meals.”

The registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Policies and procedures relating to the safeguarding of adults from abuse were available to the staff team. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge or the local authority safeguarding team if appropriate.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibility in relation to DoLS and when this needed to be applied.

Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and caring towards people who lived at the service.

There were good recruitment practices in place and pre-employment checks were completed prior to a new member of staff working at the service. This meant that people could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable people.

Staff had completed a range of training and had regular supervision sessions and the opportunity to discuss their work and training needs. Activities coordinators were employed at the service and a range of activities were undertaken throughout the week.

People told us they would approach the management if they had any concerns about the service. We reviewed the complaints policy and the documentation used during the complaints process. People had access to the complaints policy and this helped ensure that people had the opportunity and were encouraged to raise concerns or voice their concerns.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home and grounds were well maintained. Regular checks were carried out at the home to ensure people were safe. Risks to people's health, safety and wellbeing had been identified and acted upon as required. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

The manager set the staff rotas, taking people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Systems were in place to make sure that managers and staff learn from events such as falls, accidents and incidents, which reduced the risks to people who used the service.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights were safeguarded.

Is the service effective?

People were happy with the care and support they received. Comments included: 'Couldn't ask for better'; "I am happy, they treat me well and there's plenty to do"; "They look after us well".

Staff had all the information they needed to meet people's needs and they ensured people received the right care and support.

Staff were respectful and polite towards people who used the service and they involved people in their care and the day to day running of the home. People's preferences and choices were understood and respected.

Is the service caring?

People who used the service and their relatives told us that staff were kind, polite and caring towards them. We spoke with 16 people who were living in Orchard Manor. People told us they were always given choices and had never been forced into doing anything against their wishes. One person who used the service said; 'They listen and respond to what I want.' Staff spent time with people and respected their wishes. People's religious and lifestyle choices were understood and respected.

Is the service responsive?

People could regularly take part in a range of activities in and outside the home.

People were given opportunities to put forward their views and opinions about the home and the way it was run. Any ideas people had for improvement were listened to and acted upon.

On the whole people's requests for assistance were responded to in a timely way, although some people said they had to wait for a while when they requested assistance, particularly in the early morning.

The home had a complaints procedure but not all people were aware of it. The manager said they were in the process of reviewing the procedure and would be sharing it with everyone who used the service and providing staff with further training in handling complaints. We looked at the records of how written complaints had been dealt with, and found that the responses had been open and timely.

Is the service well-led?

The home had a manager who had previously been registered by CQC as the manager of another home and was in the process of applying to be registered as the manager of Orchard Manor.

The provider visited the home one day a week and the area manager visited two days a week. People who used the service, relatives and staff knew who they were and said they were approachable.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

The people we spoke with said that their needs were met and they were happy with the care provided. One person said "I am pleased with the care". One relative said "It's as good as it can be" and another said "I am very satisfied with the care".

People said that they enjoyed the meals and staff knew their likes and dislikes. Comments included: "The food is excellent"; "The meals are very nice"; "The chef is wonderful". A relative said the food was of good quality with plenty of choice, and that staff gave his wife the appropriate support she needed to eat. We found that people's nutritional needs were met.

People said they were happy with and confident in all the staff working there and that call bells were answered promptly. Some people said the staff were very busy and the home needed more staff but could not give any examples of people's needs not being met.

There was a staff training programme in place and staff said they felt supported by the management.