Stoneacre Lodge Residential Home

Stoneacre Lodge is a residential care home providing accommodation for people who require personal care. The home can accommodate 31 people. Some people were living with dementia. At the time of our inspection there were 22 people using the service.

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

We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. For example, the outside store for clinical waste was overfull, the carpet on the upstairs corridor was extremely worn, items of clean and dirty laundry were seen on the same trolley, the windowsill in the sluice was damaged and not able to be kept clean. Staff were seen not wearing PPE correctly, touching their masks and on occasions, wearing the same gloves for different tasks.

Risks associated with people’s care had been identified. However, risks to people were not always minimised. For example, the file containing personal emergency evacuation plans was not up to date, people's weights were not reviewed to ensure risks in relation to weight loss were monitored and one person was a high risk of pressure areas, but this had not been reviewed since December 2021.

People's medicines were not always managed in a safe way. Medication systems in place had not been followed by staff to ensure people received their medicines as prescribed.

On the day of our inspection we observed staff interacting with people and found there were enough staff to meet people’s needs. Staff had been recruited appropriately.

The provider had a process in place to record and analyse accidents, this was last completed in October 2021. Analysis of trends and patterns to minimise future incidents, could be improved on.

There was a policy in place to safeguard people from the risk of abuse. A record of incidents was in place which showed actions taken and the outcome. However, this had not been updated since 2020, and we identified one concern that had been reported to the local authority but not to CQC.

The provider’s system for auditing the quality of the service was not always effective. Concerns identified during the auditing process were not always resolved. For example, a pressure cushion audit stated that some cushions were stained but no record of any actions taken. We also found care plan audits had not been completed since December 2021, and the IPC audit not completed since August 2020.

There had been some changes in the management team which had led to the lack of auditing and senior staff having to lead the home with minimal experience of the manager role. The deputy manager post had been vacant approximately six months prior to our inspection, other members of the management team had needed to take time away from their roles. This had impacted on the day to day running of the home.

People did not always receive person centred care and support. For example, dining tables were bare, no placemats or tablecloths, one bedroom had a hole in the door where a lock mechanism had been removed and people could see in to the room from the corridor, the communal area was locked at both exits and limited access to the toilet, bathroom, and bedrooms, personal information was stored in an unlocked cupboard in the bathroom, the food menu was only available in a written format, there were no picture menus and people were not offered choices at lunchtime. Care plans were not person centred and reflective of people’s current needs.

Staff training was out of date with some staff not receiving infection control training throughout the COVID-19 pandemic. Staff informed us they had been given handouts by members of the management team in regard to appropriate use of PPE and infection control.

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 good (published 27 October 2020).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Concerns were identified. As a result, we undertook a focused inspection to review the key questions of safe 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 good to requires improvement based on the findings of this inspection.

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

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Stoneacre Lodge is a care home situated in Dunsville, Doncaster. The care home is registered to

accommodate up to 31 people in one adapted building. The service is provided by Seth Homes Limited. At the time of the inspection the home was providing residential care for 22 people.

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

Improvements had been made since our last inspection which took place in September 2019. We found safer staff recruitment procedures were in place. Also, 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, relatives and staff gave us positive feedback about the home. One person said, “I like living here. Oh yes, they [staff] look after me well. They [staff] are very nice.” Relatives felt their family members were kept safe and well cared for, with staff being very caring and friendly. A relative said, “Everyone is treated with the same with compassion. The staff are very understanding, what I like is the staff are not judgemental.” Management and senior staff were highly spoken of and we were told they were “responsive and professional.”

The service was person centred and risks were well managed. For example, people's medicines were managed safely, and risk assessments were in place to help keep people free from harm. Staff received training in moving and handling techniques for assisting people safely. A relative told us, “The staff definitely know what [name] likes. They know them by name and nature.”

Staff were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns. Relatives told us they felt their family member was safe at the home. A relative told us, “I feel my mother is very safe in the home, she has been there for three years. They [staff] keep me in the loop with everything.”

Positive changes to the environment and in the infection prevention and control procedures were seen. There were sufficient staff available to meet people's needs and to socially engage with them whilst adhering to the current restrictions due to the COVID-19 pandemic. The provider, registered manager and staff had managed the current COVID-19 pandemic well and implemented effective procedures. A relative told us, “They [staff] have responded wonderfully since the changes with COVID. I ring the doorbell and they arrange mum to come to the window. I speak to the staff on the door. They have it arranged well, nothing seems too much trouble for them.”

Governance arrangements were effective, reliable and drove improvements. There were a series of audits which helped the provider and registered manager to identify where improvements were needed to continue to develop 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 requires improvement (published 11 October 2019). 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 the regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

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.

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 requires improvement 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 'Stoneacre Lodge’ 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.

Stoneacre Lodge is a care home situated in Dunsville, Doncaster. The care home is registered to accommodate up to 31 people in one adapted building. The service is provided by Seth Homes Limited. At the time of the inspection the home was providing residential care for 19 people.

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

Improvements had been made and were ongoing, in how people's safety needs were assessed and managed. However, appropriate checks were not fully completed for people who applied to work at the home. Also, 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.

The provider had an ongoing action plan that confirmed what action had been completed to make improvements with targets for future work. The inspection found improvements and the breaches in legal requirements from the last inspection had been met. However, improvements had been slow, and a further two breaches of regulation were found at this inspection. It was clear more time was required for further improvements to be made and those developed, to fully be embedded and sustained.

People told us they liked living at Stoneacre Lodge however, felt there were sometimes not enough staff to meet all their needs. Staff, although compassionate, kind and caring were under pressure to meet people's physical needs and were less able to meet their emotional needs.

Staff recognised the importance of promoting equality and diversity. Staff also maintained people's privacy and dignity when providing personal care and support. Staff training had improved, and staff morale was generally positive. Staff felt well supported by the management team.

People told us they felt safe. The registered manager and staff understood their safeguarding responsibilities to protect people from avoidable harm. People told us their medicines were managed safely. We found medicines were ordered, received, stored, administered and disposed of safely.

People’s needs, and choices were assessed. Care plans had been reviewed and updated to reflect the current needs of people who used the service. Information seen in care plans helped to ensure people's individual needs and wishes were being maintained. There was a limited activity programme available to people. People told us they would like more activities, outings or one to one time with staff. People who used the service knew how to make a complaint. There was a complaints procedure and we saw a system was in place to log any complaints received.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 September 2018) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. We have identified breaches in regulation for staff recruitment procedures and safeguarding people from abuse and improper treatment. Please see the relevant key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe, effective, responsive and well led, to at least ‘good’.

At this inspection we checked if improvements had been made. We found the registered provider had made improvements but not addressed all the concerns raised at our last inspection and the service continues to be rated ‘requires improvement.’ This is the fourth time the service has been rated ‘requires improvement.’

You can read the report from our last inspections, by selecting the 'all reports' link for 'Stoneacre Lodge' on our website at www.cqc.org.uk.

Stoneacre Lodge is a 'care home' that provides care for up to 31 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection 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 management team were unsure about their responsibilities in notifying relevant people in relation to accidents, incidents and safeguarding. We found some potential safeguarding concerns, which had been recorded as accidents but not notified to us or reported to the safeguarding authority. We did not have concerns that these accidents had caused a detrimental effect on people’s health and wellbeing. However, this meant concerns may not be investigated in line with current safeguarding protocols, which could place people at risk.

People received their medicines at the right time and in the right way to meet their needs. However, we found a discrepancy in the stock amount of one medicine and found two staff had not always signed when controlled drugs were administered. These concerns had not been identified on the managers weekly audit of medicines.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

Staff were not provided with appropriate supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. Also, there was no clear system in place to record staff training. Which meant the registered provider and registered manager could not be assured all staff had completed the required training.

Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people's care when necessary.

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.

Staff knew the people they were supporting and provided a personalised service. Support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. This included being helped to maintain good health, through a well-balanced diet.

We observed staff displayed caring and meaningful interactions with people and treated people with respect. We observed people's dignity and privacy was actively promoted by the staff, supporting them in a situation where some people could not speak up for themselves.

A varied range of activities were made available and we saw staff were proactive in engaging people with individual activities which most people enjoyed.

The registered provider and registered manager had addressed some of the areas for improvement in the previous inspection report. However, issues of concern regarding staffing and good governance of the service were still found. This showed that more in-depth monitoring of the quality of the service was needed.

We found two 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 this report.

Stoneacre Lodge is a care home that provides care for up to 31 older people, some of whom were living with dementia. The home is located in the village of Dunsville, near Doncaster. On the day of our inspection there were 27 people living in the home.

The home 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.

Our last inspection at Stoneacre Lodge took place on 30 November 2016. The home was rated as Requires Improvement. We found the home to be in breach of regulations for safe care and treatment and fit and proper persons employed. Requirement actions were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found improvements had been made relating to fit and proper persons employed. However there were still improvements needed in relation to regulation 12, safe care and treatment. Sufficient improvements had not been made to meet all regulations.

The registered provider had a policy and procedure in place for the safe management of medicines. Staff were not always working in accordance with this policy which could put people at risk of not being kept safe and well.

There was a risk staffing levels could be insufficient for people’s needs to be met in a timely manner. This was because the registered provider or registered manager did not use a dependency tool to assess the number of staff required against the dependency levels of people who used the service.

Checks of the fire systems and fire fighting equipment were not always carried out at the frequency requested by the registered provider.

We received positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe and relatives also said the home provided safe care.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

Staff were not given appropriate support through a programme of regular and on-going supervision and appraisal.

People said they enjoyed the meals provided to them and there was plenty of choice. People could choose to eat their meals either in the dining room or their own room. At lunchtime staff were busy which meant some people had to wait to be assisted to eat.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way. We saw staff advising and supporting people in a way that maintained their privacy and dignity.

The registered provider had a complaints policy and procedure; however written records of complaints and concerns received were not kept.

A limited programme of social activities was in place and people who used the service wanted to be involved in more social activities and outings. An additional activity worker had been recruited and was due to start at the home within the next few weeks.

Staff said communication in the home was very good and they felt able to talk to the managers' and make suggestions. There were meetings for people who used the service, relatives and staff where they could share ideas and good practice.

People and their relatives had been asked their opinion of the quality of the service via surveys and by the regular meetings with the managers.

We identified the current audit systems were not robust enough to effectively assess, identify and act upon, risk and improvements required at the service, in order to demonstrate compliance with regulations.

We three found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

We previously carried out an unannounced inspection at this home on 8, 9 June 2016, where we identified shortfalls in the standard of care. These included shortfalls in the management of medication, induction of new staff and the on-going training of staff members employed and quality assurance systems. Following this inspection, we asked the provider to take action to make improvements.

We undertook this inspection to check that they had followed their plan and to confirm that they now meet legal requirements. We found that the provider had not made sufficient improvements and remained in breach of the legal requirements.

Stoneacre Lodge is required to have 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. At the time of our inspection there was a home manager who was registered with the Care Quality Commission.

Stoneacre Lodge is a 31-bed residential home situated in the village of Dunsville approximately four miles from Doncaster town centre. The home has quiet sitting areas and a large lounge area which looks out on to the front garden and car park. It has off road car parking facilities available. On the day of our inspection there were 28 people living in the home.

People told us that they felt safe living at Stoneacre Lodge and staff we spoke with were aware of how to identify and report abuse.

There were continued shortfalls in the way that medicines were managed. We found that there was a lack of information of when medicines which could spoil had been opened. Stocks of medicines available did not always tally with administration records.

We saw that some recruitment checks had been made, but we could not always evidence that recruitment procedures were robustly followed and that applicants were checked for their suitability, skills and experience.

Staff told us that they received suitable training, although records showed not all staff had undertaken safeguarding training.

We found the provider ensured they acted in accordance with the requirements of the Mental Capacity Act (MCA).

People were complimentary about the support that they received from staff. They told us that staff were kind and caring.

Care records did not always reflect the support that people needed therefore staff could not always understand how to care for the person appropriately. Not all care plans were up to date to reflect changes to people's needs. Daily charts were not always completed fully.

People knew how to complain and told us they would feel able to speak to staff about any concerns.

There were some systems in place to monitor the quality and safety of the service. However, some of the quality assurance systems that the provider had in place were not frequent and did not identify the concerns that were identified on this inspection.

The staff spoke positively about the manager, who they said was approachable and supportive.

Stoneacre Lodge is a care home that provides care for up to 31 older people, some of whom are living with dementia;, the home does not provide nursing care. The home is a two storey building located in the village of Dunsville, near Doncaster. There is a stair lift to the first floor bedrooms.

The service had a registered manager in post at the time of our inspection. 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.

At the time of the inspection 29 people were living at the home. We spoke with twelve people who used the service about their experiences, as well as three visitors. Everyone we spoke with told us they were happy with the service provided and the way care and support was delivered by staff.

People told us they felt the home was a safe place to live and work. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made.

A structured recruitment process was in place to help make sure staff were suitable to work with vulnerable people. However, we found some elements of the process had not been consistently followed.

There were enough staff available to meet people’s needs and many staff had worked at the home for a number of years. This helped to provide people with consistent care.

The service had a medication policy outlining the safe storage and handling of medicines, but we found this had not always been followed. We found shortfalls in relation to the recording and storing of medicines, which could mean people did not receive their medication correctly.

Relatives said they thought staff had the appropriate skills to meet people’s needs. However, we found ancillary staff had not received an induction to the home and their job role and training records were incomplete. Therefore they did not demonstrate that all staff had received essential training.

The service was not fully meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Records showed that most staff had received basic training in this topic and the management team had, or were enhancing their knowledge and skills in these subjects. However, not all the people who used the service had been assessed to determine if a DoLS application was required, and care plans did not always clearly record decisions made in people’s best interest. The deputy manager told us they were liaising with the local authority to address this issue.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided and we saw they were involved in choosing what they wanted to eat. On the day we visited the dining rooms were relaxed and people who used the service were given time to eat their meal at their own pace.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support.

People’s needs had been assessed before they moved into the home. Although people told us they had been involved in these initial assessments and planning their care, this was not always reflected in the care files we sampled.

We found most people had a clear care plan that outlined their needs, risks associated with their care and their preferences. However, on the first day of our inspection we found one person did not have a care plan in place. Although this had not had any adverse impact on the person, staff did not have clear written information about how to meet their needs and manage their care. When we returned on the second day a care plan had been formulated, but assessment tools had not been completed. The deputy manager told us any shortfalls would be assessed as soon as possible.

The home employed a part time activities person who provided two hours of activities a day Monday to Friday. However, there was no organised programme of activities to tell people what was planned and a few people said they often had nothing to do. People told us they had enjoyed the activities they had taken part in.

We saw the complaints policy was available to people who used and visited the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. Complaints received had been recorded and appropriately investigated.

The provider had a system in place to enable people to share their opinion of the service provided and the general facilities at the home.

There was a quality assurance system in place so the provider could monitor how the home was operating, as well as staffs’ performance. However, the systems in place had not always identified the shortfalls we found during our visit.

Our inspection identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The home was clean and fresh throughout. Two visitors we spoke with particularly commented about the cleanliness and lack of odours at the home. We also saw there were effective systems in place to reduce the risk and spread of infection.

Improvements had been made to the general d'cor and furnishing at the home and an action plan was in place to address areas still needing attention.

There were enough qualified, skilled and experienced staff to meet people's needs. We spoke with five people who used the service and six visitors. They told us they felt that in the main there was sufficient staff on duty to meet people's needs. One person told us, 'There is the odd time when all the staff are busy, but usually it's okay.'

Is the service effective?

People's health and care needs were assessed on a regular basis. People who used the service, and the visitors we spoke with, confirmed they had been asked about the care and support people needed. However, care plans had not been signed by them to acknowledge they agreed with the planned care.

The care plans we checked identified people's care needs and preferences in good detail and we saw they had been evaluated and updated as required.

Staff comments, and the records we sampled, showed they had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People were supported by friendly, caring and approachable staff. We saw staff interacting with people in a positive manner. They encouraged them to be as independent as they were able to be while providing support as needed. One person told us, 'They (care staff) care about us. They are always asking if we are all right, you can't ask for anything more.'

People looked well-presented and cared for. The people we spoke with all said they were happy with the care provided and complimented the staff for the way they delivered care.

Staff we spoke with demonstrated a good knowledge of the people they cared for and could tell us about their preferences and individual care needs as recorded in the care plans we checked.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs outside agencies had been involved to make sure they received the correct care and support. For example we saw assessments had been completed to make sure people were eating and drinking enough. Where people needed additional support timely referrals had been made to the GP or other healthcare professionals.

Records showed people had access to a variety of social activities. The home employed an activities co-ordinator and we saw outside entertainment was also arranged.

The home had a complaints procedure which was available to people using and visiting the service. The manager told us one complaint had been recorded since our last inspection and this had been resolved satisfactorily. We also saw thank you cards were displayed complimenting staff for the care and support they had provided.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People's comments indicated they were happy with how staff supported them and the home's facilities.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and internal and external audits. We saw action plans were in place to address any areas that needed improving and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

At this inspection we found that the provider had made sure the issue was addressed and that people were now better protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People were protected from the risks of inadequate nutrition and dehydration. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. There was an effective complaints system available and comments and complaints people made were responded to appropriately.

We spoke to seven people who used the service. They spoke positively about the care and support they received. They told us they were well looked after and liked living at the home. We spoke with two people's relatives at the time of the inspection and one person's relative by telephone. They told us that they visited every day. They said the care was of a very good standard.

However, we found that people's care plans and risk assessment had not been reviewed and updated regularly to reflect their changing needs. Care staff relied on daily records and handovers to make sure that they were kept up to date with people's needs and this meant that people were not protected from the risks of unsafe or inappropriate care and treatment.

We undertook this visit to review the provider's compliance with the compliance actions. At this inspection we found that improvements had been made and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We also found that improvements had been made with regards to the written records, which had been updated and reflected people's needs, so that people were protected from the risks of unsafe or inappropriate care and treatment.