Teignbridge House Care Home Limited

Teignbridge House Care Home Limited (Teignbridge House hereafter) is a residential care home providing personal care to up to 24 people, which includes people on intermediate care stays. At the time of our inspection there were 20 people using the service.

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

Concerns about the management and monitoring of risk had been identified at our last 2 inspections; at this inspection they were still not being well managed. Risks relating to pressure area care, monitoring of bowels and weight were not always effectively monitored. People’s food and fluid intake wasn’t adequately monitored, and staff didn’t always have enough information about how to manage people’s individual health risks. Staff communicated information about people’s health at daily handovers, however, because the information wasn’t written down there was a risk issues identified wouldn’t be followed up. Systems were not always effectively operated to ensure safeguarding was well managed and potential safeguarding concerns were identified.

Whilst some improvements had been made in relation to staff training, not all staff had completed the training required by the service and where they had, care was not always being provided in line with the law or best practice guidance. Only 4 staff had completed dementia training, despite several people at the service living with dementia. No one to one staff supervision had taken place.

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.

Care plans did not always reflect people’s needs and personal preferences and some contained inconsistencies and errors. For some people, this meant there was incorrect information about how staff should assist them. Care plans were not always regularly reviewed to ensure they met people’s current needs.

Following our last inspection, the registered manager, who is also the provider, took the decision to step back from their role. At the time of this inspection, they had not applied to deregister with CQC which meant they were still legally responsible. Quality performance, risks and regulatory requirements were not well managed. There were no systems in place to ensure senior staff and managers had oversight of daily monitoring documents. Whilst audit systems were in place, they had not identified all the areas of concern identified at this inspection, audit tools were not always comprehensive enough to identify risk and where audit systems had identified areas for improvement, action had not always been taken to address the shortfalls identified.

Improvements had been made to the environment, including the management of infection control and fire safety. New equipment had been purchased and we received positive feedback from health professionals who felt people’s health needs were well managed. People told us they felt safe. One person said, “I love it here, I feel safe.” People’s families told us they also felt people were safe. One relative said they felt their relative was “very safe” and told us, “I don’t have to worry about Mum.”

People were supported to maintain a balanced diet and their care records contained information about their likes, dislikes, and personal preferences. People were supported to access healthcare services and support, and we received positive feedback from health professionals. One said, “I’ve provided them with some extra support, and they give me good detail (about people’s needs) over the telephone.” Another health professional said, “I have full confidence that any health needs will be reported, and any plans I suggest will be actioned.”

People told us they were happy living at Teignbridge House and felt well cared for. One person said, “It’s terrific, better than a 5-star hotel.” Another person said, “It’s nice here, everyone is quite pleasant.” People’s relatives also gave positive feedback. One relative said, “They can’t do enough, I think it’s lovely, and it’s the care that counts.” Staff spoke about people fondly. One staff member said, “It’s like I’ve got 24 grandparents.”

Various opportunities were available for people to interact socially and take part in group and individual activities and hobbies. People’s families commented on an improved culture in the service. One relative said, “The staff seem more dedicated now. I’ve seen a big improvement in the last few months, their general attitude towards the residents is better.” The staff we spoke to gave positive feedback. One staff member said, “I love it here.”

Improvements relating to staffing levels, supporting people to express their views, supporting people to avoid social isolation, complaints, the culture of the service and engaging people, the public and staff had been made at this inspection.

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 14 July 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found whilst some improvements had been made, the provider remained in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s health needs. This included concerns around urinary catheter care and the notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s individual health conditions. This inspection examined those risks.

The provider has employed a consultant to address the shortfalls identified in the service and continues to work with the local authority to make improvements.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, person-centred care, staffing, safeguarding and good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

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

The care home is registered for 24 people, including people living with dementia. At the time of our inspection there were 22 people living at the home, which includes people on intermediate care stays. The registered manager is also the nominated individual.

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

During the inspection a number of concerns were identified and shared with the provider while we were on site. The provider took the concerns seriously and has worked alongside CQC and other agencies to address the issues.

Repeat breaches of the regulation linked to safe care and treatment indicated lessons were not being learnt by the provider. During this inspection, we also found new breaches in other areas of care, such as safeguarding and recruitment, which showed a deterioration in the management of the service.

The provider failed to ensure risks to the health and safety of people were assessed and that all reasonably practicable steps were taken to mitigate those risks. They failed to ensure the environment was safe with shortfalls identified in both fire safety and infection control putting people at risk of harm. We also found people identified at risk of dehydration and malnutrition were poorly monitored as records were incomplete and not reviewed. One person at risk of pressure damage was at increased risk through equipment not being appropriately used.

The provider was not proactive in responding to examples of potential abuse and had not recognised when to report a safeguarding concern. Medicines were administered appropriately but systems linked to management and auditing needed improvement.

Staff recruitment did not ensure candidates were suitable to work in care, and the staffing levels were not based on an assessment of people’s care and emotional needs. Staff said they struggled to meet people’s care needs in the afternoons because of the staffing levels, and people told us staff were too busy to stop and chat. This particularly impacted on people who chose to stay in their bedroom.

People were at potential risk because the provider failed to ensure staff received appropriate support, training, and professional development. The competency of new staff was not assessed to ensure they were safe and knowledgeable in their practice. Staff did not receive appropriate support and supervision to enable them to carry out duties they were employed to perform.

Care plans for people living with dementia did not contain records of best interest decisions or mental capacity assessments. In people’s care plans consent to care was not routinely recorded.

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's individual tastes and dietary preferences were catered for. Catering staff met with people when they moved into the service to ensure they knew their likes and dislikes. Relatives commented staff went the “extra mile” trying different dishes to tempt people who ate little and supplemented meals with snacks, ice cream, fruit, and ice lollies.

It was not always clear from care records or handover records whether health professionals had been consulted or what action was being taken. However, people told us staff knew them well and would notice if they were ill or in pain. For example, one person said, “They do know your needs and will do what they can to help. They know if I’m unwell.” Relatives were confident staff would liaise with other health professionals to ensure people received the treatment they needed.

People’s dignity was not always preserved. People’s clothes and laundry were lost or given to the wrong person. For example, a relative said, “There have been a couple of tops gone missing and we have gained a few…” Other people and relatives said it was an on-going problem.

However, people told us the staff were caring and friendly. They felt safe as staff regularly checked on their well-being. For example, they said, “Good food, good staff…My family are happy with the care. I feel I’m spoilt.” Relatives said staff had a kind way of speaking to people and one described the “wonderful relationship” their mother had with two particular care staff. Another described how they had been so attentive during a rapid decline in health for their relative. Relatives wrote, “She could not have had better care anywhere” and “We are all eternally grateful for your excellent care.”

Care plans did not contain information about how care staff should respond to peoples’ emotional needs. Guidance was not in place for staff to support people’s anxiety or mental health needs. However, we saw people’s end of life wishes were recorded and contained personal details. At the time of the inspection, there was no one receiving end of life care. Conversations with staff showed they knew people well. For example, explaining the actions they would take to support an individual with declining communication, including monitoring their pain levels through their actions and vocal sounds.

People’s complaints were not effectively addressed because there was not a meaningful complaints process. People and relatives told us there were on-going problems with the management of laundry. We checked the complaints file; there was no record of any complaints linked to laundry.

The provider did not have effective oversight of the care provided and the running of the home which meant they failed to comply with regulations, so people were at risk of harm. This meant they also failed to implement improvements at the service in a timely manner.

However, people were generally pleased with the care and said they would recommend it to others. For example, they said, “I wouldn’t go anywhere else. I like it here…”, “I’ve been very fortunate to come here” and “On the whole I like it here but there is room for improvement.” Visitors said they had “peace of mind” knowing their relatives was happy and safe. For example, they said, “I think it’s all very good. The staff are good” and “They genuinely care about my mother…I can go to bed knowing she is cared for.”

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 November 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 the provider remained in breach of 2 regulations and there were also new breaches of other regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 inspection was carried out to follow up on action we told the provider to take at the last inspection. It was originally a focused inspection which we expanded to a comprehensive inspection on the first day due to the level of concerns.

The overall rating for the service has changed from requires improvement to inadequate 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 Teignbridge House Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing deployment, training and recruitment, consent, person centred care, complaints and governance.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

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

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

Teignbridge House is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

Since the last inspection we found improvements had been made in the monitoring systems to improve the safety of the home. However, during this inspection we found some areas where further improvements were needed. We identified concerns over risks associated with the control and management of infections. People were not always being protected from risks associated with their healthcare. We also found that systems for highlighting accidents did not always ensure these were robustly collated, investigated or audited.

There were sufficient suitably trained and competent staff to meet people’s needs safely. Some aspects of staff recruitment could be improved to ensure staff were entirely suitable for the job. Actions were taken promptly after the inspection to improve their recruitment procedures for all future job applicants.

Actions had been taken since the last inspection to improve the management of medicines and we found medicines were now being managed safely.

People’s needs had been assessed and care plans had been drawn up and were regularly reviewed. A new computerised care planning system was in the process of being put in place. People were involved and consulted about all aspects of the service. People told us they were confident they could raise any concerns or complaints, and these would be listened to and addressed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were offered choices in all aspects of their daily lives. They were offered a varied and nutritious range of meals to suit all dietary needs and preferences.

People told us they were happy with all aspects of the service. They told us the staff were kind and treated them with respect. Comments included, “It’s top notch” and “People are looked after lovely”. There was a lively and fun atmosphere in the home, with a range of activities and outings to suit each person’s interests.

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 20 August 2018). We found 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 we found there had not been enough improvements made and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

Teignbridge House 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. Teignbridge House accommodates up to 24 people in one adapted building. At the time of our inspection there were 22 people living in the home.

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.’

Prior to our inspection an incident had occurred involving the lack of window restrictors on a bedroom window and a person had been injured. During this inspection we looked at the actions taken to minimise the risks of similar incidents taking place. We found the provider had taken steps to ensure other people living in Teignbridge House were protected from similar risks.

All the people living in the home needed help from staff to take their medicines. When reviewing people’s medicines, we found a number of inconsistencies between the number of tablets people had in stock compared to the numbers recorded. This meant it was not possible to tell whether people had been taking their medicines as prescribed by their doctor.

We found records were not always accurate. For example, we found some falls people had experienced had not been recorded in the accident book or the falls diary. People’s care plans were highly detailed however, and contained lots of clear guidance and information for staff on how best to support people.

Although action had been taken to implement improvements following our previous inspection in relation to the monitoring of the service, we found concerns remained as issues relating to medicines had not been identified. This meant the service was still in breach of regulation with regards to good governance.

We found the systems in place to manage the laundry in the home were not effective. People’s clothes were regularly getting lost or mixed up with the laundry of others. Complaints had been made by people in the home and by relatives. The registered manager told us they were in the process of reviewing the systems in place to manage this and were going to be allocating specific hours for staff to oversee this and ensure these issues were dealt with.

Action had been taken to ensure staff understood the Mental Capacity Act 2005, the principles of the Act and how to apply these. We found people were involved in all aspects of their care and their consent had been sought prior to any care being delivered.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staff knew how to recognise possible signs of abuse in order to protect people. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal.

The people who lived in Teignbridge House were provided with care which was person centred and met their individual needs. People and staff told us they were confident people living in Teignbridge House were receiving a good standard of care. Comments included; “You’d go a long way to find a better place than this, they’re remarkably good here at taking care of you, at first I was sceptical, but I can’t fault it, I am perfectly happy” and “On the whole when you get to this stage in life and come to live in a place like this it’s very good.”

We received some very positive feedback from everyone we spoke with about the caring nature of staff at Teignbridge House. People made comments including; “Yes it’s very good, in fact it’s excellent and the staff are all lovely”, “The carers are very good, one of the best around I would say for everything” and “They’re all very polite, they are human beings and they do a marvellous job and cope with so many situations, I feel very well cared for.”

People were supported with their wellbeing when they were at risk of isolation. One person told us they had needed to stay in their room for a few weeks because of their health. We asked them if they ever felt lonely and they replied; “If I ring the call bell they come very quickly, even at night.” They also said; “Someone usually pops in every half hour or so anyway, they all come in.”

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. People were provided with enough food and fluids to meet their needs. Care was taken to ensure people enjoyed their food and it met their personal preferences. Comments from people included; “The food is lovely. That’s why I’ve put on a stone since being here” and “Yes, the food is very good, there’s soup and two choices, if you don’t like the choices you can have something else.”

People had access to activities which met their needs. The home hired an activities coordinator who was continuously looking for ways to improve people’s lives through activities and engagement. They told us about a project they had set up called the Penpal project alongside the local junior school and how much people enjoyed this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not always being safe from risks relating to the management of medicines, records not always being accurately maintained and the systems in place to monitor the service not always being effective. You can see what action we told the provider to take at the back of the full version of the report.

Teignbridge House Care Home Limited provides personal care and support for up to 24 people. There were 22 people living at the home at the time of this inspection. Teignbridge House cares for older people including people living with dementia. If people needed support with any nursing care needs this was provided by the local community nurses.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager is also the registered provider of this service. 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 provider did not have effective systems in place to monitor the service and ensure the service ran smoothly. Some management tasks had been delegated to senior staff, such as staff training, care planning and reviews. However, the provider did not regularly monitor these to ensure all tasks had been completed safely and effectively. For example, when staff had completed training this had been recorded by a senior member of staff on individual training matrix. The provider did not have systems in place to check that staff had received training and were competent in areas they had identified as essential. After the inspection we spoke with the provider and the senior member of staff and they took prompt action to improve their training matrix, identify gaps in training and put in place a plan to ensure essential training topics are completed in the near future. However, the lack of a robust quality monitoring system meant there was a possibility the provider may fail to identify staff training needs in the future.

We found that some staff had not completed training on topics such as the Mental Capacity Act 2005 and did not have the knowledge or information necessary to ensure that the service was working within the principles of the MCA and that people’s best interests were met with the least restrictions possible. The provider did not have an effective quality monitoring process to help them identify areas where they were failing to meet current legislation. The provider had received advice in the last year from the local authority Quality and Improvement Team (QAIT) to help them draw up their own service improvement plan. However, the plan had not been regularly reviewed or updated and therefore was not fully effective.

People’s capacity to make decisions had not been formally assessed, and staff did not have sufficient information or training to ensure they followed the principles of the Mental Capacity Act 2005. After the inspection a senior member of staff told us they were booked to go on a training course provided by the local authority in the near future and they planned to complete mental capacity assessments for people living in the home after they have completing the training.

There was a warm and welcoming atmosphere. People told us they were happy living in the home. Comments included “People seem so happy here”, “I couldn’t be happier anywhere than I am here”, and “Absolutely perfect!” A visitor told us “I would say it is almost exceptional. Very caring staff. Regular staff. They don’t have lots of staff changes. I am really impressed with this care home.”

People told us they felt safe. They told us there were enough staff to meet their needs and ensure routines ran smoothly. Call bells were answered promptly. Staff turnover was low and staff recruitment records showed that staff were carefully checked to ensure they were suitable for the post before they began working in the home.

Risks to people’s health and safely had been assessed, regularly reviewed, and measures had been put in place to minimise risks where possible. Treatment and advice had been sought where necessary, for example advice had been sought from the Speech and Language Therapy (SALT) team for any persons at risk of choking.

All areas of the home were safe, clean, homely and comfortable. The provider told us about plans for redecoration and improvements in the near future. Staff took good care of people’s laundry and followed safe infection control procedures for soiled items. Staff also took a pride in ensuring people slept in beds that were comfortable, clean, and well-made. The kitchen had been inspected by the Environmental Health department and had been awarded the highest rating which showed they followed safe food handling and hygiene procedures.

Medicines were stored and administered safely. Each person had a secure medicines cabinet in their bedroom and received individualised support with their medicines according to their wishes and ability. Some people had chosen to administer their own medicines and they were supported to do so safely. Medicine errors rarely occurred, but when they did there was an ethos of learning from mistakes, reviewing their practice and making improvements promptly where necessary. Most medicines records were accurate and well maintained. Where we found some aspects of recording some controlled drugs and creams could be improved, the provider and staff took prompt action to improve their recording systems and ensure safe practice is followed at all times.

People told us the care they received was effective. Staff were experienced, well trained, and understood each person’s needs. Staff were well supervised and supported, and there were daily handovers, staff meetings and communication systems in place to make sure staff understood any changes in people’s care needs. People were supported to attend medical appointments when necessary. Medical advice and treatment was sought promptly when necessary.

People told us the staff were caring. During the day we saw staff interacting with people in a warm and caring manner. Staff were patient, gentle and kind in their manner. There were lots of smiles and laughter. Staff spent time with each person, chatting and making sure people were comfortable. A visitor told us “They are always so pleasant. I have never heard a cross word from any of them.”

People were fully involved and consulted in drawing up a plan of their care needs before they moved in. People held their own care plans in their bedroom and told us they could look at their care plan at any time. The plans were reviewed and updated every month. People told us they were confident the care plans were correct and staff gave them the care and assistance they needed.

Two activities organisers were employed, and between them they provided a full programme of group and individual activities to suit each person. Group activities were provided every weekday, mornings and afternoons. These included games, quizzes, arts and crafts, and musical entertainments. Fifteen people attended a group activity on the afternoon of our visit and we saw people smiling, happy and enjoying the interaction. Staff also spent time with people on a one-to-one basis each week, and gave special attention to people who had few visitors, and those who preferred not to join in group activities.

People told us the service was well run. People were involved and consulted in various ways. Resident’s meeting were held regularly and these were minuted and actions taken where necessary, for example, name badges had been provided for staff after people had requested this. People’s views had also been sought through questionnaires. People told us they were confident they could make a complaint if necessary and their complaint would be listened to and acted on. Staff told us they were happy in their jobs and felt well supported.

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.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

People who lived in the home told us they felt safe and were well treated by staff. When asked if they ever had been treated badly or witnessed anyone else being treated badly, one person said "All the staff are lovely. There isn't one problem at all. If there was I can approach any of the care staff". We observed staff talking to people in a patient, friendly and supportive manner throughout our inspection.

People were protected from abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. All staff had completed safeguarding training as part of their induction.

Personal emergency evacuation plans were available for each person. We found that the home was set to respond to emergencies without delay and there was clear protocol set out. This meant the disruption to people's care and welfare would be minimised.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's human rights. The Registered Manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the Registered Manager was aware of when an application should be made and knew where to go if an application was required.

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily and monthly internal audits. These audits included monitoring checks on the safety and maintenance of the home.

Is the service effective?

We observed people decided where and how they spent their time. People who lived in the home expressed their views and were involved in making decisions about their care. We spoke with five people who lived in the home. They told us they were able to make their own daily living choices such as meals and activities.

One person told us "We always get a choice of meals and you can ask for an alternative if you like". Another person said "You can have company or privacy as you like. You can watch TV with others in the lounge, or sit quietly in the other lounge or watch TV in your own room".

One person told us "When I first came here they asked me in detail what I liked, this is as close to home life as you can get. Just without the chores". They added "I'm very lucky to be here and enjoy my life".

We looked at three care plans and saw that the plans detailed people's preferences regarding personal care routines, food, interests and social activities. Records showed that people or their representatives had been involved in developing the care plans. The Registered Manager said they had regular discussions with each individual and updated the care plans on a monthly basis. This helped them to plan ways of supporting people to improve their quality of life. One person said "I don't need to look at my care plan; it's so personal you just tell the staff and they always fit in with your preferences".

Is the service caring?

People were supported in promoting their independence and community involvement. They told us they regularly went out into the community either with their family members or with support from the staff. People went out for walks, shopping, coffee, the garden centre and trips to places of interest.

One person said "We have little trips out, but it's your choice you can stay home if you want. There's no pressure, just whatever makes you happy".

We saw that attention was paid to people's appearance including their hair and nails. All clothes worn by people were clean, smart and reflected people's individual styles. This showed that staff recognised the importance of helping people to look their best. All staff spoken with told us how they ensured people's privacy, dignity and independence. People who used the service told us staff offered them choices and help when needed.

One person told us "I was living alone and I'd reached a point where my relatives were my daily carers." They added "Since my move here I'm very satisfied with the staff supporting me and my relatives just come to enjoy my company."

A staff member told us "It is very important to ensure people are treated with respect and treated as individuals." We saw staff demonstrate this during our visit. Another person told us "I spend a lot of time talking with people to find out just what they like and what they are like as a person". This meant people's rights, choices and diverse needs were being met.

Is the service responsive?

We saw strategies for managing risk were incorporated into care plans and these balanced safety and effectiveness with the right of the individual to make choices. All documents were focussed around the needs of that person and what specific issues were going to cause risk, for example falls. These were reviewed monthly or as required. Care plans showed that the person was the centre of the planning, taking into account their mobility, social care and health requirements. Risk assessments outlined how to manage risk so that the level of risk was reduced. For example pressure sore assessments were regularly assessed with appropriate support from the District Nurse as required.

One person told us "I've got everything I need and more here." Another person told us "I don't have any complaint, but would be happy to talk to the staff if I did."

Is the service well led?

Staff were monitored and supervised in their role to ensure they knew how to provide a high standard of care. There were staff meetings, with daily communications during handovers and important information shared with the communication book. Staff told us they felt comfortable raising issues with the management of the home and they were confident they would be listened to and action taken if needed. Staff training was monitored so that any gaps could be identified and training booked. This meant there were processes in place to ensure staff received the support they needed to carry out their roles effectively.

One person told us "This is a lovely place to work, we all get on well with each other and support each other." They added "I'm fully supported and have an excellent manager that I can approach easily with any concerns or suggestions".

We saw that medication was stored securely. We saw that the medication systems in use meant people had their medicines at the time they needed them and in a safe way.

The provider had carried out appropriate checks to ensure staff were suitable to work in the home. Staff had not started work until the checks were completed.

Care workers received appropriate training so they could carry out their job role effectively. People who live in the home told us care workers were competent and knew how to meet their needs. Comments included 'the staff are very good' and 'I'm very happy with the staff'.

There were systems in place to monitor the quality of the service provided. People who live in the home told us 'nothing could be better' and 'there's nothing to grumble about'. Care workers we spoke with told us 'It's much better now' and 'things have improved, we can see the difference'.

We found that records were accurate, kept securely and could be located promptly when needed.

During our observations and conversations, we saw care workers treating people with respect. People told us "the staff are brilliant' and 'the staff are very kind'. People who lived in the home told us they were happy with the care they received. Comments included 'it's lovely here' and 'nothing could be better'.

Some medicines were not stored safely. We also found issues relating to the administration, recording and disposal of medicines.

Recruitment procedures were incomplete. For example, two care workers had recently started to work at the home before essential checks had been undertaken. We found staff had not completed some areas of training to keep them up to date with current best practice.

There was a basic quality assurance system in place. Concerns which had been identified had not been put right by the service through the use of their monitoring systems. We found records were not kept in a way that protected people's safety and welfare. The care plans were not written in enough detail to ensure that care workers could follow the instructions.