Marland Court

Marland Court is a residential care home providing personal care for up to a maximum of 24 people. The service provides support to older people. At the time of our inspection there were 19 people living in the home.

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

People were generally satisfied with the service and told us the staff were helpful and pleasant. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. Staff and people living in the home raised concerns about the staffing levels. The manager made ongoing arrangements to increase the number of staff on duty on the second day of the inspection. We found some gaps in the recruitment records of new staff. There were shortfalls in some people’s care plans and records and risks to people’s health safety and well-being had not always been assessed and managed. The home had a satisfactory standard of cleanliness; however, staff were not always wearing their face masks correctly. Medicines were not always managed safely.

People were mostly satisfied with the food. However, dietary records were not consistently completed and we noted people were not provided with adapted cutlery or plate guards. We made a recommendation to improve people’s dining experience. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; however, there were appropriate policies and systems in the service. There were no mental capacity assessments seen and although Deprivation of Liberty Safeguards applications had been made, the list of applications and authorisations was out of date. We made a recommendation about these issues. Staff received appropriate training. The provider was due to introduce a more extensive training programme. Some areas of the home looked worn and damaged and would benefit from redecoration and refurbishment. We also noted there was a crack in the assisted bath chair which meant it was unsafe to use. The nominated individual had plans to improve the home and started making arrangements to replace the bath chair. People’s mental and physical health needs were not always recorded in their care plan. Staff were unaware of one person’s complex medication conditions and how these impacted on their life.

People’s dignity and independence was not always upheld and maintained. At the time of the inspection, people living on the top floor could not access the ground floor because the passenger lift was not in operation. The lift was unreliable and had broken down previously. The provider had planned arrangements to fit a stair lift. Whilst bedroom doors were fitted with locks which enabled people to open the door from inside without a key, they could not regain access without staff unlocking the door. People had not been issued with keys, which had a potential impact on their independence and autonomy. People also raised concerns about the laundry arrangements. Following the inspection, the manager confirmed the home would be refurbished and the laundry arrangements were under review.

People’s needs and preferences were not always reflected in their care plan. The temporary care plans were brief and lacked detail. One person receiving end of life care did not have a plan setting out their final wishes. Monitoring charts designed to monitor risks were not always fully completed. There was no evidence to demonstrate people were involved in the development and review of their care plan. The manager informed us a new electronic care planning system was due to be implemented. People had few opportunities to participate in activities, which meant they were at risk of social isolation. Following the inspection, the manager advised an activity coordinator would be recruited.

Whilst the management team carried out a series of audits as part of the governance systems, we found a number of shortfalls during the inspection in respect to the management of risks and medicines, maintaining people’s dignity and independence, planning people's care and the completion of records. We also found people were given limited opportunities to express their views. We saw no evidence of group residents’ meetings and people had not been invited to complete a satisfaction survey.

The nominated individual, operations manager and manager were all new to their roles. The nominated individual had purchased the provider company in July 2022 and the manager had been in post two weeks. They were all committed to making improvements to the service and had plans to improve people’s quality of life and the standards in the home. We will check any improvements on our next inspection of the home.

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

Rating at the last inspection and update

The last rating for this service was good (published 5 July 2021). We also carried out two inspections on 23 December 2021 and 26 January 2022, both of which focused on infection prevention and control and were unrated. Prior to this, we carried out a comprehensive inspection 13 March 2019.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing issues, the environment, quality of care, record keeping and the management of the home.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

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

We have identified breaches in relation to the management of risks and medicines, failure to maintain and uphold people’s dignity and independence, planning people's care and the governance and record keeping systems. We also made a recommendation about improving people’s dining experiences. Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

National guidance was followed on the use of personal protective equipment (PPE). Where concerns were raised the registered manager dealt with them promptly. There were supplies of PPE readily available to staff and visitors. Regular COVID-19 testing was taking place.

Staff had received training in handwashing, Infection Prevention and Control (IPC) and use of PPE. There were procedures and risk assessments to manage and minimise the risks COVID-19 presented to people who used the service, staff and visitors.

The systems in place allowed people to be admitted to the home safely. Government guidance on care home visiting, in place at the time of the inspection, was being followed.

The home was clean and uncluttered. Communal areas had been reorganised to promote social distancing.

Further information is in the detailed findings below.

Marland Court is a residential care home providing personal care for up to 24 adults aged 65 and over. At the time of the inspection there were 13 people living at the service.

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

People and their relatives were positive about Marland Court and the care provided. One person said, "Staff speak to me kindly, they are great. They do everything they can to try to help.”

People were protected from abuse and neglect. People lived in a safe environment where there were relatively few incidents or accidents. Risks were assessed and managed appropriately.

Medicines were managed safely by staff who had received appropriate training in the storage and administration of medicines.

The home was clean and well maintained. Staff wore appropriate PPE. People were treated in a respectful manner by all staff. We were assured that infection prevention and control (IPC) measures were appropriately followed.

The home did not have a registered manager. At the time of our inspection it was managed by a person in charge who had previous experience of managing the home.

The management team undertook regular reviews audits and checks. Where issues were identified there was evidence of action taken to improve the standard of care people received.

Some of the service’s policies and procedures were out of date. We made a recommendation about this.

People felt that they were listened to, and took up the opportunity to attend regular residents’ meetings and complete annual surveys about the quality of their care.

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 April 2019)

Why we inspected

This inspection was prompted through our intelligence monitoring system. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key 3 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.

The overall rating for the service is good. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marland Court 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 reinspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area this home was located were commonly known as 'Tier Three Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Most staff, management and visitors were using personal protective equipment (PPE) correctly and there were procedures in place around the use of PPE. Some aspects of the use of PPE needed to be looked at and we saw that by the end of the inspection, improvements had been made in this area.

We noted good practices around the disposal of PPE.

The provider and had processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Processes when visitors entered the home needed to be improved. This was to ensure appropriate measures were in place to prevent people bringing infection into the home. During the inspection, the provider representative implemented additional measures and amended policy in this important area of infection prevention.

Where appropriate, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in 'Tier Three', these visits had been restricted and were only allowed in exceptional circumstances.

Visiting rules and process were communicated effectively to people using the service and their relatives. At the time of the inspection, the provider was in the process assessing alterations to the premises to facilitate safe visiting with relatives and friends. We saw the proposals seemed a suitable way of allowing people to see their loved ones when guidance and legislation permitted.

Infection control policy and people's risk assessments had been considered and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home.

The provider insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

To an extent, people's mental wellbeing had been promoted by use of social media and mobile devices so people could contact their relatives and friends. However, not everyone was shielding and activities could start within the home consistent with guidance. The provider representative said that a programme of activities was to be introduced and staff reminded to encourage people to participate.

Staff had knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

The home was clean and hygienic. A designated cleaner was working throughout the inspection.

Staff had received Covid-19 related supervision and all had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Marland Court is a residential care home that was providing personal and nursing care to 19 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿ People told us they felt safe at Marland Court. Staff understood how to protect people from harm and safeguarding policies and procedures were in line with local authority and national guidelines. Regular checks on the safety and security of the premises were undertaken.

¿ There were sufficient staff to ensure basic needs were met but care staff were expected to undertake regular cleaning and household duties. This meant that they did not always have enough time to attend to their caring and support duties. We recommended that the service reviewed the deployment of staff and consider the impact on people’s well- being.

¿ Any accidents and incidents were recorded., with evidence of learning from incidents and action taken to prevent reoccurrences.

¿ Medicines were well managed. Senior staff had been trained to manage medicines and competency checks were carried out on a yearly basis. People told us they were happy with the support they received to take their medicines.

¿ Having a small staff team meant people were supported by staff who knew them well and how they liked their needs to be met.

¿ Staff told us that they were supported and encouraged to keep their knowledge up to date and were given opportunities to learn. They had access to regular face to face training and were able to apply their knowledge to assist the people they supported.

¿ People enjoyed the food at Marland Court. A visiting family member told us that their relative “Loves the food and woofs it down. We know he's eating: he’s putting on weight". Staff understood and monitored people’s dietary requirements and communicated well with the cook to ensure any changes in need were quickly addressed.

¿ Person centred care and support was delivered by kind and patient staff, and we received positive feedback from people about the caring nature of all the staff at Marland Court. They told us that they had a say in how their care was delivered, and that staff respected their personal belongings.

¿ At the time of our inspection nobody was identified as having any specific cultural or religious requirements or diverse needs, but staff we spoke with understood how to work with people from diverse backgrounds

¿ Care plans provided sufficient information to guide and instruct staff on how to deliver care and support. However, there were not always enough staff to provide stimulation and activities.

¿ The service was well managed by a registered manager who was well respected by the people living and working at Marland Court. She understood her duties and responsibilities and ensured a visible presence throughout the service.

¿ We saw and were told that people were consulted on how they wanted their support to be delivered, and there was evidence of good partnership working, especially with the local authority and commissioning teams.

¿The service met the characteristics for a rating of ‘good’ in the four key areas of Effective, Caring, Responsiveand Well led, and Requires improvement in Safe.

¿ More information is in the full report.

Rating at last inspection:

Requires improvement (Report published 21 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

Our previous inspection in January 2018 (Published March 2018) identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. These were in relation to; the provider had failed to notify the Commission, as required by legislation, that three Deprivation of Liberty Safeguards (DoLS) applications had been authorised by a supervisory body, had failed to display their previously awarded rating as required, had failed to store hazardous substances safely and failed to ensure that staff received appropriate induction and training to a satisfactory level on commencing their employment.

During this inspection we found the required improvements had been made. We will continue to monitor all information received about this service to ensure that the next planned inspection is scheduled accordingly.

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

Marland Court is registered to provide accommodation for up to 24 older people who require personal care. There were 17 people using the service at the time of the inspection. The home is a converted and extended house situated in its own grounds in a quiet residential road; close to the main road that connects the towns of Rochdale and Heywood. There is adequate car parking to the front of the home.

We last inspected Marland Court on 25 and 26 April 2017. During that inspection we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; unsafe and unclean premises, no effective system in place to assess, monitor and improve the quality and safety of the service, insufficient staff on duty, medicines were not managed safely, the privacy and dignity of people who used the service was compromised and suitable and sufficient activities and community involvement were not provided.

Following the last inspection of 25 and 26 April 2017 we took enforcement action in respect of the provider failing to comply with Regulation 12 (2)(d) of the Health and Social Care act 2008 (Regulated Activities) Regulations 20014 (unsafe premises) and Regulation 17 (1)(2)(a) of the Health and Social Care act 2008 (Regulated Activities) Regulations 20014 (an ineffective system in place to assess, monitor and improve the quality and safety of the service). Warning Notices were served on the registered provider requiring them to comply with the relevant regulations within 14 days from the date of the Warning Notices. During this inspection we found that the provider had complied with the requirements of the Warning Notices.

The service was also placed into Special Measures following the last inspection which meant it was kept under regular review and inspected within six months of the last inspection report being published. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the last inspection of 25 and 26 April 2017 we asked the provider to take action to make improvements. The provider sent us an action plan informing us that they had taken action to ensure the regulations had been met.

During this inspection we found there had been a significant improvement and the provider had met all the previously breached regulations. Due to the improvements seen on this inspection the provider has been taken out of Special Measures.

Although we found that improvements had been made, we found further breaches of the Health and Social Care Act 2008 (Regulated-Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was in relation to; the provider had failed to notify the Commission, as required by legislation, that three Deprivation of Liberty Safeguards (DoLS) applications had been authorised by a supervisory body, had failed to display their previously awarded rating as required, had failed to store hazardous substances safely and failed to ensure that staff received appropriate induction and training to a satisfactory level on commencing their employment.

You can see what action we have told the provider to take at the back of the full version of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. 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.

The home did not have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home had appointed a manager who had been in post for approximately nine months. We are aware that the manager had submitted their application to the CQC to become the registered manager.

We saw that, overall, staff treated people with dignity, respect and patience. We did see however that a bedroom occupied by two people did not have a privacy screen in place. We discussed with the manager the fact that this compromised people’s privacy and dignity. On the second day of the inspection a privacy screen was in place.

The medicine management system was safe, although the recording of the administration of skin creams needed to be improved.

People's care records contained enough information to guide staff on the care and support required. The records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

We saw the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

We found people were cared for by sufficient numbers of staff who were safely recruited. Suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. There had been an increase in the activities provided and people told us they enjoyed the activities available.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We saw people looked well cared for and there was enough equipment available to ensure people's safety, comfort and independence were protected. People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People told us they enjoyed their meals. We saw that food stocks were good and people were able to choose what they wanted for their meals.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. Records showed that equipment and services within the home had been serviced and maintained in accordance with the manufacturers' instructions.

Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity or gas supply.

There had been an improvement in the monitoring of the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities for people to comment on the facilities of the service and the quality of the care provided.

Records we looked at showed there was a system in place for recording complaints and any action taken to remedy the concerns raised. Records showed that any accidents and incidents that occurred were recorded and monitored.

We last inspected Marland Court on 25 June 2015 where we found the service was meeting all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home did not have a manager who was registered with the Commission (CQC). There had been no registered manager in post since July 2016. A new manager had recently been appointed but had not started the process of registering with the CQC at the time of the inspection. A registered manager is a person who has registered with the CQC 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 this inspection we found there were eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service. When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The provider had failed to ensure the premises were kept clean and safe. This placed the health and safety of people who lived, worked and visited the home at risk of harm. There were unguarded hot radiators and pipes and some windows were without restrictors. This posed a serious risk of harm to people who used the service. The periodic gas safety check and fire risk assessment had not been undertaken by their due date and there were no records in place to confirm if the periodic inspection of the electrical installation had been undertaken. Following the inspection, action had been taken to address most of the safety issues and we were sent confirmation that the gas and electricity facilities had been serviced and the fire risk assessment had been undertaken. During the next inspection we will check if the outstanding safety issues have been addressed.

There were not enough staff on duty at all times to ensure that people were adequately supervised and cared for safely.

Medicines were not managed safely. The storage and disposal of medicines was not as safe as it should have been and people were at risk of not getting their medicines in accordance with their needs and wishes.

The privacy and dignity of people who used the service was compromised. This was because there were no locks on toilet and bathroom doors and the bedroom of one person who was in hospital was being used by another person. Since the inspection we have been told that locks have been fitted to the toilet and bathroom doors. This will be checked on the next inspection.

Suitable and sufficient activities and community involvement were not provided to help promote people’s well-being.

There was no effective system in place to assess, monitor and improve the quality and safety of the service. Some of the systems that were in place did not identify the issues of concern that we found on this inspection.

Although staff received the essential training necessary to enable them to do their job effectively and care for people safely we have recommended that the induction programme be improved. This will help to ensure staff are prepared for their role by assisting them to develop their knowledge, skills and understanding .

A complaints procedure was in place and readily accessible to people. It did not however document the CQC contact details; necessary to ensure that people, if they wished, were able to refer their concerns to CQC.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

People’s rights were protected as the manager knew the procedures to follow if people were to be deprived of their liberty. The manager had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

We saw people looked well cared for and there was enough equipment available to ensure people's safety, comfort and independence were protected. People told us they felt the staff were kind, helpful and caring.

People's care records contained enough information to guide staff on the care and support required. The records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People told us they enjoyed their meals. We saw that food stocks were good and people were able to choose what they wanted for their meals.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. The service 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.

During our inspection visit we spoke with one person who used the service, two care workers, the manager and the deputy manager. We also looked at medication and care records and staff training records.

We found that records for the management of medication were up to date and accurate. However, we also found that medication was not always given to people at the right time in relation to food. With the exception of pain killers medication was given to people between 8am and 8pm. Giving people their medication at the wrong time in relation to food and not allowing sufficient time to elapse between doses could seriously affect the health and wellbeing of people who used the service.

Discussion with two care workers and examination of records confirmed that all members of staff were required to attend moving and handling training annually. One person told us she felt safe living at the home and said, 'The staff are excellent.'

We saw that care records lacked the information required in order to ensure people received safe and consistent care.

Is the service safe?

We saw that people were treated with dignity and respect. Two people told us the home was a safe place to live. One person told us they would tell a member of staff if they were unhappy about anything and said, 'I can talk to them.'

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Policies and procedures were in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Recruitment procedures were thorough and made sure that all the required information was obtained before any new employees started working at the home. These procedures helped to protect people from the recruitment of unsuitable staff.

Medication was managed and administered by members of staff who had received training in the management of medication. However, we saw that some of the medication administration records had not been accurately completed. Although there was no evidence of any medication errors a lack of clear records increased the risk of mistakes being made.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medication.

Is the service effective?

People's health and care needs were assessed with them or their relatives before they were admitted to the home. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people's changing needs.

We found that people's weight and appetite was monitored. When any problems were identified advice was sought from the doctor, speech and language therapist and dietician. We saw that care workers were attentive to people's needs at lunch time and sat next to the people who required assistance to eat their meal.

Discussion with care workers and examination of records confirmed that induction training was in place for new employees. In addition to this a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that members of staff spoke to people in a courteous and friendly manner and offered appropriate encouragement when supporting people. People who used the service told us they liked living at the home and received the care and support they needed. . One person said, 'The staff are very nice and friendly.' The relative of one person said, 'They're doing a good job. The staff are very good.'

People's personal preferences, interests and diverse needs had been recorded in their individual care plans and support was provided in accordance with people's wishes.

People who used the service and their representatives were given the opportunity to complete annual satisfaction questionnaires. These questionnaires were then evaluated in order to identify any areas for improvement.

Is the service responsive?

People who used the service told us the daily routine was flexible and they could choose when to get up and go to bed and whether to spend time in their own room or in communal rooms. One person said, 'You can do what you want.'

Leisure activities were routinely organised at the home. These included arts and crafts, reminiscence, jigsaws, armchair exercises and visits to local attractions such as the pub.

People knew how to make a complaint if they were unhappy. One person told us they would tell a member of staff if they were unhappy about anything and said, 'I can talk to them.'

Is the service well-led?

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

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered most aspects of the service provided.

Discussion with members of staff confirmed that they had received appropriate training and understood their roles and responsibilities. This helped to ensure that people who used the service received the care and support they needed.

Two care workers told us the manager was approachable and supportive.

During this inspection we found that the provider had carried out sufficient actions to meet the areas of non-compliance we had identified in the inspection conducted in June 2013.

They felt safe living at the house and had no issues or concerns.

The person told us that they felt the environment was pleasant and the home looked nice.