The Vicarage Residential Care Home

The Vicarage Residential Care Home is a residential care home providing accommodation and personal care to up to a maximum of 30 people in 1 adapted building. At the time of our inspection there were 19 people using the service.

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

There was a lack of activities and social stimulation on offer and activities were not based on individual preferences.

Accidents and incidents were recorded but there was limited evidence of lessons learnt following on from an incident meaning the risk of this occurring was not always mitigated. Individual risk assessments were in place and care plans were detailed and person centred. However, people were not always involved in the care planning process.

People were safeguarded from the risk of abuse and people at the service felt safe. There was sufficient staff deployed to meet people’s needs and recruitment processes were robust. Medicines were stored and administered safely.

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.

There were systems in place for managing complaints but not everyone that used the service was aware of what the procedure was. People’s end of life wishes were recorded and identified.

Governance systems were in place, and we saw evidence of audits taking place. People and their relatives spoke highly of the registered manager and the staff team.

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 25 October 2019) 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 the provider remained in breach of regulations.

This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

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

Enforcement and Recommendations

We have identified a breach in relation to a lack of person-centred care activities. The provider had failed to ensure care was designed to meet people’s needs, taking their preferences into account. We have also made a recommendation in relation to lessons learnt.

Please see the action we 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.

The Vicarage Residential Care Home is a residential care home providing accommodation and personal care for people aged 65 and over. The service can support up to 30 people. At the time of the inspection there were 21 people living at the home.

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

National guidance was followed on the use of personal protective equipment (PPE) and regular Covid-19 testing was taking place. There were supplies of PPE readily available to staff. Staff were aware of what PPE they should wear and had received appropriate training in infection prevention and control, hand washing and use of PPE.

The environment was very well lit, clean and clutter free. Clear and detailed cleaning processes and procedures were in place.

There was a national lockdown at the time of our inspection and visiting was restricted. The provider had installed an external visitor pod, accessible without visitors having to enter the home. The provider was in the process of improving access to the pod by installing a level access ramp.

The provider was aware of national guidance on the safe admission of residents to care homes. Records showed the most recent new admission into the home had been admitted according to the guidance.

We were assured that this service met good infection prevention and control guidelines.

Risks to people, including falls, were well managed. Care plans and risk assessments gave clear guidance to staff on what needed to happen to keep people safe. People had access to appropriate health care professionals. Care records included detailed records of care and support provided.

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

Rating at last inspection

The last rating for this service was requires improvement (published October 2019).We undertook a targeted inspection in July 2020 (published August 2020). We did not change the rating as we only looked at the part of the key question we had specific concerns about.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 undertook this targeted inspection to check on specific concerns we had about infection prevention and control (IPC), risk management, care provided and record keeping.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Vicarage Residential Care Home 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.

The Vicarage Residential Care Home is a residential care home providing accommodation and personal care for people aged 65 and over. The service can support up to 30 people, at the time of the inspection there were 21 people living at the home.

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

Within the context of areas reviewed as part of this targeted inspection, 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 best practice.

Risks to people who used the service and staff relating to infection prevention and control, and specifically Covid 19, had been assessed and appropriate action taken. The provider was promoting good infection control and hygiene practices. Staff had received additional training, including handwashing and use of personal protective equipment (PPE). Systems in place ensured equipment and premises were checked and maintained as required.

Staff received the training and support they needed to carry out their roles effectively and safely. Records gave staff clear direction on how to support people with their mobility. Staff had been trained in moving and handling. Required equipment was available and checked regularly.

Staff were aware of their responsibilities to protect people from abuse. Systems were in place to ensure safeguarding concerns were reported and dealt with appropriately. Staff told us they could raise concerns with the registered manager. Where required the provider had notified the local authority and CQC of any incidents.

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

Rating at last inspection

The last rating for this service was requires improvement (published 25 October 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check on specific concerns we received about infection control, staff training and supervision, manual handling, building maintenance and the management and reporting of safeguarding’s. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Vicarage Residential Care Home 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

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

There was a lack of activities on offer and activities were not based of individual interests, needs and preferences.

A range of quality monitoring and auditing had been introduced. Although we saw significant improvements had been made, we have not rated the well-led key question as 'good'. There is a history of non-compliance. To improve the rating to 'good' would require the embedding of audit systems and a longer-term track record of sustained improvement and good practice.

The home was visibly clean and free from malodours. There was an on-going programme of redecoration and refurbishment. Health and safety checks in the home had been carried out. There was a programme of regular maintenance to the building and servicing of equipment. Staff had received training in safeguarding people from abuse. Medicines were managed safely. Safe systems of recruitment were in place.

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.

There were sufficient staff to meet people’s needs and staff received the induction, training and support they needed to carry out their roles. People's nutritional needs were met. Everyone we spoke with told us they enjoyed the food. People’s health needs were met.

Staff treated people with dignity and respect. People told us staff were kind and caring. Staff were warm and very kind and friendly towards people and engaged in conversations. There was also gentle banter and people clearly enjoyed having fun with staff. Staff spoke with genuine affection about the people they were supporting and considered the home to be a family.

Care records were person centred, reviewed regularly and updated when people’s needs changed.

The provider had notified CQC of significant events such as safeguarding concerns.

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 July 2019) and there were multiple 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 improvements had been made and the provider was no longer in breach of those regulations. This service has been in Special Measures since August 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to a lack of person-centred activities. The provider had not ensured care was designed to meet service users' needs and preferences. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Vicarage 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.

The Vicarage is a large Victorian property that has been extended and adapted into a care home for older people. Bedrooms are located on the ground and first floor, storage and laundry facilities are in the basement. There is one lounge and two dining rooms. The Vicarage is registered to provide accommodation for up to 30 older people and is situated in the Audenshaw area of Tameside.

At the time of our inspection there were 23 people living at The Vicarage.

This inspection was carried out over two days between 22 and 23 January 2019. Our initial visit on 22 January 2019 was unannounced.

We last inspected The Vicarage in May 2018. At that inspection we rated the service as inadequate in all domains; safe, effective, caring, responsive and well-led. The overall rating for the service was inadequate and the service was placed in special measures. At that inspection we found regulatory breaches of six Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of person-centred care, poor infection control, keeping people safe, staff numbers, medicines, dignity and respect, safety of the building and equipment, incorrect diets, complaints, staff training and induction and inadequate governance of the home. Three of these breaches of regulations were repeated breaches from the previous inspection of January 2017; the safe management of premises and equipment, staff training and induction, and ineffective governance of the service.

At the last inspection in May 2018, we also identified three breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to notify us of death of service users and other incidents at the home and a failure to display previous inspection ratings.

The service had a registered manager in place. 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 this inspection we found improvements had been made in some areas of the service. However, we identified repeated breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to keeping people safe from harm, staff training/levels, dignity and respect and governance of the home. Three of these breaches had been identified in the inspection of January 2017. This meant that we had identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on three consecutive inspections. At this inspection we also identified one further breach of the regulations relating to consent.

We also identified two repeated breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to notify us of death of service users and other incidents at the home.

We made one recommendation relating to ensuring conditions of Deprivation of Liberty Safeguards (DoLS) were being met.

Since the last inspection the service had been supported by the local authority’s Quality Improvement Team (QIT) and they had made progress in some areas of the service. These included the implementation of new policies and procedures, cleanliness and décor of communal areas, making the environment more dementia friendly, the employment of a deputy manager, improved infection control practice, building safety checks and documentation relating to people’s care needs. However, we found the registered manager had only recently started to engage with this support and the service had not made enough progress in relation to the safety of people living at home or their experience of living at the home.

As a result of the last inspection’s findings the local authority suspended placements at the home.

Accidents and incidents were recorded and counted; however, no action had been taken to analyse trends or mitigate further risk to people.

The home did not provide person-centred care and people were not involved in planning their care. People did not have keys to their rooms and a ‘bathing schedule’ was in place.

We found the communal areas of the home to be clean and free from odour. However, some people’s bedrooms were unclean and had an offensive odour. On visiting some people’s rooms we found instances where bedding was unclean, old and of poor quality.

We saw some caring interactions between people and staff; however, we also saw instances where people were not given choice and staff did not always gain consent. People did not always look clean or well groomed.

We observed some improvement in safe moving and handling techniques when assisting people. However, we also saw one instance where a person was not assisted safely.

We saw that supervisions for staff had been introduced since the last inspection alongside the introduction of a matrix to give managerial oversight of staff training; however, we found staff had not consistently received all the training they required.

No staff had received first aid training and there were no adequate first aid kits on site. We requested this be remedied as a priority during the inspection.

A tracker procedure had been introduced to monitor people who were subject to Deprivation of Liberty Safeguards (DoLS).

People’s consent to care had not always been obtained and decisions had been made about their care without their, or a representative’s, involvement.

People’s day consisted of sitting in the lounge and everyone being moved to the dining room for meals. People did not have access to the gardens as this was not safe.

Some activities had recently been introduced at the home; however, there was no activities co-ordinator in post and care staff told us they were required to add this into their care and support duties.

People’s doors had a self-closing mechanism and this may make it difficult for them to leave their room if they wished. In the rooms we visited, we found call bells did not have cords to enable people to call for assistance and we requested risk assessments were put in place during the inspection. We found everyone living at the home had a motion sensor beam in their room that alerted staff via an alarm call if they got out of bed. We did not see where people had been individually assessed as to whether this was a required safety measure.

The service had not fully complied with a Notice of Deficiencies issued by the local fire service regarding fire safety at the home.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

The Vicarage 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.

The Vicarage is a large Victorian property that has been extended and adapted into a care home for older people. Bedrooms are located on the ground and first floor and storage and the laundry are located in the basement. There is one lounge and two dining rooms. The Vicarage is registered to provide accommodation for up to 30 older people and is situated in the Audenshaw area of Tameside.

At the time of our inspection there were 28 people living at the Vicarage.

This inspection was carried out over two days between 21and 22 May 2018. Our initial visit on 21 May was unannounced.

We last inspected The Vicarage in January 2017. At that inspection we rated the service as good in the caring domain and requires improvement in safe, effective, responsive and well-led. The overall rating for the service was requires improvement. At that inspection we found regulatory breaches of three Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These previous breaches related to the safe management of medicines, the safe management of premises and equipment, staff training and induction, and ineffective governance of the service. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

The service had a registered manager in place. 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 this inspection we identified repeated breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified breaches of three further regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The total of six breaches related to a lack of person-centred care, poor infection control, keeping people safe, staff numbers, medicines, dignity and respect, safety of the building and equipment, incorrect diets, complaints, staff training and induction and inadequate governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

We identified three breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to notify us of death of service users and other incidents at the home and a failure to display previous inspection ratings.

We made one recommendation to ensure the home’s décor is more dementia friendly.

The home did not provide person-centred care and people were not involved in planning their care. People did not have keys to their rooms and a ‘bathing schedule’ was in place. Activities were only provided twice per week and people were not offered any personalised activities.

We found poor cleanliness and infection control practices throughout the inspection. The home was malodorous and the laundry system used at the home posed a potential risk to people through cross contamination.

Accidents and incidents were recorded; however, no action had been taken to analyse trends or mitigate further risk to people.

Up-to-date risk assessments were not always in place for people or the building.

Medicines were not always stored or managed safely. Staff had not had their competencies checked to ensure medicines were administered safely.

People were not always treated with dignity and respect.

Staff did not always use safe moving and handling techniques when assisting people.

People’s movement around the home and grounds was restricted. The registered manager, or other staff members, did not know if people living at The Vicarage had Deprivation of Liberty Safeguards (DoLS) in place. No capacity assessments were carried out.

Systems and processes to safeguard people were not in place and the registered manager did not demonstrate they had sufficient oversight of safeguarding at the home. Not all staff had undergone training on how to safeguard people from abuse.

People who had been prescribed a specific diet were not always receiving their food prepared to their requirements. This placed people at the risk of harm.

The building required a full health and safety audit. Fixtures were in poor condition and wardrobes were so unsafe we requested they be fixed to the walls immediately.

Some of the required safety checks and maintenance for the building and equipment were in place and regularly monitored. However, there was no testing of the safety of water systems. Legionella testing was not in place. There was no hot water feed to many rooms in the home and the registered manager had installed individual water geysers. There was no risk assessment in place to demonstrate the safety of these geysers.

Actions from the previous fire risk assessment had not been completed from November 2016. We requested the local fire service conduct a visit to the home to ensure safety of the people living at the home. This resulted in action being taken by the fire service.

There was a complaints book in place; however, people were not made aware of their right to make a complaint about the service. There was no complaints information displayed in communal areas and people did not receive a welcome pack or handbook on arrival at the home.

There was no training matrix in place in order for the registered manager to keep oversight of staff training. We received information regarding staff training 20 days after we requested it and found there were gaps in the training that staff are required have.

The registered manager told us they rarely held staff meetings or provided supervision for staff. There was no staff appraisal system and no competency checks were carried out on staff to check their performance.

There was no coherent dependency tool used by the registered manager to ascertain safe staffing levels and the rotas we reviewed did not reflect safe staffing levels. Staff and visitors told us they felt staffing levels were too low at the home and we observed several instances at the home where staff were not present for periods of time.

Governance of the home was inadequate. The registered manager did not employ systems and processes to keep an operational or strategic oversight of the home. The registered manager is present at the home part-time and does not have a management support structure in place.

The registered manager had not completed statutory notifications to CQC of any accidents, DoLS, serious incidents, and safeguarding allegations as they are required to do. This had been identified as a failing during the last inspection; however, the registered manager had continued to be non-compliant in their requirements to submit notifications to CQC.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.

We received mixed feedback from residents and visitors about the quality of the food at the home. There was a menu in place with a set meal each day. There was no alternative listed on the menu; however, the cook told us they would make something different if the person wished.

Care records at the home showed us that people received input from other health care professionals, such as district nurses and opticians.

People, their relatives, visiting professionals and staff gave us mixed comments around the care and support they received at The Vicarage. Some people told us they were happy with the care provided at the home and some people felt there needed to be improvements.

We observed some good, caring interactions between staff and people who lived at the home; however, we also witnessed incidents where people were not treated with dignity and respect which required us to report our concerns to the registered manager during the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

Our last inspection to the service took place on 30 September 2014 and the registered provider was compliant with the regulations in force at that time.

The Vicarage is a large Victorian property that has been extended and adapted into a care home for older people. The Vicarage is registered to provide accommodation for up to 30 people. There is wheelchair access to the service and parking is available at the front of the property. At the time of our inspection there were 25 people using the service.

The registered provider is required to have a registered manager and the manager in post was registered with the Care Quality Commission (CQC) in 2013. 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 premises required health and safety work completing to ensure that they met the regulations for fire safety. Some areas of the premises were not well maintained and did not maintain standards of hygiene appropriate for the purpose for which they were being used.

The recording, administration and return of medicines was not being managed appropriately in the service. We saw no evidence that people did not receive their medicines as prescribed, but this was not well recorded.

The registered provider failed to notify the CQC about Deprivation of Liberty Safeguard applications which had been authorised by the supervisory body. We have written to the registered provider about this separately from this report.

We found that the induction and training programme for staff was not robust. People and relatives told us they found the staff to be friendly, helpful and approachable and we observed good interactions between people using the service and staff during our inspection.

Quality assurance and record keeping within the service needed to improve. There was a lack of auditing within the service. We saw evidence that care plans, risk assessments, food/fluid charts and end of life plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm.

The environment within the service was comfortable, clean and homely, but it was not particularly designed to be dementia friendly. As 76 percent of people using the service lived with dementia, improvements could be considered regarding the dementia design aspect whenever the service is refurbished or redecorated. We have made a recommendation around this in the report.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People were treated with respect and dignity by the staff. People and relatives said staff were caring and they were happy with the care they received and they had been included in planning and agreeing the care provided. People had access to community facilities and most participated in the activities provided in the service.

People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. The registered manager had investigated and responded to the five minor complaints that had been received in the past year.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents.

You can see what action we told the registered provider to take at the back of the full version of the report.

The inspection was undertaken by one inspector who visited the home at 06:30 am. We talked to staff and people who used the service. We also looked at records, observed staff interactions with people who used the service and talked with the registered manager.

We considered the evidence collected and addressed the following question, is the service safe?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service Safe?

Staffing was provided at a level which enabled people's needs to be met.

Staff interactions with people who used the service were seen to be calm and relaxed. People were protected from abuse or poor treatment.

Personal protective equipment (PPE) was provided to minimise the risk of cross infection.

We did not speak with people living in the home about this standard. We spoke with the provider who is also the registered manager and with other staff.

We found that in all of the areas that we identified on our last visit the provider had acted to remedy the problems.

We therefore found that the service was now compliant with this standard.

We spoke with four sets of visitors. All of them visited their relative in the home on a regular basis. They all spoke highly of the quality of care which their relative was receiving. One said: "We're very happy. He's well looked after. He's safe. Staff are caring." Another said: "All the staff are good. They really do look after her."

We found that the variety and quality of food provided was high. One person said: "It's good the food. I can't fault it." Another said they had just had a "good lunch". One relative stated that if a person wanted another helping it was always provided.

We found that the home was meeting the outcomes we looked at in this inspection, except for the outcome relating to record keeping, where we found inadequate systems and determined that action was needed.

We looked at the care records and found that assessments and care plans were in place. We saw that they were regularly reviewed to make sure that people's needs were met.

We toured the communal areas and some of the bedrooms and found that all areas were comfortable and well furbished.

We also looked at staff support and training. We saw the staff records and found the staff were well trained and there were good systems in place to ensure they were well supported in their work.

We found that the provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.