Lyndhurst Residential Care Home

Lyndhurst Residential Care Home is a residential care home registered to provide personal care and accommodation for up to 20 people aged 65 and over. There were 17 people living at the home at the time of this inspection.

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

Risks associated with people’s care were assessed and people’s care plans gave staff the basic information needed to care for them safely. However, the level of detail and robustness of some of these records required improvement. The environment both internally and externally was generally safe and well-maintained. A wide-ranging schedule of improvement works had started at the home since our last inspection. Some areas of the home still required redecoration and/or upgrading, and we identified some minor repair works which the provider had not yet identified or addressed.

The effectiveness and organisation of quality assurance processes at the home had notably improved since our last inspection. However, some of the issues we identified during this inspection still had not been identified or addressed by the provider’s own quality processes. Therefore, the provider requires further time to fully embed, sustain and develop the improvements made in this area.

People told us there were enough staff at the home. One person commented, “There’s enough staff, people never wait long for help. The staff are on the spot.” Staff were visible around the home throughout our inspection and any call bells were answered promptly. Staff were safely recruited, ensuring new staff were suitable to work with vulnerable adults.

People living at the home were safeguarded from the risk of abuse. People said they felt safe living at the home. One person said, “I’m safe and happy here. I get on with the staff, they are friendly and kind.” Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns.

The home was clean and hygienic. Staff followed the relevant guidance and best practice in relation to infection prevention and control. The home had a COVID-19 testing programme in place for people living at the home and staff. Staff and people living at the home had been supported to access COVID-19 vaccinations.

There was a kind and caring culture amongst staff at the home. Staff interacted with people with kindness and care throughout the day. People appeared content and comfortable in their surroundings. People living at the home spoke positively about the staff. One person said, “All the staff are kind. I know the staff, as we chat and they get to know us and have a laugh.”

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 28 November 2021).

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 regulations.

Why we inspected

We received concerns in relation to the safety, maintenance and cleanliness of the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. Whilst the provider had made improvements since our last inspection, we have found evidence that the provider needs to make further 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.

We found no evidence during this inspection that people were at risk of harm from the concerns received. 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 Lyndhurst 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.

Lyndhurst is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 20 people. The service is a domestic style property and accommodation is over three floors

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

Although assurance and auditing processes were in place, they were not always effective and did not always mitigate risk to the health and welfare of people living at the service.

The service did not always identify and report accidents and incidents appropriately. Incidents were not analysed effectively meaning that people were exposed to a risk of harm.

Environmental and health and safety checks had not identified that some fire doors did not operate effectively, meaning there was a risk to people.

The appearance of the physical environment was tired in places and in need of refurbishment, including bathrooms. However, it was recognised that the service was in the process of an improvement plan.

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.

Safe recruitment practices were in place for staff and there were enough staff to meet people’s care and support needs.

People and their relatives spoke positively about the staff and care received by their loved one. One person told us, "It feels like home, the staff are lovely and know me well. I have everything I need."

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 Good (published January 2019).

Why we inspected

The inspection was prompted by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to an external investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls from height and missing persons. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Quality assurance processes had improved since the last inspection. The registered provider maintained oversight of the provision of care people received. Routine audits and checks were being completed, the quality and safety of care was regularly assessed and improvements identified and followed up on.

People and relatives told us that staff delivered safe care.

Staff were familiar with safeguarding and whistleblowing procedures and understood the importance of complying with such policies.

Risk assessments were detailed, contained relevant information and were regularly reviewed as a measure of keeping people safe.

People received their medication in a safe manner. Robust medication processes were in place and the staff received appropriate medication training.

People received safe care in a responsive and timely manner. Staffing levels were appropriately managed and people received care from consistent, regular staff.

Recruitment was safely managed. The necessary pre-employment checks were completed and people received care from staff who were suitable to work in adult social care environments.

The home was safe, clean and hygienic. Health and safety measures were in place to ensure people lived in a safe, well-maintained environment.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. People’s level of capacity was appropriately assessed; measures were in place to ensure consent to care and treatment was appropriately monitored, reviewed and managed.

People’s overall health and well-being was effectively assessed and managed. Referrals were made to external healthcare professionals accordingly.

People made positive comments about the quality and standard of food people they received. Menus offered choice and variety on a daily basis.

People were supported in a kind, caring and compassionate manner. Staff were familiar with the support needs of the people they were supporting and provided care in a person-centred way.

The registered provider had a complaints policy in place. People and relatives knew how to make a complaint if they needed to.

People were encouraged to participate in a variety of different activities. There was an activities timetable visible throughout the home and we received positive feedback about the activities that were planned.

We received positive feedback about the overall management of the service and the quality of care people received.

More information is in the full report below.

Rating at last inspection: Requires Improvement (report published 12 December 2017)

About the service: Lyndhurst is a care home that provides personal care for up to 20 older people. The registered provider also supports people living with dementia. At the time of the inspection 15 people lived at the service.

Why we inspected: This was a planned comprehensive inspection based on the ratings at the last inspection.

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

Lyndhurst is a ‘care home’ and is registered to provide care and support for up to 20 people who have physical disabilities and/or mental health problems. The registered provider also supports people who are living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there were 16 people living at the home. Accommodation is provided across three floors and facilities include two dining rooms/social areas, a smoking area, a large garden area to the rear of the building as well as a small car park at the front.

At the time of the inspection there was two registered managers in post. A ‘registered manager’ is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous comprehensive inspection which took place in April 2017, the home was rated as ‘Inadequate’ and placed in ‘special measures’. We found the registered provider was not meeting legal requirements in relation to person centred care, need for consent, premises and equipment, good governance and staffing.

Services in 'special measures' are kept under review and inspected again within six months. The expectation is that providers who have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvements are made and 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.

Following the previous inspection the registered provider submitted an action plan which outlined how they were improving the standards of care and quality of service. We checked at this inspection to make sure that the provider had made enough improvements to meet their legal requirements.

During this inspection we found a number of improvements had been made however the registered provider was found to be in breach of ‘safe care and treatment’.

We reviewed a number of care records for the people who lived at Lyndhurst care home and found that care plans and risk assessments were not being maintained. Some risks had not been appropriately recorded and there was inconsistent information found in different assessments. This meant that the delivery of the care being provided was not safely monitored or reviewed, meaning that people were exposed to unnecessary risk.

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

During the previous inspection the registered provider was found to be in breach of ‘good governance’. During this inspection, we identified a number of improvements which had been made in relation to this regulation although it was still evident that further systems and processes needed to be implemented and maintained in order to improve the standard and delivery of care which was being provided.

We have made a recommendation to the registered provider in relation to continual improvement of quality assurance systems.

There was evidence to suggest that most documents we showed that the service was operating in line with the principles of the Mental Capacity Act, 2005 (MCA). This was because most people were involved with the decisions taken in relation to their care and treatment, and there was a best interest process in place for people who lacked capacity to be involved. However some records we reviewed evidenced that there was still some confusion regarding the principles of the MCA. The registered provider was no longer in breach of the regulation in relation to ‘need for consent’ however we have made a recommendation regarding further improvements needed.

There was evidence during this inspection that improvements had been made to the environment and risks which had been identified on the previous inspection. During this inspection we did identify a number of areas which could have potentially posed a risk to people living at the care home. We discussed our concerns with the registered managers and they immediately responded and rectified the areas which were discussed. The registered provider was no longer in breach of the regulation in relation to premises and equipment.

During the inspection we found that the area of ‘staffing’ had improved since the last inspection. Routine supervisions and appraisals were taking place, staff were receiving the necessary training to enable them to fulfil their roles to their full potential and staff expressed that they felt supported on a daily basis. The registered provider was no longer in breach of the regulation in relation to ‘staffing’.

During the previous inspection we found the provider in breach of regulations in relation to ‘person centred care’. This was because people were not receiving the care and support which was right for them or met their needs. During this inspection we found that care records were personalised, staff were able to provide person centred care and the environment had been adapted to provide support to people who were living with dementia. The registered provider was no longer in breach of the regulation in relation to ‘person centred’ care.

Recruitment was being safely and effectively managed within the home. Staff personnel files which were reviewed during the inspection demonstrated safe recruitment practices. This meant that all staff who were working at the home had suitable and sufficient references and the appropriate criminal record checks had been conducted.

Accidents and incidents were being recorded and there was evidence which demonstrated that the registered managers were analysing and assessing the data on a monthly basis. The process and systems which were in place to assess and monitor accidents and incidents enabled the registered managers to analyse if changes needed to be made within the home and if further risks needed to be mitigated.

Medication processes and systems were safely managed. During the inspection we found that routine medications audits were being conducted, medication administration records (MARs) were being appropriately completed and staff had received the appropriate training. This meant that people were receiving a safe level of care in relation to the medications which they were being prescribed.

The day to day support needs of people living in the home was being met. The appropriate referrals were taking place when needed and the relevant guidance and advice which was provided by professionals was being followed accordingly.

People told us that their privacy and dignity was respected. Staff were able to provide examples of how they ensured privacy and dignity was maintained as well as describing how people’s choices and preferences were supported.

Staff provided support to people with care, compassion and kindness. Staff were observed speaking to people in a friendly, sincere and warm manner. People were observed looking happy and content in the environment and there was a positive atmosphere throughout the course of the inspection.

There was an activities co-ordinator in post at the time of the inspection who was responsible for organising a range of different activities. The feedback we received about activities was positive. People we spoke with said they enjoyed the activities which were organised and people were observed taking part in the activities.

We received positive comments about the standard of food throughout the course of the inspection. People expressed that they were happy with the variety of food and enjoyed the different choices available.

There was a formal complaints policy in place at the home. There was evidence of how complaints were being responded to which were in accordance to the organisational procedures. At the time of the inspection there were no formal complaints being investigated.

Staff morale was positive. Staff expressed that they were ‘happy’ in their roles and expressed how much they ‘loved’ working at Lyndhurst. Staff said that they felt supported by both registered managers and believed there was an open and supportive culture.

The registered managers were aware of their responsibilities and had notified the CQC of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. The registered provider ensured that the ratings from the previous inspection were on display within the home.

There was a vast amount of policies and procedures in place. Specific policies which we reviewed included confidentiality, whistle blowing, safeguarding adults, equality and diversity and supervisions policies. Policies and procedures were available to all staff and they were able to discuss specific procedures and processes with us during the inspection.

This unannounced inspection took place to check if the provider had made enough improvements to meet their legal requirements.

Lyndhurst Residential Care Home is registered for a maximum of 20 people who have physical disabilities and/or mental health problems. They also provide care for people who are living with dementia. There were 18 people living in the care home at the time of our inspection.

There were two registered managers on site at the time of the inspection and a representative for the care provider was also present.

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 care provider had demonstrated they had made some improvements on this inspection and provided us with a new action plan to continue with their improvements. They had refurbished some people’s rooms and confirmed they had plans to continue to refurbish 10 other rooms within the care home. Window restrictors had been fitted, repairs to door locks had been completed, a mag lock fitted to the side gate of the premises, a new roof window was in place, CCTV internal cameras had been disconnected, a four week rolling menu was now in place with choices of meals for people and all care plans had been audited.

The care provider was no longer in breach of regulation 12 safe Care and Treatment of the Health and Social Care Act Regulations 2014

There was a clear system of recording and logging incidents in place. Medicines were being managed safely.

The service were previously in breach of regulation 15 Premises and we found they remained in breach of this regulation on this inspection. We found numerous hazards in the rear garden area of the care home, a boiler door was not secured and a bathroom light was not meeting health and safety regulations. The provider took action immediately to remedy these concerns however, this remained a breach of regulations.

The care provider remained in breach of regulation 15 Premises of the Health and Social Care Act Regulations 2014

The environment had not been improved for people living with dementia by way of providing pictured menus or memorabilia.

This was a breach of Regulation 9 of the Regulated Activities Regulations 2014 (Person Centred Care).

We found the service were no longer in breach of Regulation 13 of the Regulated Activities Regulations 2014 (Safeguarding service users from abuse and improper treatment) as they had ensured they were no longer adopting restrictive practices within the care home.

However, we did find they remained in breach of Regulation 11 of the Regulated Activities Regulations 2014 (Need for Consent) in view of them not ensuring covert medication practices were lawful with a best interests process clearly documented.

Staff training was being provided by a range of trainers including external companies. However, we found one staff member had not received any mandatory training when we spoke with them on our inspection despite them working within the care home for a period of months.

The care provider remained in breach of Regulation 18 of the Regulated Activities Regulations 2014 (Staffing).

People who lived at the care home told us they enjoyed the food and were provided with choices of food. We did not see a weekly menu on display for people to know what their choices were during the forthcoming week which we fed back to the provider.

The care provider was no longer in breach of Regulation 14 of the Regulated Activities Regulations 2014 (Meeting Nutritional and hydration needs).

We previously made a recommendation the service were not providing person centred care in relation to people who were living with dementia. We did not see any further improvements on this inspection as we found two people who were living with dementia whose care plans which were not detailed enough and did not always include the person’s routine.

Staff were observed interacting in a positive way with people who lived there and they were knowledgeable about the people they were providing care and support to. People told us they were well cared for and most people apart from one person told us they were spoken to in a respectful and dignified way.

There was a complaints process in place and people told us they had never had cause to complain to management.

There were audits completed by the registered managers and a representative of the care provider was visiting the care home to oversee the improvements. They had also instructed a management consultancy to provide additional input to drive improvements. The registered managers had completed courses such as mental capacity and dementia care. However, we did not see improvements in relation to the overall governance systems as the issues we found on our inspection had not been identified by the provider’s own quality assurance systems.

The care provider remained in breach of Regulation 17 of the Regulated Activities Regulations 2014 (Good Governance).

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.

Lyndhurst Residential Care Home is a 20 bedded care home providing care for people with physical and mental health problems. It provides accommodation over three floors and is set back off a busy main road.

There were two registered managers in post at the time of our inspection with one registered manager mentoring the other with a view to the newly registered manager taking over the role.

A registered manager is a person who has registered with the Care Quality Commission (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.

We found the service was not safe. There was no system in place of recording incidents which had occurred within the care home. We were made aware of a serious incident by a visitor but the registered managers had not identified it as serious enough to report to the Local Authority or CQC. Some aspects of the premises were unsafe with some windows not restricted in line with Health and Safety Guidance. Cleaning liquids and hazardous equipment were not stored securely to keep people safe.

We observed medication being administered and found there were safe systems in place of administering and storing medication. We viewed medication risk assessments in the care plans. Not all staff were up to date with medication training but the registered manager arranged medication training during the inspection.

The service had a safe system of recruitment in place and staff had received an induction. We highlighted that the trainer who provided training such as adult protection, infection control, Mental Capacity, food hygiene and health and safety training, did not have evidence of their competency to demonstrate they were delivering training which was up to date. Although the staff training matrix showed all staff training was in date we were concerned regarding the standard of training being delivered. Dementia training was not being offered to staff.

Staff were able to tell us about how they would safeguard people who were at risk or if they had concerns about people. Staff felt able to raise any concerns with the registered managers.

There were no mental capacity assessments or Deprivation of Liberty Safeguards (DoLS) applications in place at the time of our inspection for people who needed them. The registered manager was in the process of writing a DoLS application for one person but needed assistance to complete it. We advised the registered managers to seek training in mental capacity/DoLS. Consent had not been sought in line with the Mental Capacity Act.

People had enough to drink and eat at the time of our inspection but people told us they did not have a choice of meals. We raised this with the registered manager who then ensured a choice of meals was implemented. The meal time experience could have been improved for people and we highlighted people's dietary requirements were not recorded in the kitchen at the time of our inspection.

The service was not always caring. We found the risk assessments for people with dementia were not always demonstrating a caring approach as they lacked detailed information needed to be able to care for them effectively. There were no dementia friendly areas or memorabilia within the care home.

Staff were respectful of people and people told us they were happy with their care. Staff listened to people and promoted their dignity at all times. People felt they could approach the registered managers if they had concerns and were aware there was a complaints procedure.

The service was providing person centred care. Relevant key people were involved in developing care plans to document people’s care needs. Care files included information regarding people’s history, preferences, likes and dislikes and people were supported to engage in activities meaningful to them however, care plans for people with dementia lacked detail.

The service was not well led. The service had failed to notify CQC of a police incident whereby the registered manager had phoned the police to attend the care home. From discussion with the registered managers it was evident they were not aware it was their responsibility to provide a Police Statutory Notification if they called the police to attend at the care home. The registered managers also had limited knowledge of mental capacity/DoLS and were not completing DoLS applications for all the residents who needed one. The quality audits including the audit of the building did not identify what needed to be improved.

Healthcare professionals we spoke with provided us with positive feedback 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.

' 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 is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider had taken action to ensure the home environment was maintained to a suitable and safe standard so as to protect people living at the home, staff and visitors from risks to their health and welfare.

Is the service effective?

People who lived at the home told us they received the care and support they needed and staff were able to tell us how they met people's needs.

Improvements to the way in which care was planned meant that people who lived at the home were protected against the risk of receiving inappropriate care and support.

Is the service caring?

People who lived at the home gave us good feedback about the staff team and we saw staff interact with people with respect, warmth and familiarity. Staff were attentive to people and provided a constant presence in the main communal lounge.

Is the service responsive?

The provider had introduced new care plans for each of the people who lived at the home since our last inspection visit. These included a sufficient amount of information about people's needs and the actions staff needed to take to meet people's needs.

Risks to people's welfare and safety had also been assessed and plans put in place for managing any identified risks.

Is the service well-led?

The provider had made improvements to the way in which the quality of the service was assessed and monitored since our last inspection of the service.

The provider had taken action to improve the home environment and reduce risks to the welfare and safety of people who used the service, staff and visitors.

' 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 is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Risks to people's safety were not appropriately assessed and there were few plans in place to show how risks were managed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing risks.

Some areas of the home environment were not maintained to a suitable and safe standard and this failed to protect people living at the home, staff and visitors. 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 safety and suitability of premises.

Is the service effective?

People who lived at the home told us they received the care and support they needed and staff were able to tell us how they met people's needs. However, the way in which care was planned meant that people who lived at the home were at risk of not receiving the care and support they needed to maintain their health and welfare.

The provider had not made sufficient improvements to the way in which care was planned since our last inspection when we raised concerns about the quality of care planning. We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure the appropriate planning of care for people who live at the home.

Is the service caring?

People told us staff were attentive and we saw that care workers showed warmth and familiarity when supporting people. People's comments included, "They are great here, it's a relaxed family atmosphere" and "The carers are very good."

Is the service responsive?

Following our last inspection we told the provider that they needed to make a number of improvements. These included improvements to how care was planned, improvements to the home environment, and to how the quality of the service was assessed and monitored. During this visit we found that sufficient improvements had not been made in any of these areas. Care plans had been reviewed and updated but the quality of information in them remained poor. None of the areas of the home environment which we raised as requiring attention at our last visit had been addressed. We also found no evidence that the provider had taken any action to develop the quality assurance system.

Is the service well-led?

The service was not managed in a way that ensured people's health, safety and welfare were protected. Risks to people's safety and welfare were not well managed. Risk assessments were ineffective and the home environment was not being maintained to an appropriate and safe standard.

The provider was not assessing and monitoring the quality of the service effectively and had not taken action to address the concerns we had identified during our previous inspection visit. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

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

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by the staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. There were no concerns with regards to people's capacity to make their own decisions and people were encouraged to be independent and use the local community.

Safeguarding policies and procedures were in place and staff were clear about their responsibilities to identify and report suspected abuse.

Some areas of the home environment were not maintained to a suitable and safe standard and this failed to protect people living at the home, staff and visitors.

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 safety and suitability of premises.

Is the service effective?

People were receiving the care and support they needed. However, care plans did not always reflect the needs of the person concerned and the systems in place for reviewing care plans failed to ensure they were accurate and up to date. People are at risk of not receiving the care and support they require if their needs are not reflected in the planning of their care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure the appropriate planning of care and support for people who live at the home.

Is the service caring?

Staff told us they were clear about their roles and responsibilities and they told us how they ensured people were treated with dignity and respect.

People were supported by attentive staff who were constantly present in communal areas to support them. We saw that care workers showed warmth and familiarity when supporting people. People commented, 'I get all the help I need' and 'The carers are great.' A relative told us, 'I can't fault the care staff they are always very friendly and helpful.'

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs, district nurses and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and regular resident's meetings. People's feedback was then used to make improvements to the service.

Is the service well-led?

The systems in place for assessing and monitoring the quality of the service were not effective. The system failed to identify risks and to ensure that these were managed appropriately.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

Their comments included:

"The staff are lovely."

"I am more than happy here."

"I can go out when I want and can go to bed when I want."

During our inspection we found evidence that care records for the people who used the service were all up to date and contained enough information and relevant risk assessments for people to be cared for safely and effectively.

People who we spoke with told us that they felt safe and had no concerns about the care they had received from staff. We saw that appropriate safeguarding records were kept and reported on. Overall we found that records were kept securely and were well organised. We found that relevant pre-employment checks had been carried out on staff working in the home and personnel files were up to date and kept securely.

People who used the service were largely positive about the care and support they received at the home. Comments included:

"This place is great I can go out when I want".

"They decorated the room before I moved in"

"I am happy that my relative is safe and secure here".

We found that the provider had reviewed their monitoring arrangements and had introduced a number of new policies and procedures following our visit last year.