Archived: Asheborough House Care Centre - Saltash

Asheborough House Care Centre - Saltash is a residential care home providing personal and nursing care to up to 31 people. The service provides support to older people and people with physical disabilities. At the time of our inspection there were 20 people using the service.

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

At our last inspection the service had experienced low staffing levels. The registered manager had been required to work many shifts, including night shifts, to cover the rota. This meant they had less time to spend on management tasks. This had led to lapsed staff training and supervision. The service had been at a tipping point with all contingency plans exhausted.

At this inspection we found some improvements had taken place. There were sufficient staff on shift to support people at the time of this inspection. Recruitment had been successful. However, the service was still using some regular agency staff to support some shifts.

Staff support, such as supervision and training provision, had improved. Some staff remained overdue for some training; however, we were assured that the registered manager was closely monitoring the situation and supporting specific staff to update training. Staff had not yet received an annual appraisal but this was planned as staffing stabilised.

Oversight and governance by the registered manager was improved. They did spot checks on the service along with a regular programme of audits. The registered manager told us, “No one knows when I might appear. I arrived here at 3.30am this morning just to support the night staff and do some checks.”

At this inspection staff morale was good. Staff told us, “I like it here, it’s a good place to work” and “The registered manager really looks after us all.”

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet. When needed, people were having their food and drink intake recorded and were regularly weighed.

People received their medicines in a safe way as prescribed for them. However, there were improvements needed to some aspects of the way medicines were managed.

Some care plans did not contain specific guidance for staff to guide them on how to support some people. However, we saw and were told by staff that appropriate care was being provided and this was recorded in the daily notes. The registered manager addressed this during the inspection.

Mental capacity assessments had been carried out where it was indicated. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. Six authorisations for restrictive care plans, were in place at the time of this inspection. We confirmed this with the local authority.

Recruitment procedures were robust.

People told us they felt safe with staff. There were systems to help protect people from abuse. Staff had received training on how to recognise abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s preferences and choices had been recorded.

At our last inspection the service was noted to be in need of renovation. At this inspection we found the broken windows, seen at the last inspection, had been replaced. However, the service was still in need of re-decoration and updating in places.

Staff understood the importance of respecting people's diverse needs and promoting independence. People told us they liked living at Asheborough and that the staff were caring and responded when they called. One person told us, “It is a good place to live and the staff are lovely.”

People and staff were asked for their views by the registered manager through a survey and responses had been audited. Relatives told us, “They (Asheborough care staff) are very responsive and communicative. They share information with us and have been very amenable around timing of our visits. They seem genuinely concerned for (Person’s name) well-being. (Person’s name) is very happy there and he always seems to have something to do” and “The staff are lovely and they look after (Person’s name) well.”

Staff meetings had been held to seek the views of staff and share information.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 23 December 2021).

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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.

The management team were continuing to support staff to contain the COVID-19 outbreak at the service. Daily oversight and careful management of staffing levels had meant staff shortages were being managed on a daily, or sometimes hourly basis. Staffing levels were being supported by the use of agency staff. However, the registered manager told us the pool of available agency nurses and staff were limited and they were relying on the goodwill of the services nurses to complete additional hours. Two nurses told us, “It has been going on so long it is becoming difficult” and “I feel I have a professional duty to support at times like this, but it is hard sometimes”. Care and housekeeping staff also worked additional hours to support any gaps. We did not identify staffing shortages had directly impacted on people’s health and welfare. The service was also being supported by the local authority

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. Essential care givers and visits to people in receipt of end of life care were possible. However, the service was currently closed to other visitors. People understood the need for these restrictions and were confident staff were taking appropriate steps to manage the outbreak of the infection.

Three relatives we spoke with following the service inspection, told us they understood the need for the restrictions in place, and were confident staff were taking appropriate steps to manage the outbreak of the infection. The service had identified a number of designated essential care givers. This is a person who can provide companionship, but also additional care and support. They can visit more often and during periods of COVID-19 outbreak.

Relatives we spoke with told us, “I have every confidence in them [staff]. I know it’s been difficult, but they are good at communicating with us,” “I feel [person’s name] is safe living at Asheborough House. I have peace of mind” and Very kind and considerate. All the staff and the manager.”

The service had a committed staff team to ensure people received care and support in a safe and hygienic environment. People were supported in the service in accordance with national guidance. The staff team supported people and their relatives to understand the policies and procedures surrounding protection against COVID-19.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised.

Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19. Visiting was taking place according to current government guidance.

Asheborough House Care Centre is a nursing and residential care home which predominately provides nursing care and support to people who have been diagnosed with a form of dementia. The home is registered to accommodate up to a maximum of 31 people. At the time of the inspection there were 22 people living in the service.

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

At our last inspection there were concerns with the recording of medicines at the service. At this inspection we found improvements had been made and medicines were appropriately recorded.

The service had experienced low staffing levels for many months. Several staff had left due to either being ‘burnt out’ or felt they were not suited to supporting the complex needs of some people living at the service.

Staff told us the registered manager was approachable and listened when any concerns or ideas raised. The registered manager was working many days and night shifts each week to cover the rota and told us they were unable to carry out any ‘business as usual’ tasks, such as checking records in the service. Staff training and supervision was provided, although this had lapsed recently due to the shortages of staff.

High level of agency staff were being used to cover most shifts. These staff were not always consistent and therefore were not familiar with the people who lived at Asheborough. Some beds had been closed due to low staffing levels.

The service was actively trying to recruit new staff. They were receiving low levels of applicants. New staff were recruited safely.

Care plans showed risks were identified, assessed and reviewed. Staff were monitoring specific health needs such as people’s weight, nutrition and hydration and skin care. Preferences and choices had been recorded. People had access to healthcare professionals when required.

An activity co-ordinator supported people to enjoy activities. This staff member also provided care and support to people at Asheborough.

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.

Cleaning and infection control policies and procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. People were able to have friends and family visit them in the service, under COVID-19 guidance and protocols.

The service sought the views of relatives and staff, although this had not been done recently due to staff shortages.

The premises were in need of some renovation. A maintenance person was in post to address any faults.

Regular checks were taking place of all equipment, gas, water and call bell systems.

The registered manager had completed some audits recently but was unable to complete many due to the staffing crisis.

The service had exhausted their contingency plans for staffing shortages and was at a tipping point at the time of this inspection. The registered manager and all the staff were exhausted but remained very committed to ensuring people were safely cared for.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published on 30 November 2020) and there was a breach of regulation. 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 staffing levels. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led to look at these concerns and to follow up on breaches from the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the caring or responsive key questions and therefore we did not inspect that key question. 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.

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.

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

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.

Asheborough House Care Centre is a nursing and residential care home which predominately provides nursing care and support to people who have been diagnosed with a form of dementia. The home is registered to accommodate up to a maximum of 31 people. At the time of the inspection there were 26 people living in the service.

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

Since the last inspection improvements had been made to how risks were identified, assessed, monitored and reviewed. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

There were clear records to show, when assessed as needed, staff were monitoring specific health needs such as people’s weight, nutrition and hydration and skin care. Where people had been assessed as requiring pressure relieving mattresses, to protect them from skin damage, there was an improved process in place. This ensured such devices were always set correctly for the person using them, and in accordance with their current weight. Any changes in people’s health were escalated to the relevant professional and relatives were kept informed.

Records of people's care had been updated, since the last inspection, and were individualised and detailed their needs and preferences. Individual activity plans had started to be developed with people, to help understand how they would like to spend their time, and this was on-going.

While the management of medicines had improved since the last inspection we found ‘as required’ medicines had not been routinely added to people’s medicines administration records (MARs), since the service started to use a new pharmacy recently, and only added when the medicines were given. The manager advised us, they had raised this with the pharmacy, and plans were in place for the pharmacy to add these to the (MARs) sheets. We also found when entries on people’s medicines records had been handwritten, some of these had not been signed as witnessed by two staff.

A risk assessment of the building had been completed in relation to locked doors and any adaptations that could be made to support people living with dementia. This assessment had recorded the reasons why some doors needed to be locked and the impact on the individuals it might affect. Some door signage and use of coloured eating utensils had been trialled, to see if it might promote the independence of people living with dementia, and the development of this project was on-going.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "Staff know [person]and how to look after them", "Staff are always willing to support people emotionally by providing the physical comfort they need” and “Staff are very helpful."

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.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months some families had met people in the garden and new arrangements were in place for families to meet in a safe area of the home during the winter months.

People, their relatives and staff were regularly asked for feedback on the service’s performance. There was a stable staff team who knew people well and worked together to help ensure people received a good service. People, their relatives and staff told us the management were approachable and listened when any concerns or ideas were raised.

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 on 30 August 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.

Why we inspected

We received concerns in relation to medicines management, inconsistent care monitoring records, staff access to care plans and people’s movement around the premises being restricted. As a result, we carried out a focused inspection to review the key questions of safe, effective, responsive and well-led to look at these concerns and to follow up on breaches from the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the caring key question and therefore we did not inspect that key question. 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.

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.

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

Enforcement

At this inspection we have identified a continued breach in relation to the governance and oversight of the service.

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.

Asheborough House Care Centre is a nursing and residential care home which predominately provides nursing care and support to people who have been diagnosed with a form of dementia. The home is registered to accommodate up to a maximum of 31 people.

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

Systems and records were had not been used effectively to identify risks to people or enable staff to reduce risks. Recruitment processes had not been used to provide assurance new staff were suitable to work with vulnerable adults.

Medicines were not always managed safely. People’s care plans lacked guidance for staff on the use of ‘as required’ medicines and records had not been accurately maintained.

The environment had not been designed or updated to reflect best practice in dementia care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. It was not possible for people to move freely about the service due to several locked doors. It was unclear why these locks were required or that they were the least restrictive option.

People’s care plans and how they spent their time, did not always reflect their personal preferences.

The provider’s governance system had not identified all the areas for improvement highlighted during the inspection. Where improvements had been identified these had not been implemented promptly to improve the service people received.

People told us they felt safe and staff told us they understood their responsibility for reporting any safeguarding concerns. Staff supported people to stay healthy. People told us they enjoyed the food. Systems were in place to help ensure people’s dietary needs were known and catered for.

Staff talked about people with affection. People and relatives valued the compassion shown by staff.

Staff had received regular training and assessments of their competence. The manager had planned more training and more in-depth staff supervision sessions.

The manager had identified some areas requiring improvement and was acting on these.

We made recommendations about staff recruitment and the environment.

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 31 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to keeping people safe, people’s consent, person centred care and the governance of the service.

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.

At the previous comprehensive inspection on 27 and 30 October 2015 there were breaches of legal requirements. For example, we found risk assessments were not always reflective of people’s needs and care plans were not reflective of the care being given. There were not always suitable numbers of staff deployed to meet people’s needs, people did not have end of life care plans in place and although accidents and incidents were recorded, they were not always audited to look for themes to reduce the likelihood of a reoccurrence. We asked the provider to send us an action plan on how they would meet these requirements. We also found the provider's systems to monitor the quality of service people received were not effective. Enforcement action was taken on this issue. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to our enforcement action. We undertook a focused inspection on 29 February 2016 to check they had followed their plan and to confirm they now met legal requirements. We found the legal requirements were being met.

Asheborough House Care Centre is a nursing and residential care home which predominately provides nursing care and support to people who have been diagnosed with a form of dementia. The home is registered to accommodate up to a maximum of 31 people. At the time of the inspection, there were 27 people living at the service.

There was 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.

People were well cared for at Asheborough House. One staff member told us; “I can one hundred percent say that every resident here is so well looked after”. Staff were exceptionally kind, caring and compassionate and the interactions we observed were warm, affectionate and caring. People’s dignity was upheld and their confidential information was securely stored.

Without exception, people and their relatives told us the service was very caring. One relative said; “They go above and beyond their duties all the time”. Staff were extremely caring and treated people with kindness, compassion and affection. The service was committed to delivering outstanding end of life care, in which people’s wishes were respected and where people experienced a pain free, dignified death.

There was a strong focus on delivering innovative, personalised activities for people. There was a commitment to forging links with the local community and ensuring people remained visible and active whether in the service or in the community.

Relatives were made to feel important and were always warmly welcomed at the service. Staff and managers were considerate towards them and ensured that they felt looked after and valued. Relatives were kept informed of any changes and were able to have an open and honest dialogue with staff and managers. Relatives felt able to approach the managers with any issues and their feedback was sought and valued.

Systems were in place to deal promptly and appropriately with any complaints or concerns. The registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment. Feedback on the service was sought in creative ways to ensure everybody had their voices heard.

The service was well led. The registered manager valued their staff, paid attention to detail and led by example. They were committed to continuous improvement and development. All of the staff said they felt valued and supported by their colleagues and the managers. Other agencies were very positive about the leadership of the service.

The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from quality audits, incidents, concerns and complaints were used to help drive continuous improvement across the service.

People were kept safe within the service, they had their medicines as prescribed and on time. People were cared for by staff who had undergone checks to ensure they had the correct characteristics to work with vulnerable people. Staff understood their role in safeguarding people and in recognising and reporting signs of abuse.

People were supported by staff who were skilled. They had received training to carry out their roles which was regularly updated and refreshed. Staff were supported by an on-going programme of supervision, competency checks and an appraisal.

People’s consent was sought prior to staff providing them with any assistance. Staff had a sound knowledge of the Mental Capacity Act (MCA) and understood how to apply this to the care and support they provided to people. Staff understood that capacity could change over time and was decision specific. This was reflected in people’s care records and in the way staff interacted with people.

People’s health and social care needs were addressed holistically through access to a range of health and social care professionals. People’s care records were personalised, contained the correct guidance for staff and recognised the person as a whole, including their social history, choices, aspirations and goals.

The service was visibly clean and infection control practices were robust. The environment was comfortable and people’s bedrooms were spacious, bright and personalised to suit their preferences. People enjoyed the meals and were offered choice. People had enough to eat and drink and feedback on the meals was extremely positive, from both people and their relatives.

2015. Breaches of legal requirements were found and enforcement action was taken. This was

because the provider's systems to monitor the quality of service people received were not effective.

After the comprehensive inspection the provider wrote to us to say what they would do to meet the

legal requirements in relation to our enforcement action. We undertook this focused inspection on

29 February 2016 to check they had followed their plan and to confirm that they now met legal

requirements. This report only covers our findings in relation to those requirements. You can read

the report from our last comprehensive inspection by selecting the 'all reports' link for Asheborough House Care Centre – Saltash on our website at www.cqc.org.uk.

Asheborough House Care Centre – Saltash provides nursing and residential care for up to 31 older

people who require support in their later life or are living with dementia or mental ill health.

There were 28 people living at the service at the time of this inspection. The home is on three floors, with access to the lower and upper floor via stairs, a lift or chair lift. All bedrooms have wash hand basins. There are shared bathrooms, shower facilities and toilets. Communal areas include three lounges, and one dining room. There is a garden for people to use when they wish to.

The service had not had a registered manager since August 2015; however an application for a new manager had been made and was in process. 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.

Monitoring systems had been devised, implemented and improved to help ensure the quality of care people received was effective and met their needs. A quality assurance policy had been created to reflect the new processes which were in place, and other polices had been written to support the new quality auditing systems. Records showed one of the directors had also been visiting the service to meet with the manager, to discuss the operation and delivery of the service. This helped to support the manager with the leadership of the service and to promptly identify when the manager may require support. People, their family and loved ones were being encouraged to be part of the creation of their care plan and with care planning reviews.

The manager had been working positively with the local authority service improvement team, to complete an action plan which had been put into place, following our last inspection.

This is a summary of what we found-

Before our inspection we received some anonymous information of concern about the service. The information related to the care and welfare of people, with regards to staff not treating people with dignity and respect.

As part of our inspection we met with the registered manager of the service, the matron who took clinical responsibility for the service and with the nurse on duty. We also spoke with care staff and domestic staff who were working on the day of our inspection.

Is the service safe?

At the time of our inspection we did not find the service to be safe.

People's needs were assessed, but care and treatment was not always planned and delivered in line with their individual care plan. The care home provided care for people who predominately had a diagnosis of dementia or mental health, however, we observed that basic knowledge regarding dementia care was absent from the care and support people were receiving.

Is the service effective?

At the time of our inspection we did not find the service to be effective.

Where people did not have the capacity to consent the provider acted in accordance with legal requirements.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The recent judgement made by the Supreme Court on 19th March 2014 places a responsibility on providers to ask two key questions; is a person subject to continuous supervision/control? and is the person free to leave? If a person does not have capacity and is subject to both continuous supervision/control and not free to leave, then a person is being deprived of their liberty. We found there was a code on the front door to the home which was displayed, which meant people who lived at Asheborough House, who had mental capacity, were able to come and go as they pleased. For others, who had been professionally assessed as not having mental capacity documentary evidence was in place in peoples care plans. We found that not all staff were trained in the DoLS and people were not always asked for their consent before staff assisted them.

People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We found that the system for staff supervision and appraisal was sporadic which meant staff were not always given the opportunity to discuss their training requirements or to discuss positive and critical aspects of their working performance. We found that essential training applicable to individual staffing roles was not always carried out.

Is the service caring?

At the time of our inspection we did not find the service to be caring.

Peoples' privacy, dignity and independence were not respected. People's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care. From our observations and from reading documentation, people who lived at Asheborough House were not always treated like individuals. We saw a mixed approach by staff in the way they involved people and showed respect to people. Some staff that we saw working with people showed through their actions, empathy towards the people they cared for, whilst others did not.

Is the service responsive?

At the time of our inspection we did not find the service to be responsive.

We looked at people's care plans. A care plan is a document which provides direction and guidance to staff about how to meet a person's care needs. We saw from people's care plans that social activities and the encouragement of stimulation was lacking.

We were told by the manager that the home had three registered mental health nurses (RMN's) currently employed. One RMN worked during the day, and one RMN worked at night. The senior RMN was on leave and would be returning in November 2014. The clinical matron confirmed that they were currently 'top heavy' with registered general nurses (RGN's). An RGN and RMN are both qualified nurses, but work in different fields, for example RGN's work in general health whilst RMN's specialise in psychiatry.

Care plans and associated risk assessment documentation was well ordered. We found care plans to be detailed with regards to clinical care needs. However, care plans did not always give specific guidance and direction about how to meet a person's needs.

Is the service well-led?

At the time of our inspection we did not find the service to be well-led.

The provider had a manager who was registered with the Commission. The provider did not have an effective system to regularly assess and monitor the quality of service that people received. People who used the service, their representatives and staff were not asked for their views about the care and support they received.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences.

Staff were clear about the actions they would take should they have any concerns about people's safety.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit and all agreed that the home had sufficient staff.

We saw that Asheborough House Care Centre held all records securely to protect people's confidentiality.

The people using the service had complex needs which meant they were not all able to tell us their experiences. Because of this we used a number of different methods to help us understand the experiences of people using the service. This including observation and talking to staff.

An agency staff working at the home said, 'It's a lovely home and everyone works as a team'.

We saw that people were involved in decisions about their care and treatment.

People's needs were not always met because whilst staff were available in sufficient numbers, some staff lacked the skills and knowledge about dementia care to ensure people's needs were met. This may have been due to few staff having completed dementia training;

We saw that staff did not always treat people with respect and people were left for long periods without any interaction.

There was a good provision of equipment and the home was very clean and fresh. The home employs an activities co-ordinator and staff had time to spend with people, however they each spent time with the same few people throughout our visit.