Southport Rest Home Limited

Southport Rest Home Limited is a residential care home providing personal care to up to 25 people. The service provides support to older people, some of whom lived with dementia. At the time of our inspection there were 19 people using the service.

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

Improvements were needed to ensure all people who use the service had appropriate risk assessments and care plans which reflected their current care needs.

Governance systems at registered manager and provider level were insufficient and at times ineffective. Improvements were needed to monitor the safety of the environment as well as the quality of the care being delivered. Existing checks had either not identified the improvements needed at Southport Rest Home Limited; or failed to demonstrate any actions taken to address the improvements which were needed.

People spoke positively of the care they received and were supported by staff who knew them well. Support to people was delivered in a caring and patient manner. People were comfortable in the presence of staff and positive relationships had developed. There were enough staff on duty to meet people’s needs and staff told us they felt well supported.

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.

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

Rating at last inspection

The last rating for this service was good (published 24 April 2019).

Why we inspected

We received concerns in relation to practices to prevent and control infection and fire safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

People’s experience of living at the home was positive. We were told repeatedly that people enjoyed living at Southport Rest Home and that their needs were consistently met.

People were cared for by staff who knew them well, understood their needs and provided effective care to keep them safe. Risk was subject to regular review and was effectively managed. People received their medicines as prescribed from trained staff. The home was clean and measures were in place to reduce the risk of cross-infection.

Staff received regular training and support and were equipped to provide effective care. Care was provided in-line with best-practice guidance and legislation. People had access to a good choice of food and drink and maintained a healthy diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People and their relatives spoke positively about the staff and the way in which care was provided. Staff treated people with kindness and respect and supported their dignity in a sensitive manner. People were encouraged and supported to maintain their independence. They were actively involved in decision-making regarding their own care and developments within the wider home.

Care was personalised and met the needs of each individual. Care records captured important information regarding people’s histories, families and preferences. This information was used to tailor the provision of care to meet each person’s needs. There were a very low number of complaints recorded. People told us this was because any concerns were addressed as soon as they were raised. End of life care was provided in accordance with people’s faith and wishes.

The registered manager, provider and staff promoted an open, positive culture with a focus on high-quality, person-centred care. The registered manager made effective use of audits and other sources of information to review and improve practice. The home had forged links with other providers and resources in the local community to support further development.

More information is provided in the full report.

Rating at last inspection: Good (report published 19 July 2018)

Why we inspected: This was a scheduled inspection based on the previous rating from the last comprehensive 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.

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

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions we asked around providing a safe and well led service to at least good. We also asked the provider to complete an action plan which told us how they would achieve this.

We undertook an unannounced focused inspection of Southport Rest Home on 2 July 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our February 2018 inspection had been made. The inspector inspected the service against two of the five questions we ask about services: is the service safe? is the service well led? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

Southport Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.

Southport Rest Home is owned and managed by Southport Rest Home Ltd and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. It is located close to the amenities provided by the town.

A registered manager was 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 this inspection we found improvements had been made.

People had a care needs assessment and risk assessments were completed to identify risks to people’s health and well-being. This information helped formulate a plan of care which contained the required amount of detail to demonstrate the care and support people required. This breach had been met.

The service’s systems to assure the quality of the service were now more robust. This included audits which identified key areas of practice. Standards were being maintained and we saw evidence of how the registered manager was driving forward improvements. This breach had been met.

Sufficient numbers of staff were available to provide support to people in accordance with individual need. Agency staff were used in an emergency and the same agency staff were asked to work in the home. This ensured there was a staff team who knew people and were familiar with their care and support needs.

Measures were in place to ensure the environment and equipment was safe and well maintained. This included the completion of health and safety checks and ‘general’ maintenance of the home.

Medicines were managed safely and people received their medicines as prescribed.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff received a programme of mandatory and optional training relevant to the care and support people needed. Regular supervision and annual appraisals took place. Staff meetings were held to keep staff informed and to support them in their role.

Staff reported that ‘in general’ the culture of the home had improved since the last inspection. Staff told us everyone worked as team.

Feedback was sought from people living in the home and their relatives to ensure standards were being maintained. People attended residents’ meetings and received satisfaction surveys. These were due to be sent out this month.

The registered manager and provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications relating to incidents and the rating from the last inspection was clearly displayed both in the home and on the provider’s website.

We carried out an unannounced comprehensive inspection of this service in July 2017 when a breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found. This was in respect of Regulation 12 - Safe care and treatment. We found people were not adequately protected from the risk of unsafe administration of medicines because medicine errors remained at a high level over a prolonged period. We found concerns around the auditing system to reduce the number of medicine errors.

Following the last inspection, we asked the provider to complete an improvement action plan to show what they would do and by when to improve the key question is the service ‘safe’ and is the service ‘well led’ to at least ‘good’. The breach regarding the safe management of medicines was met, however we identified a further breach relating to safe care and treatment and this domain remains ‘requires improvement’. The rating for ‘well led’ also remains as ‘requires improvement’ due to concerns around the governance of the service.

Southport Rest Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Southport Rest Home Ltd is owned and managed by Southport Rest Home and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. It is located close to the amenities provided by the town and is adjacent to a local park.

The service had a registered manager 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.

There was a clear organisational management structure in place. The registered manager was able to evidence a series of quality assurance processes/systems and audits carried out internally. These were not sufficiently robust to identify issues to help maintain standards and support the development of the service.

We found for one person, risks to their health were not assessed and a plan of care formulated to

ensure consistent outcomes for their safety and wellbeing.

We found improvements in the way medicines were administered to ensure people received their medicine safely. Monitoring of medicine management was robust and there was a reduction in medicine errors. Improvements had been made to meet the relevant requirement. This breach had been met.

Staff administered medicine safely and people were able to manage their own medicines with staff support.

Prior to this inspection we received information of concern that staff were not trained in the use of equipment to transfer people safely, for example, a hoist and there was a lack of moving and handling equipment to support people. We saw staff were supported with a training programme which included moving and handling training. The registered manager however made arrangements for further moving and handling training to take place later this month to support staff’s learning. We spoke with the registered manager who told us the home had sufficient moving and handling equipment to support people safely.

Staff attended supervision meetings. The registered manager informed us they were commencing a programme of staff appraisal, as part of staff’s development.

Prior to this inspection we received information of concern that people could not eat meals of their choice. We saw people's dietary needs were managed with reference to individual need and requirement. No one raised any concerns with us regarding the meals.

People living at the home were supported with their care needs by the staff and external health and social care professionals to meet their health needs.

Throughout the inspection we observed positive and warm engagement between people living at the home and staff.

We saw how staff communicated and supported people. Staff had a good knowledge of people’s support and how they communicated these needs.

Staff supported people for end of life care. Relevant health and social care professionals were involved to ensure they met people's needs and wishes at the end of their life.

Staff and visitors we spoke with told us there was sufficient numbers of staff on duty. We observed that people’s needs were met in a timely way when people needed assistance.

Staff understood what adult abuse was and the action they should take to ensure actual or potential abuse was reported.

Staff had an understanding of the Mental Capacity Acct (2005) and how it applied in a care setting. Staff sought people’s consent around key decisions and people and relatives were involved in their plan of care.

Arrangements were in place for checking the environment and equipment was safe. We however identified some issues which had the potential to affect people’s safety. The registered manager took swift action to rectify this on inspection.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

People had access to a complaints' policy and procedure. Complaints recorded were managed in accordance with the complaints’ procedure.

Social activities were organised and these were appreciated by the people living at the home.

The home was clean and we found systems in place to manage the control of infection.

We saw people attended meetings to share their views about the service. Satisfaction surveys to collate people’s views were last distributed in 2016.

The registered manager was aware of their responsibility to notify us, the Care Quality Commission (CQC) of any notifiable incidents in the home.

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

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 23 people were living at the service. The service is a charitable trust which describes itself as a Jewish care home. Facilities at the service include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was in post. However they were not available on the day of the inspection. 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.

During an inspection in August 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, meeting nutritional and hydration needs, good governance, protecting people from abuse and improper treatment and receiving and acting on complaints. We inspected the service again in December 2016 and found that the necessary improvements had been made and the service was no longer in breach of regulations. During this comprehensive inspection we checked to see whether the improvements had been sustained and if the service met all regulatory requirements.

When we carried out the last unannounced comprehensive inspection in August 2016, we identified concerns in relation to the management of medicines and safeguarding service users. We issued a warning notice and told the provider to improve. At the next inspection in December 2016 we saw that practice had improved and that medicines were being administered safely. The PIR submitted prior to the inspection demonstrated that recent medicines audits had identified a high volume of errors including; missed medicines, missed signatures and stock control discrepancies. None of these errors had resulted in actual harm to people’s health, but the numbers were sufficiently high to cause concern. As part of this inspection we checked to see what action had been taken to ensure that medicines were administered safely.

A comprehensive medication policy was in place to support staff with the safe management of medicines. Staff who administered medicines had received medicines training. An audit of medicines was completed on a regular basis.

The audits we reviewed indicated that the number of errors had reduced over the previous six months. However, 400 errors were recorded in the previous 12 months.

Care records clearly evidenced that risk was appropriately assessed and reviewed on a regular basis. Accidents and incidents were recorded in sufficient detail to allow for analysis. They were audited by senior members of staff on a regular basis to look for patterns or trends. There were no significant findings from the audits viewed during this inspection.

The provider regularly completed a number of safety checks and made use of external contractors where required. Checks included; moving and handling equipment, gas safety, electrical safety, water temperatures and fire safety. Each of the checks had been completed in accordance with the relevant schedule.

Staff were safely recruited and deployed in sufficient numbers to meet the needs of people living at the service. Staffing levels were based on the number of residents rather the completion of a dependency tool. People’s dependency and care needs were reviewed regularly and people were supported to move to alternative accommodation if their needs could no longer be safely met.

Staff told us that they felt well-supported by the service and were given access to good quality training and regular supervision. The majority of training had been refreshed in accordance with the provider’s schedule.

The records we reviewed showed that the service was operating in accordance with the principles of the Mental capacity Act (2005). Previous applications to deprive people of their liberty had been submitted appropriately. However, none of the people living at Southport Rest Home at the time of the inspection was subject to a DoLS authorisation.

The feedback regarding food contained within resident meeting minutes was largely positive although there were some complaints within residents meeting minutes with regards to the authenticity of the food. The service adopted a strict Kosher meal service and followed the requirements for meat and milk produce to be handled separately. The service had attempted to mitigate the impact of these restrictions on non-Jewish residents.

Staff supported people to maintain their health and wellbeing. The care files we looked at showed people attended medical appointments in accordance with their individual needs.

The people that we spoke with told us that they were treated with kindness, dignity and respect by staff. Throughout the inspection we saw staff engaging with people in a positive and caring manner.

People’s privacy and dignity were respected throughout the inspection. We saw that staff were attentive to people’s needs regarding personal care and discrete when asking if people required assistance.

Relatives told us that they were free to visit at any time and were made to feel welcome by staff. People living at the service were also visited by volunteers who sat with people and chatted, organised activities or shared a meal.

People’s care files provided information about people’s health, behaviours, communication and the way in which they wanted their support delivered. This information was personalised through the use of an individual ‘passport’ containing easily accessible information on people’s likes and dislikes.

People had access to a range of individual and group activities including; quizzes, baking, crafts, day trips and entertainment. Two computers were available for residents use within the service with easy to use software and adapted keyboards to encourage use.

There was an accessible process in place for people to express their concerns, offer compliments or submit complaints. Records demonstrated that the management had responded to concerns in a timely manner.

The majority of staff spoke positively about the management and oversight of the service and the recent improvements that had been made. The majority of improvements made at the last inspection had been maintained. However, the improvements in relation to the administration of medicines had not been maintained to an adequate level.

Residents meetings were held regularly and relatives were encouraged to comment on the service. This demonstrated that the service recognised the value of consultation with people. We were told and saw that changes had been made following consultation. However, the minutes of meetings did not always record these actions.

Southport Rest Home had a clear vision and values which demonstrated an improved awareness of the needs of people of different faiths. There was evidence of good links to the local community and a commitment to improve further. For example, We saw that the service had recently been involved in consultation with regards to the promotion of diversity in Jewish care homes.

The care home had demonstrated an improved and sustained approach to safety and quality. The service completed regular audits of essential safety and quality indicators and we saw evidence that action had been taken as required.

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

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 19 people were living at the home. The home is a charitable trust which describes itself as a Jewish care home. Facilities at the home include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was 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.

During the last inspection in August 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, meeting nutritional and hydration needs and good governance and we issued warning notices in relation to these areas. The provider was also not meeting legal requirements in relation to protecting people from abuse and improper treatment and receiving and acting on complaints and we issued a requirement notice regarding this. During this focused inspection we checked to see whether improvements had been made in these areas and to ensure legal requirements were being met. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southport Rest Home on our website at www.cqc.org.uk.

When we had previously visited this home in August 2016 and found the home to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in respect of the management of medicines. We issued a warning notice.

At this inspection we saw medicines were now being managed safely. A medication policy was in place to support staff with the safe management of medicines in a care home. Staff who administered medicines had received medicine training. A senior member of staff member confirmed the medicine training they had received and that they checked to make sure staff administered medicines safely to people.

We found that the provider had made improvements regarding the safe administration of medicines and legal requirements were met.

During the last inspection we found that people were not adequately safeguarded against the risk of abuse and neglect because the provider had not acted on information of concern. We also found that safe disciplinary procedures had not been followed because a member of staff remained in work following serious allegations.

During this inspection we spoke with people living at the service, the head of care and the registered manager to see what changes had been made and what impact they had on the safety of the service. The head of care confirmed that staff conduct and practice were monitored and regularly observed and that staff had been briefed on the importance of reporting concerns. They also told us that between themselves and the registered manager, cover was provided over seven days. No concerns had been identified by the head of care or the registered manager since the last inspection.

People living at Southport Rest Home had access to a number of ways of raising concerns, but each person that we spoke with said that staff treated them with respect at all times.

We found that the provider had made improvements regarding safeguarding service users from abuse and neglect and legal requirements were met.

During the last inspection in August 2016, we identified concerns regarding restrictions placed on the provision of food and drinks for people who were not Jewish. The decision to provide only Kosher food meant that some foods were not available to people. Additional requirements relating to Jewish festivals meant that people’s choices were further restricted. People told us that the restrictions had not been fully explained before they moved to the service. We also received complaints about the general quality and choice of food available to all people living at Southport Rest Home.

Two people who had recently moved to Southport Rest Home told us that the restrictions relating to Kosher foods had been fully explained to them before they moved. However, the service user guide and promotional materials did not explain how these restrictions would impact on people who were not Jewish.

The service had purchased additional cutlery and crockery to allow people to eat non-Kosher foods in their own rooms if they chose and a new menu had been produced which offered greater choice. People told us that the choices were explained to them each day and alternatives were also available.

We found that the provider had made improvements with regards to the provision of food and drink and legal requirements were now being met.

When we carried out the last unannounced comprehensive inspection of Southport Rest Home in August 2016, we identified concerns in relation to receiving and acting on complaints. During this inspection we looked to see if the provider had made improvements to ensure they were compliant with legislation.

People were clear and confident about the processes for making a complaint although none of the people that we spoke with had done so. The records that we saw contained details of two complaints. One was informal and was not directed at the service or its staff. The other had been fully documented, investigated and an outcome letter issued. The procedure was clearly defined in a template that was used to record the complaint. The provider had also developed the procedure for making complaints by placing complaints forms in a prominent position in the main hallway.

We found that the provider had made improvements with regards to receiving and acting on complaints and legal requirements were now being met.

At our last inspection in August 2016 we identified concerns relating to the governance of Southport Rest Home. In particular we were concerned that there was no clear and consistent process in place for the auditing of safety or quality. This concern related to the management of the service and the oversight provided by the trustees. During this inspection we checked to see what progress had been made in relation to this requirement by speaking with the registered manager and a trustee and looking at records.

At this inspection it was clear that the trustees had developed a stronger and more regular presence in the service. We saw that they had been involved in resident’s meetings and regular meetings with the registered manager. We saw from other records that audits of medicines and care plans had been conducted regularly since the last inspection and that changes had been made as a result of issues identified. The manager had become registered since the previous inspection and had implemented a number of changes and developments to improve the safety and quality of the service. When we spoke with them they acknowledged that more work was required to develop and embed systems and generate further improvements.

We found that the provider had made improvements with regards to governance and legal requirements were now being met.

During the last inspection we identified that the majority of staff had not received formal supervision or appraisal in 2016. We made a recommendation regarding this.

At this inspection we checked records and spoke with staff to see what improvements had been made. We saw that staff had been scheduled for supervision in accordance with the provider’s action plan. Some supervisions had not taken place due to annual leave and sickness. The registered manager assured us that these would be re-scheduled as a priority.

Although improvements had been made we have not revised the overall rating; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review the rating for this service at the next comprehensive inspection.

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 19 people were living at the home. The home is a charitable trust which describes itself as a Jewish care home. Facilities at the home include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was not 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. A manager had been recently appointed and was in the process of applying to become registered. The manager was not available on either day of the inspection. The manager was represented by trustees and administrative staff.

We looked at the medicines, medication administration records (MARs) and other records for nine people living in the home. We found there were still concerns with medicine management and the service was in breach of regulation.

Some people living at the home told us that they did not always feel safe. We were told by staff that concerns had been reported prior to the appointment of the current manager that did not appear to have been acted on.

People told us that they were concerned by the lack of choice of food and the restrictions imposed by the need to store, prepare and serve Kosher food.

We saw evidence that the processing of complaints had improved recently. We were told that each person had a copy of the complaints procedure in their room. Records from May 2016 onwards were detailed and recorded outcomes. However, a number of people living at the home told us about making complaints that did not appear in the records that we were shown and had not been resolved to their satisfaction.

The manager told us that audit systems were in place for some important activities, for example, administration of medicines. But it was clear that audits were not extensive or robust enough to ensure that safety and quality were effectively monitored. This meant that the issues and concerns identified on this inspection such as those relating to medicines, staff conduct and food had not been identified and effectively monitored.

Accidents and incidents were recorded, but there was no evidence that they had been assessed to identify patterns and triggers. The documents that we saw contained limited information presented in different formats. There was no consolidated record of accidents and incidents available during the inspection.

All of the staff that we spoke with confirmed that they felt better supported following the appointment of the new manager. However, records indicated that the majority of staff had not received a supervision or appraisal in 2016.

We made a recommendation regarding this.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Applications to deprive people of their liberty had been submitted appropriately.

We received mixed views regarding the attitude, approach and conduct of the staff. However, throughout the inspection we saw staff engaging with people in a positive and caring manner.

We observed that care was not provided routinely or according to a strict timetable. For the majority of the day staff were able to respond to people’s needs and provided care as it was required.

We saw evidence in care records that people had been involved in the review of their care. Some of the care records that we saw were signed by the person themselves indicating their involvement and consent to the provision of care. However, evidence of people’s involvement and consent was not consistently recorded in care records.

The home had a programme of activities including quizzes, crafts and chair exercises. Information on activities was distributed each day. There was no programme of activities displayed.

The manager maintained records of notifications to the Care Quality Commission and safeguarding referrals to the local authority when concerns had been identified. Each record was detailed and recorded outcomes where appropriate. However, appropriate notifications and referrals had not been made for some of the issues and concerns identified during the inspection.

The home was increasingly developed with input from people living there and staff. We saw that improvements had been made to the physical environment following discussions with people. Discussions had also taken place about changes to the menu and activities. The manager facilitated regular staff meetings and staff told us that they were more confident about speaking out and making suggestions.

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

A person told us "It's a lovely place,I feel very secure here". Staff told us "People are looked after here".

People who lived at the home told us that they were looking forward to the new activities programme. The manager of the home told us that this was as a result of a recent meeting with people who lived at the home who felt they would like more activities in the day.

We found that people's nutritional needs where being met and there was a choice of meals available. When we spoke with people who lived at the home they told us that they felt that they would like to know what choices were available in advance. The manager told us that menu's will now be displayed outside the dining room.

We found that people's health needs were being met. We reviewed documentation and spoke with staff who had a good knowledge of people's health needss and were able to demonstrate how to escalate any concern's appropriately. We saw that people were seen appropriately by a wide variety of health professionals.

We found that there was enough staff to provide care at the home. We reviewed staff records and found that they were appropriately trained. We spoke with staff who said they felt supported.

We reviewed cleanliness in the home and found it to be of a high standard.

We looked at the care records and daily notes for three people living in the home. These were generally well organised and included detailed assessments of need, risk assessments and strategies to manage those risks. We spoke with six people in some depth. They said that staff supported them well. We saw there was good communication when staff carried out care. One person told us, 'The staff are really kind and know how to help me.'

Staff we spoke with were knowledgeable about managing medication. We checked a number of medication administration records (MAR charts) and they were accurate, signed and dated appropriately.

Staff we spoke with told us they had good access to training to help them carry out their work. The manager told us that she would be putting more regular supervision meetings in place to support staff. The home held staff meetings every three months to ensure staff were up to date with information related to how the home was run.

The home had systems in place to record, and securely retain, information regarding the care delivered to people and to the running of the home.