The Wingfield

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

Staffing levels had been reviewed, yet feedback about staffing numbers from people and their relatives remained variable.

New staff had been employed, which had reduced agency use. Recruitment checks had been completed, but there were discrepancies in some of the information. This did not demonstrate a robust recruitment process was being followed.

Records did not show some people’s fluid intake was being effectively monitored. The registered manager responded to this feedback and on the second day of the inspection, all records were fully completed.

Improvements had been made to infection prevention and control. The home was clean, and systems such as auditing, and staff training were in place.

People felt safe at the home and staff knew how to identify and act on potential abuse. Any safeguarding concerns were appropriately reported.

Risks people faced had been identified and assessed, with action taken to ensure safety.

Improvements had been made to the management of medicines, which ensured people received their medicines as prescribed.

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.

Improvements had been made to care planning and staff were knowledgeable about people’s needs. People and their relatives were generally happy with the care provided.

People knew how to raise a concern or formal complaint. They were encouraged to be honest if not happy about the service, so improvements could be made.

Improvements had been made to the overall management of the home. The registered manager at the time of the inspection had provided clear leadership and direction to drive improvement.

There were a range of audits to identify and assess the quality and safety of the service. Senior managers monitored these and completed regular audits themselves.

Systems were in place to encourage people, relatives and staff to give their views about the service. Social activities were arranged, and people were encouraged to be part of the local community.

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 August 2022). 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

The inspection was prompted in part due to concerns received about people’s care and delays in responding to people’s call bells.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and responsive sections of this full report.

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

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

Recommendations

We made two recommendations for the provider to review the recruitment practice within the home, to ensure it was undertaken in line with their recruitment policy and ensure that they keep staffing levels under review .

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Wingfield is a care home providing personal and nursing care to 89 people. Some people are living with dementia. The home is made up of two buildings, three separate communities. The Lodge, Memory Lane (Dementia Care Unit) and general nursing community. At the time of the inspection there were 58 people living at the service.

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

The home had experienced various changes in management, with three different managers in quick succession. This had caused inconsistent oversight and leadership, and low staff morale. The newly appointed manager confirmed the home was on a journey, but currently, it was not where they wanted it to be. They said the culture of the home had improved, and a stricter admission criterion had been adopted. This had enabled some stability, to minimise the pressure on the staff team.

People, their relatives and staff told us there were not enough staff. This impacted on the quality of care provided which meant people were waiting to use the toilet and were not able to get up and go to bed when they wanted to. Some people walked around the home and went into other people’s rooms. Staff were not aware of their whereabouts. This impacted on people’s safety.

In addition to care staff shortages, there was a shortage of housekeeping staff. This had put additional pressure on the housekeeping team and limited the amount of cleaning they could do. The manager confirmed focus was being given to housekeeping and care staff recruitment, with the aim of being fully staffed without needing to use agency staff.

Staff did not wear their masks correctly and some staff also wore stoned rings, bracelets and nail varnish. This compromised good infection prevention and control. The kitchenette in The Lodge was not clean as there was debris on the floor and walls, and there were dirty cups in the cupboards.

Care planning did not always take into account people’s needs and preferences. Staff did not have written guidance to ensure people received effective support whilst experiencing distressed behaviours. Some monitoring records were not completed in real time, which meant there was a risk they were not accurate. Other records lacked detail so could not be accurately analysed. Some daily records contained disrespectful language and a lack of understanding of people’s needs.

People and their relatives told us there was not a lot to do in the home. Two new activity organisers had been employed to address this. They were beginning to get to know people, to help plan activities in line with personal preferences. Due to the relaxation of government guidance regarding the pandemic, people were able to receive visitors as they wished.

The service was experiencing difficulties with the supply of medicines. This had particularly impacted on one person, who did not have their prescribed medicine for two days. Staff did not always have clear guidance when administering medicines prescribed ‘as required.’ The systems for stock control had been improved, following an incident whereby a bottle of pain-relieving medicine could not be found.

There were systems in place to assess and monitor the quality and safety of the service. However, not all shortfalls found during the inspection had been identified. Action plans regarding other areas were in place and being worked through. It was recognised the manager needed time to embed these changes.

Staff had received training in safeguarding and knew how to recognise potential signs of abuse. Risks to people’s wellbeing such as falling and nutrition, had been assessed with measures taken to improve safety. Overall, safe recruitment practice was being followed.

People and their relatives knew how to raise a concern or formal complaint. The manager believed empowering people was important, so had reintroduced meetings for people to give their views.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2021)

At our last inspection we recommended that the provider sought guidance on their quality assurance systems to ensure they were submitting all legal notifications as required. At this inspection we found systems were in place to document and report any accidents and incidents appropriately.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care, inadequate staffing and management. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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 evidence during this inspection that people were at risk of harm from the concerns raised with us, and those identified during the inspection. Please see the safe, responsive and well-led sections of this full report.

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

Enforcement and Recommendations

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

We have identified breaches in relation to safe care and treatment, person-centred care and governance.

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.

The Wingfield is a care home providing personal and nursing care to 57 people. The home is made up of two buildings, The Lodge and Memory Lane. The service can support up to 89 people.

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

The provider had not notified CQC of significant events in the home when they were legally required to. These were incidents in which people had sustained injuries or where there had been physical altercations between people living in the home. The provider had taken appropriate action after these incidents to keep people safe.

We have made a recommendation about statutory notifications required by the service.

The provider had infection prevention and control procedures in place. However, some staff were observed not wearing PPE correctly which the provider addressed with additional training. Cleaning was observed throughout the service however wasn’t recorded clearly.

Recent changes in management of the service hadn't been communicated to the majority of relatives. Relatives felt people didn’t receive enough activity throughout the day to keep them engaged. Individual interactions between people and staff were caring and people appeared comfortable with staff.

Relatives told us they felt their loved ones were safe and happy at the home. The pandemic had impacted relative’s involvement with reviewing people’s care plan. However, relatives were kept updated with any changes in people’s health. Provision had been made to ensure people were able to maintain contact with those important to them throughout the COVID-19 pandemic.

There were safe recruitment practices that followed legal requirements. People received their medicines as prescribed. Staff understood how to protect people from the risk of abuse and knew what to do if they suspected something was wrong. Risks to people had been assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

People's communication needs were met. Staff understood how to provide a person-centred service. The service had a policy in place to provide people with end of life care if required.

Staff received appropriate training and supervision and had the knowledge and skills to provide the care people needed. Staff knew people well and supported them to stay healthy.

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 24 May 2019).

Why we inspected

We received concerns in relation to people’s nursing and personal care needs, staffing levels and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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.

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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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

Follow up

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

The Wingfield is a ‘care home’ with nursing. It comprises of two separate sites, The Lodge and Memory Lane. Memory Lane specialises in providing care to people living with dementia.

The whole service can support up to 89 people. At the time of the inspection there were 54 people living there.

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

Prior to the inspection we received concerns from one family about a perceived lack of communication from staff about the health and wellbeing of their loved ones during the Coronavirus pandemic and when visitors were not able to visit.

Following the site visit we spoke to a number of relatives to understand their experiences. There were mixed responses from relatives we spoke with about communication regarding their family member. Most relatives were happy with the level and frequency of communication from the home and the provider. Some relatives were unhappy that they could not make direct contact at times. This may have been due to an increase in enquiries when family members were poorly, and a different system being used prior to and after the home managers being absent.

Prior to the inspection we received concerns about staffing levels, the use of personal protective equipment and perceived cross infection between the two sites of the home. We reviewed staffing rotas and the use of agency staff and found them to be sufficient. As part of this inspection, a public health specialist reviewed infection prevention and control measures and found them to be sufficient. They have provided the registered manager with a report and recommendations.

Some areas of the home were in need of minor improvements. This included worn surfaces, scratched or chipped paintwork and bins without lids. Hand sanitizers were not placed around Memory Lane. This may have been due to the safety of people living with dementia, staff also did not have personal hand sanitizer bottles.

The majority of relatives told us they were very satisfied with the care their family member had received. They highly praised the dedication and care provided by staff and acknowledged how difficult the Coronavirus outbreak was for everyone.

The two buildings were generally clean. Staff were observed using the appropriate personal protective equipment (PPE). Staff were knowledgeable about effective infection prevention and control (IPC) procedures, had received appropriate training and were observed using procedures effectively. Staff told us they had plenty of access to the correct levels of PPE and they had never been without the appropriate equipment.

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 CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 24 May 2019).

Why we inspected

This was a targeted inspection based on concerns raised around the numbers of people and staff confirmed COVID-19 positive, the use of personal protective equipment and infection, prevention and control practices and staff’s ability to contact the senior management team to gain support when the Registered Manager was not available. In addition, we had received a number of concerns from relatives and friends about communication from the staff at the home during the Coronavirus pandemic. A decision was made for us to inspect and examine those risks associated with the Key Questions of Safe, Effective and Well-led only.

We have found evidence that the provider needs to make some minor improvements, but overall the service followed infection control policy and guidance from Public Health England.

We found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the Safe, Effective and Well-led sections of this full report.

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

Follow up

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

People’s experience of using this service:

There was evidence in care records to suggest that people did not always receive consistent personalised care that was responsive to their needs. Some care records showed where recommendations and methods of support were being followed accurately, others did not. This meant some people may not have received appropriate support. The management team were made aware of this shortfall at the time of the inspection and took immediate action to rectify it.

The service had improved from requires improvement to good, in the domains of safe and well led and received a good rating overall.

The registered manager had made steady progress with improvements to safety and the overall running of the service. They had a continued action plan to make further ongoing improvements.

The service had safe recruitment processes in place and staffing levels were improving, but relatives still had some concerns about the use of agency staff. However new staff were being recruited.

People told us they felt safe and staff were trained and knowledgeable about safeguarding people from the risk of abuse.

People’s needs were assessed by a multi-disciplinary team and care plans were reviewed and updated regularly.

People received kind, dignified and respectful care and support from a team of committed staff. People and relatives were complimentary about the quality of care and told us they were happy with the support they received.

The service was well-led by a dedicated management team who provided good support for staff to be able to do their job effectively.

Rating at last inspection: Requires improvement (report published 14 March 2018).

Why we inspected: This was a planned inspection base on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform when the next inspection should take place.

The Wingfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Wingfield is a care home with nursing registered to provide personal and nursing care for up to 89 older people. The Wingfield is part of Barchester Healthcare Homes Limited. The service is housed in two separate buildings a short walk from each other on a site that is shared with a GP surgery and pharmacy. The smaller building, The Lodge has accommodation for up to 32 people on three floors. The second building, Memory Lane has accommodation on two floors for up to 57 people, and specialises in providing care to people living with dementia. At the time of our inspection, there were 19 people living at The Lodge and 41 people living in Memory Lane.

There was 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.

Staff were not recruited safely, references from previous employers were not always verified and checked and where issues were identified, the service had not followed up to check discrepancies. Where potential issues had been identified and disclosed by the applicant risk assessments had not been put in place to make sure people were being supported by suitable workers.

Safeguarding concerns had been raised about four members of staff. The provider had taken the decision not to suspend all of them pending an investigation. Where this decision had been made there were no risk assessments in place to safeguard people whilst an investigation took place.

There were areas in the service, which due to their poor condition could not be cleaned effectively. The areas we highlighted as in need of maintenance are not part of the refurbishment programme.

People told us they felt safe and were cared for by staff who were kind and caring. We observed positive social interactions during our inspection, which demonstrated that staff knew the people they were supporting well.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Where people had their liberty restricted, the service had completed the related assessments and decisions had been properly taken. Staff had been trained and understood the general requirements of the Mental Capacity Act (2005).

People’s medicines were managed safely. We observed medicines were administered safely and in line with the provider’s policy. Safe storage and disposal arrangements were in place. Nurses administered medicines and had appropriate training to make sure they remained competent.

Staff were trained in a number of areas to support them to undertake their duties effectively. Staff had regular formal supervision and told us they currently felt well supported. Staff felt they could approach the registered manager with any concerns.

Management of complaints had improved, we found they were investigated and responded to within the timescales of the provider’s policy. Lessons learned were shared with staff via staff meetings, which were held regularly.

Care plans reflected people’s current needs and were reviewed regularly. Where needed monitoring records were completed in full and checked daily by nursing staff.

People were supported to eat sufficient food and drink. Meals were well presented and there was a choice of menu. Staff were available to support people to eat and drink, as there were sufficient numbers of staff on duty.

People could pursue their interests, as there were dedicated activity workers who planned activities with people. Activities were evaluated regularly to measure engagement.

We found one breach of Regulations; you can see what action we told the provider to take at the back of the full version of the report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook this focused inspection on the 6 and 7 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We had also received complaints about the service provided on five different occasions since the last inspection.

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 ‘The Wingfield’ on our website at www.cqc.org.uk’

The Wingfield had not had a stable management team since the registered manager left in 2015. A new manager had recently been appointed and had submitted an application to the Care Quality Commission (CQC) to become the registered manager. 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 our focused inspection on the 6 and 7 June 2017, we found that the provider had not followed their plan which they told us would be completed by the 30th March 2017. This meant not all legal requirements had been met.

The service used a DICE tool (a dependency assessment tool) to work out staffing levels. All staff we spoke with told us the tool did not reflect the needs of people living with dementia. We observed many people in Memory Lane stayed in bed and staff told us they were not able to get people up due to staffing levels. Relatives told us they had also raised concerns about staffing levels.

The service was not consistently meeting the requirements of the Mental Capacity Act 2005 (MCA). The service had liaised with Wiltshire Deprivation of Liberty safeguards team and had received advice on the implementation of the MCA. We saw evidence that mental capacity assessments had been completed for some people who lacked capacity to consent to care and treatment at The Wingfield. However, we found many people still did not have a capacity assessment in place. Staff showed a good understanding of the MCA and we saw staff giving people choice and asking for permission before providing support.

People were given a visual choice of two meals and if they didn’t like what was on offer, they could ask for an alternative. Pureed food was presented well and appeared appetising. We found though that people were not always encouraged to eat and drink sufficiently. We observed food taken away from people without staff encouraging them to eat. We observed people with prescribed build up drinks next to them, untouched. Where people were prescribed thickeners we found an increased risk to people due to conflicting information available and the knowledge of the staff.

We found the service had started to implement a system of reviewing and updating all care plans. However care plans we looked at, were not person centred and information within the plans was contradictory. People were not supported to follow their interests and take part in social activities.

Complaints received had not been investigated and responded to in a timely way.

Staff told us they did not always feel supported by management, but were hoping the new manager would make positive changes to the service.

Staff had received additional training in dignity and respect since our last inspection. The service no longer used agency staff to provide care, which meant more continuity in care. We observed staff knocking on doors before entering people’s bedrooms. People told us staff were caring and we observed positive interactions between people and staff.

We found repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 1 and 2 November 2016. The first day of the inspection was unannounced.

The service did not have 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 deputy manager and two operations managers who were responsible for the day to day running of the service. One of the operations managers was in the process of applying to be the registered manager.

At the last comprehensive inspection in August 2015 we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because insufficient care staff were deployed which meant care was not consistently provided in a timely way, the service did not effectively assess and promote infection control, the service did not always follow the requirements of the Mental Capacity Act 2005 when people did not have capacity to consent to care and treatment. In addition, the service did not have effective quality and safety assurance information gathering systems in place.

At this inspection we found that the provider had taken action to address some of the issues highlighted in the action plan, however some issues remained and still needed improvement. The service was managing risks of infection effectively. We found bedrooms and communal areas were clean and tidy. The service had adequate stocks of personal protective equipment such as gloves and aprons for staff to use to prevent the spread of infection.

Staffing levels had improved, however staff were more effectively deployed in the Lodge, than they were on Memory Lane. The majority of people living in Memory Lane stayed in their bedrooms and did not see staff other than when care tasks were completed, which meant people could be at risk of social isolation.

The requirements set out in the Mental Capacity Act 2005 (MCA) were not always followed when people lacked the capacity to give consent to living and receiving care at the home. People living with dementia were not always supported to make choices. At The Lodge staff said they had received training on this topic and understood the importance of encouraging and enabling people to make informed choices about their daily lives. On Memory Lane permission was not always sought from people prior to tasks being undertaken.

People told us they enjoyed the food and there was a good choice of meals. The chef knew people’s likes and dislikes as well as nutritional requirements. At The Lodge, people had access to food and drinks throughout our inspection. At Memory Lane people were not always supported to eat sufficient food and records did not accurately reflect what people had or had not eaten.

People’s privacy and dignity was not always respected. On Memory Lane we observed staff consistently entering people’s rooms without knocking or seeking permission to enter. There was a pleasant and friendly atmosphere throughout The Lodge.

Care plans were regularly reviewed, but the quality of information within the plans was variable. Although some were comprehensive and detailed, others were not and contained conflicting information.

Complaints and concerns were investigated, however not always responded to in a timely way. We found that for some complaints measures were not put in place to prevent incidents from reoccurring.

People who were able to tell us said they felt safe. Comments included “Yes I do like it here; I can take it or leave it. I’ve been here for years, Yes I feel safe here.”

People were kept safe by staff who recognised the signs of potential abuse and knew what to do when safeguarding concerns were raised. Staff told us they received training in the safeguarding of vulnerable adults and training records confirmed this.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner. People had access to healthcare services to maintain good health.

Safe recruitment practices were followed before new staff were employed to work with people. People received individualised care and support from staff who had the skills, knowledge and understanding needed to carry out their roles. Staff told us they had access to training appropriate to their role. New staff received a comprehensive induction prior to working independently with people.

People were supported to follow their interests and take part in social activities. There was a timetable of weekly activities, which included a book club, cooking, day trips and arts and crafts. Whilst group activities were on offer daily the activities coordinator told us they currently had two days a week where they offered people 1:1 social stimulation. We observed during our two days of inspection that there were many people on Memory lane who remained in their room. Those who remained in their rooms were only visited when staff were providing a care task. This put people at risk of social isolation.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence.

Staff we spoke with were positive about the support they received and felt they could approach management with their concerns at any time.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service told us they were satisfied with the service they received. People felt the staff supported them and met their needs. One person who used the service said "I feel that I can do what I want."

People told us that staff treated them with dignity and respect. One person said 'the staff are very good and take time to listen.' We saw staff speaking to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live on the units. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people. The service trained their staff and had the procedures which protected people from abuse. People told us they did not have any complaints but would speak to staff if they had concerns. One person said 'I know that I can speak to the manager at any time.'

The service and the building were monitored and risk assessed to ensure they were suitable for the people who used them.

The evidence we collected showed us the service kept people safe and met their care needs.

Staff supported people appropriately, including when they gave them their medication and meals. We saw one person did not sit down to eat but continued to walk about throughout the mealtime, eating as they went. We saw the home maintained full records of what the person ate, to ensure they received adequate nutrition. We observed a very frail person was being given regular mouth care, to keep their mouth clean and comfortable.

We saw medication was administered in a safe way. Medicines were stored securely. Full records of medications administered were maintained.

People spoke favourably about the staff. One person told us 'they do care, it's not just a job to them.' The provider had safe systems for recruiting new staff. Staff records were appropriately completed and stored securely.