Ashgables House

Ashgables House is a residential care home providing personal and nursing care to up to 26 people. The service provides support to people living with complex mental health needs some of whom may also have a learning disability or autism. At the time of our inspection there were 18 people using the service.

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

Risks assessed for people were not always mitigated effectively, we made a recommendation about how risks were managed within the service.

People were cared for by staff who were recruited safely and had received appropriate training for their role. There were systems in place to protect people from the risk of abuse and medicines were managed and administered safely in the service.

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 told us they were supported by staff who knew them well and were kind. People were supported to be involved in their care and maintain their independence. Where people required support from staff, this was done respectfully.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People were supported to have choice and control of their lives. There was evidence that people were supported to participate in their care planning and the daily running of the service. People’s rooms were clean and personalised with family photographs and personal effects.

Right care

Care was person-centred and considered people’s privacy, dignity and human rights. Staff were knowledgeable about the people they cared for and ensured people received care that met their diverse needs.

Right culture

The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives. There was an open and inclusive approach to the running of the service.

Rating at last inspection and update

The last rating for this service was inadequate (published 01 March 2022). This service has been in Special Measures since January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 15 December 2021. Five breaches of legal requirements were found.

We undertook this focused inspection to check if the service had improved and now met legal requirements. This report only covers our findings in relation to the key questions safe, caring, response and Well-led which contain those requirements.

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 Inadequate to Requires improvement. This is based on the findings at this inspection.

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

Follow up

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

Ashgables House is a residential care home providing accommodation and personal care for up to 26 people living with diagnoses including mental, physical health and learning disability needs. At the time of this inspection 18 people were living at the service. The service had two buildings, the building named the annexe, was for male service users only and the main house was of mixed occupancy.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service had made some improvements to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture, but further improvements were needed.

Right support:

• Improvements had been made to involving people in activities of their choosing and creating enhanced opportunities for people.

People's requests were not always respected by staff.

• There were adequate numbers of staff to support people.

• Some improvements had been made to the décor of the service to make the spaces a more homely environment, but further work was needed.

Right care:

• People continued to not be protected against potential abuse.

• Observations showed that in practice people were not always treated in a dignified manner by staff.

• People were supported to attend meetings and give feedback about the service.

• The majority of people were happy with the care they received at the service.

• Care plans were reflective of people’s support needs.

Right culture:

• It had taken the service a long time to implement competent leadership to drive change and this had affected the progression of improvements to the service.

• Notifications about incidents of abuse to people had not been made to CQC.

• Staff told us the culture of the home had improved and this was having a positive impact on people and the way staff supported them.

• Staff demonstrated good understanding of people’s needs.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 20 August 2021) and there were multiple breaches of regulation. There is a condition on the providers registration to submit a monthly action plan of improvements they undertake in the service. This service has been in Special Measures since January 2021. During this inspection the provider has not demonstrated that all of the necessary improvements have been made. The service remains rated as inadequate overall for a third consecutive time.

Why we inspected

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

This report only covers our findings in relation to the Key Questions safe, caring, responsive and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a new breach of Regulation 12(3) in relation to staff vaccination records not being recorded in line with the department of health requirements. The provider remains in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 10, failure to ensure people were treated in a dignified approach, 13, the failure to safeguard people from abuse, 17 good governance and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, the failure to notify of incidents of abuse.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Ashgables House is a residential care home providing accommodation and personal care for up to 26 people living with diagnoses including mental, physical health and learning disability needs. At the time of this inspection 20 people were living at the service. The service had three units, one unit was for male service users only and the other two units were of mixed occupancy.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. CQC placed a condition on the providers registration following the inspection in January 2021. This required the provider to review how they met or intended to change practice in order to meet the needs of service users with a learning disability and/or Autism taking into account current guidance and best practice.

Right support:

• People were not receiving the support they needed or wanted. People’s right to access and be involved in their community was dictated by poor levels of staffing.

• There was a lack of meaningful opportunities provided to people and the focus was not on promoting and developing people’s skills.

• Medicines were not being safely managed.

• At the time of this inspection the service was working on their minimum safe staffing levels. This was described to us as their ‘pandemic staffing level’ despite not having a current outbreak.

Right care:

• The interim manager told us they were trying to achieve this by going through the care plans but was aware it still needed to be improved. Care practices continued not to promote people’s dignity at all times. This was evident in the written terminology staff used, the way preferences were not always followed and how some staff approached people.

• People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

• People continued to not be appropriately protected against risks and the potential harm of abuse. Some identified risks and the actions to keep people safe were not being followed at the time of this inspection. We raised safeguarding’s in respect of two people following this inspection due to our concerns about their immediate safety.

• Although some steps had been taken to improve the management of infection prevention control in the home there were still areas of the service that were unclean, and a lack of staff were available to maintain cleanliness.

Right culture:

• The culture continued to impact negatively on people’s experiences. The divided staff team and low staffing levels meant people’s emotional needs and well-being was not always a priority. Although some improvements had happened, the focus of this had not been well directed or led to manage people’s immediate safety.

• The leadership and governance of the service had not addressed areas that required immediate attention and improvement. This included risks to people and the management of these, medicine management, staff recruitment and the negative culture that had remained.

• The majority of staff spoke negatively about what it was like to work at the service and described a bullying culture that had been allowed to develop.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 9 April 2021) and there were multiple breaches of regulation.

Following the last inspection, we served a condition on the providers registration to submit a monthly action plan of improvements they were undertaking in the service. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since the inspection in January 2021. During this inspection the provider has not demonstrated that improvements have been made. The service remains rated as inadequate overall and is still in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

During the inspection in January 2021 we were made aware of a specific incident in which a person using the service was taken to hospital following a fall. This person was found with unrelated significant indicators of neglect and has since sadly died of Covid-19. This incident is currently being investigated separately to this inspection under CQC's specific incident protocols.

We have found evidence that the provider needs to make improvements. Please see the full report for details.

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

Enforcement

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Following this inspection, a letter of intent was sent to the provider to request information on how they would take action in response to some immediate concerns. The provider response did not offer enough assurances, so we wrote to the provider a second time. Following this response, we took urgent action to serve a Notice of Decision and stop any new admission to the service without the prior approval of CQC.

We are currently considering what further enforcement action will be taken. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

Ashgables House is a residential care home providing accommodation and personal care for up to 26 people living with diagnoses including mental, physical health and learning disability needs. At the time of this inspection 21 people were living at the service. The service had three units, one unit was for male service users only and the other two units were of mixed occupancy.

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

At the time of this inspection people were put at increased risk from unsafe infection prevention control management. People were not being appropriately protected against risks and action had not been taken to prevent the potential of harm. Internal audits did not reflect an overview of incidents in the service in considering patterns and future prevention measures. Medicines were not always managed safely.

At the time of this inspection the service did not have sufficient levels of trained staff to meet people’s needs.

People were not always supported to have maximum choice and control of their lives and the systems in the service did not support this practice.

During the first inspection visit we observed some examples of undignified practice.

There was a lack of governance in assessing monitoring and improving the quality and safety of the service.

The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right support:

• People’s support needs were not always correctly recorded to ensure they received the most appropriate care. This included information around risks to people, continence care and how to maintain their skin integrity.

Right care:

• Care practices did not always uphold or respect people’s dignity. We saw examples of punitive responses recorded to address people and observed a lack of respect for people's home.

Right culture:

• The culture in the service was impacting negatively on people’s experiences and care support. There was a lack of effective leadership and governance at the service. Systems in place were not being reviewed appropriately to promote positive changes for people.

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 (31 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of a COVID-19 outbreak at the service. The concerns included infection prevention control measures and low staffing levels. A decision was made for us to inspect and examine those risks.

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

We inspected and found there was further concerns, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective, caring and well-led only. No areas of concern were identified in the responsive key question, therefore we did not inspect this. Ratings from previous comprehensive inspections for that key question were used in calculating the overall rating 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.

During the inspection we were made aware of a specific incident in which a person using the service was taken to hospital following a fall. This person was found with unrelated significant indicators of neglect and has since sadly died of Covid-19. This incident is currently being explored separately to this inspection under CQC’s specific incident protocols.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the four key question sections of this full report.

Enforcement

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

A positive condition has been applied to the providers registration. This requires the provider to submit a monthly improvement plan to CQC so we can regularly monitor the service and ensure timely action is taken to improve this service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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

This inspection took place on 4 October 2018 and was unannounced. We returned on 5 October 2018 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

People who used the service were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded promptly to requests for assistance.

People told us they felt safe when receiving care. People were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

Sufficient staff were deployed to meet people’s needs. Staff had the right skills and knowledge to provide the care and support that people needed.

The service was responsive to people’s needs and wishes. People had regular meetings to provide feedback about their care and there was an effective complaints procedure. People were supported to take part in social activities they enjoyed and to keep in contact with friends and family.

Staff demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The management team regularly assessed and monitored the quality of care provided. Feedback from people was encouraged and was used to make improvements to the service. The registered manager had a good understanding of improvements they wanted to make to the service and had plans in place to implement them.

Ashgables is a residential home providing care, rehabilitation and support for up to 26 people with mental health needs and learning disabilities.

At this inspection there were 24 people living at the service.

At the last inspection, the service was rated Requires Improvement. We found improvement had been made at this inspection.

The service had a new manager in post. They were going through the registration process to become a 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.

On the day of the inspection staff were relaxed, and there was a calm, quiet atmosphere. Staff had a clear roles within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People’s medicines were not always managed safely. People received their medicines as prescribed, received them on time and understood what they were for however, the service’s policy did not reflect practice at the service and audits were not robust and in line with best practice. Records relating to skin cream required improvement. We also found the systems in place to monitor the use of medicines which require additional storage needed to be more robust. The service acted promptly to make changes to ensure medicine management was in line with best practice. We issued a recommendation in this area.

People were supported by staff that were knowledgeable about the Mental Capacity Act (2005), which ensured they were involved in decisions about their care and their rights were respected. The service followed their processes which protected people’s human rights and liberty. However, records required clarity. The records shown showed the staff had not followed the principles of the MCA and made appropriate applications to restrict people’s liberty from the assessments of capacity.”

People were comfortable with staff supporting them and we observed positive interactions. Care records were in date and personalised. Staff responded quickly when they noted changes to people’s mental or physical well-being contacting the appropriate health professionals for example people’s mental health nurses. People or where appropriate those who mattered to them, were involved in discussions of care needs and how they would like to be supported. People’s preferences for care and treatment were identified and respected.

Staff exhibited a kind and compassionate attitude towards people. Positive, caring relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted and encouraged to live full and active lives. Staff were thoughtful in finding ways to overcome obstacles that restricted people’s independence.

People were supported to maintain good health through regular access to health and social care professionals, such as GPs, mental health nurses, social workers, occupational therapists and physiotherapists.

People we observed were safe and told us they felt safe living at Ashgables. The environment was uncluttered and clear for people to move freely around the home. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Regular fire tests and checks occurred and personal evacuation plans were in place.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. People were supported by a staff team that had received a comprehensive induction programme, training for mental health conditions and ongoing support from the management team. Supervision and staff meetings were in place. Staff told us they felt listened too. Staff were aware of the whistleblowing policy should they require this.

The service had a policy and procedure in place for dealing with any concerns or complaints. The management team had responded to minor concerns in a timely way.

People described the management to be supportive and approachable. Staff talked positively about their jobs. The manager was supported by an assistant manager, deputy manager and an operations manager for the company.

There were effective quality assurance systems in place. New auditing processes for medicines were implemented during the inspection period. Incidents were appropriately recorded and analysed from trends. Learning from incidents and concerns raised was used to help drive improvements. The management team took inspection feedback seriously and acted upon our recommendations and findings to further enhance the quality of care.

We made recommendations that the service review their medicine practice in line with best practice and review their policies and procedures in line with the Mental Capacity Act Code of Practice.

The inspection took place on 11 and 12 May 2016 and was unannounced. The inspection was carried out by one inspector. At our last inspection in June 2014, we did not identify any concerns. This was the home’s first rated inspection.

A registered manager was employed by the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present and approachable throughout our inspection. Staff and people who used the service told us the registered manager was always available if they needed to speak with her and had confidence in her abilities to manage the service. The relatives of people using the service were not available to speak to during the inspection however; positive written feedback was seen about the service from some people’s relatives.

Many of the people currently living at the service have lived there for many years and have developed more specialist healthcare needs often associated with their increasing age. Due to this, in some cases people now require nursing care or care from staff with more specialist training. The service has started to address this and had already liaised with other healthcare professionals for support. They were aware they need to evolve to continue to provide effective support as required by the people living at Ashgables.

Risk assessments were in place but staff did not always have the full knowledge to support people in a way that would keep them safe from harm. Where some risk assessments had been completed there was not always a structured process in place to robustly monitor these risks. However, people told us they felt safe when receiving care and staff had the knowledge and confidence to identify safeguarding concerns and what to do if they were concerned about the safety and well-being of people using the service.

There were sufficient levels of staff and they were seen to be visible for people to call on should they need support. Staff recruitment records showed relevant checks had been completed before staff were employed at the home. These included employment references and Disclosure and Barring Service (DBS) checks. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.

Storage, disposal, ordering, receipt and administration of medicines were well managed.

The home was free from odours and appeared visibly clean with evidence of ongoing cleaning during our inspection.

Staff had completed mandatory training and training updates as required. The registered manager used a training matrix to manage the training needs of the staff team. Staff told us they received the training they required to give people the care they needed. Staff were also supported to carry out their role through regular supervisions (one to one meetings). It was noted however, that for more specific training such as management of people’s specific medical requirements, staff required more training in these areas. We spoke to the registered manager about this and she confirmed that this was something they were aware of and looking into. Further training courses were identified to rectify this during the inspection.

People were able to make specific choices and decisions about their daily life. The registered manager was aware of the legal requirements to ensure decisions were made in people’s best interests and was in the process of ensuring this was being met.

People had a varied diet and were offered choices in terms of food and drink and spoke positively about the food. However, some interaction from staff who supported people to eat their meals was not always done in a dignified manner.

During the inspection, there were some negative interactions between staff and people which did not demonstrate dignity or respect. However, people said they liked the staff and at other times during the inspection, staff were seen to be kind and caring towards people.

People were supported to have access to healthcare service and received ongoing healthcare support.

People were involved in developing their care plans and these contained information on their preferred routines, likes, dislikes and medical histories. Staff used these care plans to guide them in supporting people’s needs. However, some care plans were seen to lack detail and guidance for staff to follow.

People who lived at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The registered manager also sought the views of relatives and professionals. The provider and registered manager had systems in place to monitor how the service was provided, to improve the quality of care provided.

Quality assurance systems were in place to regularly monitor the quality of the service. The registered manager worked with external services and organisations to share best practice and support.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

People were protected from the risks associated with medicines. There were systems in place to ensure the safe storage and administration of medicines.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. Comments included; 'they provide everything that I need' and staff provide 'excellent care'.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, 'I am very well treated by staff'. Staff told us they were able to provide the care that people needed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service, their relatives and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people's records which indicated they had been consulted over the care they received. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and other services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We observed that staff were kind, considerate and responsive to people's needs. We looked at the homes recruitment procedures and found that all staff had undergone the appropriate checks to ensure they were safe to work with people. Staff told us they were very satisfied with the induction they had received when they started work at the home.

During our visit we did have concerns around the cleanliness in some areas of the home and around the general maintenance in units one and two. We also highlighted areas with the administration and the quality systems of medicines which needed to be addressed.

Although the people receiving services in the home told us they were happy and we saw they were well supported; we found that failure to maintain a safe environment may put people living in the home at risk.