Deerswood Lodge

Deerswood Lodge is situated Crawley, West Sussex. It is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential 'care home' providing care for up to 90 people who may be living with dementia, physical disabilities, older age or frailty. At the time of inspection there were 73 people living at the home.

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

Since our last inspection it was evident the managers of the service and staff had worked hard to make the required improvements and raise the standard of care people received. Most of the providers quality assurance and safety systems for managing risks had been embedded, sustained and had continued to improve the providers oversight of care people received. However, some improvements were still required to ensure that all systems for monitoring people’s health and care were effective in identifying potential risks from which actions to mitigate those risks could be taken. Although processes had been reviewed and updated, more time was required to monitor their overall effectiveness and embed them in everyday practice.

People and their relatives told us they felt safe and were cared for by a consistent team of staff who knew them well. Risks to people’s health were assessed and people were supported to stay safe. Care and support plans were person centred and provided staff with clear guidance on how to support people. Staff were aware of their safeguarding responsibilities and knew how to report and escalate concerns.

Accidents and incidents were appropriately reported by staff, investigated by the managers and action taken to mitigate risks and reduce the risk of reoccurrence. There was a strong emphasis on learning from accidents and incidents to improve people’s experiences of care. Staff worked hard to maintain a safe and homely environment which was clean and well maintained. Infection prevention and control practice was safe and in line with current government guidance.

People told us there were enough staff to meet their needs and staff came quickly when they called. Staff had undertaken training relevant to the needs of the people they were caring for and had the skills and competence to provide safe and effective care. Staff felt supported and engaged in supervision where they received feedback on their practice and had opportunities to develop.

Medicines were managed safely and people received their medicines as prescribed in a safe and respectful way. People prescribed as required medicines (PRN) had care plans to guide staff as to when PRN medicine should be administered and alternative interventions that people could try.

People were supported to develop and maintain relationships which would reduce the risk of isolation and promote their emotional wellbeing. People told us they enjoyed a range of activities and were involved in the running and development of the home. Information and the environment had been adapted to meet the needs of people living with dementia and communication needs. People’s wishes and preferences were understood by staff and people were treated with kindness and respect. We observed people were treated with dignity when receiving care at the end of their lives.

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.

The culture of the service was positive, person centred and promoted good outcomes for people. Feedback from relatives and health professionals was complimentary about the care people received and the management of the service. One relative said, “I think its improved since [registered manager] took over, recently areas have been re painted or refurbished. There is a homely feel as you enter the building.”

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 21 February 2020).

Why we inspected

We received concerns in relation to people’s care, infection control, the management of people’s medicines and the culture of the service. 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 requires improvement to good. 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 Deerswood Lodge 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.

Deerswood Lodge is situated in Ifield, Crawley, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 90 people some of whom are living with dementia, physical disabilities, older age and frailty. At the time of the inspection there were 44 people living in the home.

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

People’s care and experiences had improved. The provider and management team had worked with external health and social care professionals to develop their own and staff's knowledge and understanding, in relation to people’s care. This had been fully embraced and changes had been made to the culture within the home. There was an increased focus on person-centred care. People and their relatives were treated as partners in their care and their views and preferences were acknowledged and respected. Systems and processes had been introduced to provide better oversight of people’s care and risk had been reduced. There was an increased confidence that once the systems and processes that had been introduced had a chance to be fully embedded and sustained in practice, that further improvements would be made. Systems had not always identified areas of practice that still needed improvement in relation to two people’s care and on one occasion people who required their weight to be monitored to help minimise potential risk had not been monitored effectively.

Some people were living with dementia, signage as well as information available to them, had not always been adapted to meet their needs. We have recommended that the provider access guidance in relation to providing accessible information for people who are living with dementia.

There had been significant improvements to improve the safety of care people received. There was improved oversight and risk had been reduced. Medicines management and oversight of risks in relation to falls, skin integrity, hydration and nutrition had improved. The occupancy of the home and the dependency of people had decreased. This helped ensure staffing levels were sufficient to meet people’s needs. The registered manager and provider had worked in collaboration with the local authority when there were concerns about people’s care and had learned from instances when care had not gone according to plan. People were protected from the spread of infection.

People told us staff were kind, caring and compassionate and they were happy living at the home. One person told us, “It’s so good here, I’d miss it if I had to leave.” Another person told us, “Some carers are lovely, like friends, so caring. They have time for us.” People were treated with respect and their privacy and dignity was maintained. They were involved in their care and their views and preferences were listened to and valued. People were supported to maintain their skills and their independence was encouraged. People’s social and emotional needs were met and there were plans to improve this further. People were not at risk of social isolation.

The registered manager and provider had worked with external health and social care professionals to assess and review people’s care in line with best practice guidance. People’s health needs were met through this coordinated approach to their care. People were supported to maintain their nutrition and hydration. People told us staff were experienced and knowledgeable. There were better systems to ensure people received sufficient amounts to eat and drink to maintain their health. 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.

Rating at last inspection and update

The last rating for this home was Inadequate (Supplementary inspection report published 11 November 2019). There were six breaches of regulation in relation to people’s safety, privacy and dignity, consent, person-centred care, staffing and the leadership and management of the home. We served three Warning Notices and the provider was required to complete an action plan to show what they would do and by when to improve. The home has been in Special Measures since April 2019. During this inspection, the registered manager and provider demonstrated improvements had been made and they were no longer in breach of regulations. They are no longer rated as Inadequate overall or in any of the key questions. Therefore, this home is no longer in Special Measures. The home has been rated as Requires Improvement and had now been rated as Inadequate or Requires Improvement at the last six consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow-up

We will continue to monitor the intelligence we receive about this home. There are conditions on the provider’s registration of this home and they are required to submit information to CQC to enable us to have oversight to ensure the improvements made are being sustained and standards of quality and safety are improving. We will work alongside the provider and the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Deerswood Lodge is situated in Crawley, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 90 people some of whom are living with dementia, physical disabilities, older age or frailty. At the time of the inspection there were 58 people living in the home.

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

There were continued concerns about some people’s safety. Risk to people’s safety had not always been identified or lessened. Medicines management was not always safe, and people did not always receive their medicines according to the prescriber’s instructions. Staffing levels, competence and the deployment of staff had not always been aligned to meet people’s assessed needs. Lessons had not always been learned to help improve the care people received. The provider had not always assured themselves that staff were appropriately trained, experienced or competent. Competency checks to assure themselves of staff’s skills had not been completed. New staff had not always completed inductions or training which the provider considered necessary to meet people’s assessed needs. This increased the risk that people would receive unsafe or inappropriate care.

Insufficient improvements had been made since the last inspection to ensure people received high-quality and safe care. The provider had failed to continually improve and improvements that had been made were yet to be embedded and sustained in practice. There had been a turnover within the management team and systems and processes to support the running of the service were not always robust. Audits, to enable the management team and provider to have an oversight of the service, were not always completed. Shortfalls that have been found at this inspection, had not always been identified by the management team or provider. The provider was working with external health and social care professionals to help improve people’s experiences.

People who were living with dementia, did not always receive respectful or dignified care. There was sometimes a lack of person-centred practices to ensure that people’s needs, preferences and wishes were respected and met. The environment and information had not always been adapted to support people’s understanding and orientation around the building. There was sometimes a lack of meaningful and stimulating pastimes or interactions with staff to occupy people’s time. People were at risk of social isolation.

We recommended that the provider accessed guidance in relation to providing accessible information and stimulating, meaningful and appropriate environments for people who are living with dementia.

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; the policies and systems in the service did not support this practice. People’s needs were not always fully identified and assessed to enable staff to deliver care that met people’s preferences or requirements. People had access to external health care professionals when they were unwell. People were complimentary about the food and told us they had choice and their preferences were respected.

Most interactions between staff and people demonstrated kind and compassionate care. People told us they were fond of the employed staff and found them caring and compassionate. One person told us, “Staff are good, I get on well with them, and they are kind and answer queries”.

Rating at last inspection

The last rating for this home was Inadequate. (Supplementary report published 10 August 2019).

This is the second consecutive time that the home had been rated as Inadequate and in special measures.

Why we inspected

Although an inspection was planned based on the previous rating, a decision was made for us to inspect sooner and examine risks. The inspection was prompted in part due to a number of concerns received about people’s safety, medicines management, the responsiveness of staff and the leadership and management of the home. We have found evidence that the provider needs to make improvements. Please see all the sections of this full report.

Enforcement

We have identified six breaches in relation to person-centred care, dignity and respect, consent to care, safe care and treatment, staffing and the leadership and management of the home. You can see what action we have asked the provider to take at the end of this full report. 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.

The overall rating for this home is 'Inadequate' and the home is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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.

Follow-up

We will continue to monitor the intelligence we receive about this home. We will request an action plan from the provider and meet with them to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

• Deerswood Lodge is situated in Crawley, West Sussex. It is a residential ‘care home’ registered for up to 90 older people, some of whom are living with dementia or frailty and other associated health conditions. At the time of the inspection there were 77 people living in the home.

People’s experience of using this service:

• There were serious concerns about the care some people had received and the provider’s lack of oversight to ensure that appropriate improvements were made.

• Risks were not always well-managed relating to choking and falling and there were concerns about people’s safety.

• Medicines management was not safe. Three people had not always had access to medicines to manage their health condition in accordance with the prescriber’s instructions. There was a risk that their condition was not well-managed and their mobility could have been affected. Medicines errors had occurred.

• Staffing levels were not always aligned to people’s assessed needs. People, relatives and staff told us that they felt at times there was not sufficient staffing to meet people’s needs.

• The provider had not always considered nor assessed agency staff’s competence before they started work. There were a number of accidents and errors involving agency staff. Lessens had not always been learnt from accidents and errors.

• There were concerns about the lack of oversight and failure to make significant, timely improvements. Since the last inspection on 17 July 2018, the registered manager had left. For a temporary period, a new registered manager had led the home, who has also since left. The management team consisted of a deputy manager and an operations manager who was providing management oversight until a new manager was recruited. There was mixed feedback about the leadership and management. One person told us, “The management has been less than good recently.” Another person told us, “The deputy manager is coping very well, she is easy to approach.”

• The provider’s values were not always promoted in practice. Concerns about people’s care had not been rectified and improved upon in a timely manner to ensure people received the care they had a right to expect.

• Quality assurance processes had not always identified the concerns that were found at the inspection. When issues had been identified there had been insufficient action taken to ensure improvements were made.

Rating at last inspection:

• At the last inspection the home was rated as Requires Improvement. (Published 24 October 2018). The home had been rated Requires Improvement at the last three consecutive inspections.

Why we inspected:

• The inspection was brought forward due to information of concern that we had received in relation to people’s care.

• At the last inspection on 17 July 2018, we found two breaches of regulations.

• At this inspection we checked the provider’s progress. We found continued breaches of these regulations.

Enforcement:

• The overall rating for this home is 'Inadequate' and the home is therefore in special measures.

• Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

• If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

• 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.

• 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 the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated as Inadequate.

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

Deerswood Lodge is situated in Crawley, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Deerswood Lodge is registered to accommodate up to 90 people across separate units, each of which have separate bedrooms with ensuite shower facilities, a communal dining room and lounge. There are also gardens for people to access and a hairdressing room. The home provides accommodation for older people and for those living with dementia. At the time of the inspection there were 80 people living at the home. The home had 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.

Prior to the previous inspection on 26 and 28 July 2017, the registered manager had notified CQC about a death that had occurred. An incident that had occurred prior to the death indicated potential concerns about the management of risk in relation to falls. While we did not look at the specific circumstances of the incident at this inspection, we did look at associated risks. Whilst all other parties have completed their investigations, the CQC investigation remains at this stage, ongoing.

At the last inspection the home was rated as Requires Improvement. The provider was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive and Well-led to at least good. A recommendation was made to improve the access to meaningful activities. There were concerns with regards to the sufficiency of staff, the maintenance of records and people’s care records not always being reviewed to reflect their current needs. At this inspection people’s access to meaningful activities and stimulation had improved. People and staff provided mixed feedback with regards to the staffing levels. Although no longer a breach of Regulation in relation to staffing, staffing levels were identified as an area in need of improvement. There is a continued concern regarding the maintenance of records and the reviewing of people’s care. The provider and registered manager had failed to improve the service people received. This is the third consecutive time that the home has been rated as Requires Improvement.

At this inspection, we found medicines were not always stored safely. People were not always provided with dignified care when receiving their medicines. Some people had specific healthcare conditions and required their medicines at specific times. Records for one person showed that they had not been given their medicines in a timely manner to maintain their health or to support them to manage their condition. This was an area of concern.

Records to document people’s care such as topical cream charts, fluid charts and repositioning charts were not always completed in their entirety. Reviews of people’s care records had not always taken place following incidents. Staff were not always provided with the most up-to-date and current guidance to inform their practice. This was an area of concern.

People were asked their consent for day-to-day decisions that affected their care. Staff supported them in the least restrictive way possible and policies and procedures supported this practice. However, people were not always supported to have maximum choice and control of their lives. For people who had a health condition that had the potential to affect their capacity, their capacity had not been assessed in relation to specific decisions. Relevant people had not always been consulted to make decisions in people’s best interests. This was an area of concern.

People told us that staff made them feel safe. People felt that staff were well-trained and knowledgeable to meet their needs and assure their safety. People and staff were aware of the importance of raising concerns about people’s wellbeing and safety. People were protected from abuse and made aware of their right to complain.

People were protected from the spread of infection. External healthcare professionals ensured that people’s heath was maintained. There was a coordinated approach to people’s healthcare. People received good end of life care.

People had a positive dining experience. They told us that they were happy with the food and had access to drinks and snacks throughout the day and night. One person told us, “The food is good, freshly cooked”.

Staff demonstrated respect. People’s privacy and dignity were maintained and they were supported by staff in a sensitive and dignified way. Staff were kind, caring and compassionate. People told us that they felt well-cared for. They spoke fondly of the staff and person-centred practice was evident. One person told us, “I can’t fault the girls. Most of them are extremely helpful and are there when you want them”.

The environment provided spaces for people to enjoy time on their own or with others. There was a fun, lively and welcoming atmosphere. People had access to a varied range of stimulation. Activities, external events and entertainment was available for people to enjoy.

People and relatives were complimentary about the leadership and management of the home. They told us that the home was well-organised and that the registered manager listened and acted upon their ideas and suggestions. One person told us, “Yes, the place is run well”.

Staff were appropriately supported and involved in decisions that affected their work. Partnership working with external organisations and healthcare professionals ensured that good practice was shared.

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

Deerswood Lodge is a residential care home providing accommodation and personal care for up to 90 older people, some of whom have physical disabilities or are living with conditions such as diabetes and dementia and who may require support with their personal care needs. On the day of the inspection there were 82 people living at the home.

Deerswood Lodge is situated in Crawley, West Sussex and is one of a group of services owned by a National provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are well-maintained communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, two unit managers and team leaders.

We previously carried out an unannounced comprehensive inspection on 8 June 2016. A breach of a legal requirement was found in relation to safe care and treatment, as risks to each person’s individual needs were not always identified or minimised and risk assessments and care plans were not always sufficient. Due to this, staff were not provided with sufficient guidance to inform their role and ensure the person’s safety. It was also identified that the recording of conditions associated with peoples’ Deprivation of Liberty Safeguards (DoLS) authorisations and staffs’ awareness of these was an area in need of improvement. The home was rated as ‘Requires Improvement’.

At this inspection it was evident that improvements had been made within these areas. The registered manager and staff had a good awareness of the Mental Capacity Act 2005 (MCA) and had assessed peoples’ capacity and made the necessary applications to the local authority when people needed to be deprived of their liberty. There was an awareness of the conditions associated to authorisations of DoLS and these were clearly documented in peoples’ care plans to inform staff and guide their practice. Risk assessments had been completed that identified the hazards and the measures that had been put into place so that staff were provided with guidance to inform their practice and ensure peoples’ safety.

The inspection was prompted in part, by a notification of a death of a person who lived at the home. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the death and the incident prior to it, indicated potential concerns about the management of risk in relation to falls. This inspection examined those risks.

There was mixed feedback with regard to the sufficiency, deployment and abilities of staff. People told us and records confirmed that people sometimes had to wait unacceptable amounts of time to received support. One person told us, “It’s not nice when you have to wait about ten or fifteen minutes to use the commode”. The registered manager was in the process of recruiting staff, however, in the interim period had ensured that agency care staff were available to meet peoples’ needs. People told us and our observations confirmed that some agency staff lacked the knowledge, abilities or understanding of peoples’ needs and sometimes failed to engage or interact with people. A comment from one person echoed this, they told us, “Sometimes the agency staff aren’t so good but the main ones know me and I get what I need”. The skills, sufficiency, supervision and deployment of some staff is an area of concern.

There were quality assurance processes in place to enable the registered manager to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. However, we found several examples of where this had failed to identify incomplete records. Records were not always completed in their entirety and therefore it was unclear if people had not received the level of care required or if staff had failed to document their actions in records.

Not all people had access to the varied range of activities that were offered. There was an apparent difference in the provision of activities or the stimulation and interaction provided to people, particularly for those who were living with dementia and who were less able to engage in activities. We have made a recommendation about the provision of meaningful activities for all people.

People were protected from harm and abuse. There were appropriate, skilled and experienced, permanent staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. Peoples’ freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. When asked why a person felt safe, they told us, “I don’t worry about burglars or getting mugged here”.

People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the management, storage, administration and disposal of medicines.

People were asked for their consent before being supported. People and their relatives, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented peoples’ needs and wishes in relation to their social, emotional and health needs and these were reviewed regularly.

Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity and were involved in their care as much as they were able. It was apparent that permanent staff knew peoples’ needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff and people were encouraged to maintain contact with their family and friends.

People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. One person told us, “The doctor comes in on Wednesdays so you can ask to be seen if you need to”.

People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The foods really good and there’s a good selection”. Another person told us, “I’m a hungry person and they make sure I get plenty”.

The registered manager welcomed feedback and used this to drive improvements and change. Compliments and concerns were shared with staff to promote learning and reflection. People, relatives, staff and healthcare professionals were complimentary about the leadership and management of the home. One person told us, “The manager is approachable and happy to listen to you”. People told us that they were happy at the home. One person told us “I think it’s beautiful and couldn’t be better”.

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

Deerswood Lodge is a purpose built service with accommodation provided over two floors divided into smaller units of ten single bedrooms with ensuite bathrooms. Each unit has an open plan lounge and kitchen/dining area and all rooms on the first floor can be accessed by a passenger lift. There are additional communal areas throughout the building and accessible, secure gardens and grounds. On the day of inspection there were 82 older people living at Deerswood Lodge with a range of physical disabilities including people living with dementia, requiring varying levels of support to manage their daily activities and maintain good health.

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. The registered manager was present throughout the inspection.

Individual risks were not always identified and plans in place did not contain sufficient guidance for staff to reduce known risks. For example, one person was a smoker but there was no risk assessment or plan in place to manage the risk to themselves or the environment. Another person had a catheter in place but there was no clear guidance for staff on how to recognise if the catheter was blocked and what to do in the event of a blockage. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was meeting the requirements of the Mental Capacity Act (MCA) 2008 and the Deprivation of Liberty Safeguards (DoLS). Conditions attached to stafndard DoLs applications were met however they were not detailed in people’s individual care plans to ensure that staff consistently upheld people’s rights and this is an area that needs improvement.

Feedback regarding the quality of food was varied. People told us and we observed that people had sufficient to eat and drink. However, risks and nutritional preferences were not always clearly identified and guidance for staff lacked detail. For example, one person’s care plan stated they should have a modified diet. However the reason for the modified diet was not given and not all of the recommendations made by the Speech and Language Therapist had been incorporated into the care plan. This meant that there was insufficient guidance for staff on how to support the person to minimise the risk of choking. This was identified as an area of practice that needs improvement.

Staff had received training in safeguarding adults and had a good understanding of their role in keeping people safe, how to recognise abuse and report any concerns. One person told us they felt, “Safe and comfortable.” There were safeguarding and whistleblowing policies in place and a robust recruitment process to ensure that any staff employed were safe to work with people.

Environmental risks were well managed. There were health and safety and equipment checks in place and any repairs were attended to promptly by maintenance staff. Accidents and incidents were recorded and monitored for trends with actions plans in place to reduce the risk of recurrence.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. Staffing levels were calculated according to people’s needs. Any gaps in the rota due to staff vacancies were managed effectively through the deployment of regular agency staff. Staff were knowledgeable and well trained. There was a training plan in place and staff received regular supervisions and spoke positively of the support and development they received.

People told us they received their medicines correctly. The management of medicines was safe and in accordance with current professional guidelines and people received their medicines as prescribed.

Staff supported people with kindness and consideration. People told us they got on well with staff and that staff listened to them. Staff used people’s preferred form of address when addressing or referring to them and delivered support sensitively and discreetly.

There were regular residents meetings and the provider undertook bi annual residents surveys to capture the views and opinions of people. The complaints procedure was displayed and all complaints were dealt with appropriately and within a reasonable time frame.

Care plans were person centred. People’s individual records contained life histories which detailed their social histories, hobbies and interests. There was a dedicated activities team and activities were delivered morning and afternoon seven days a week. Visitors were free to come and go as people wished and people were supported to establish and maintain friendships.

There was a comprehensive quality system in place to monitor quality and identify areas for improvement. Feedback from audits and action plans were communicated through regular team meetings.

The management team had good oversight and knowledge of the needs of individual people. Staff said they were approachable and that they could go to them for advice or if they were unsure about anything. The provider was open to new ideas and the service was working collaboratively with other health care professionals to deliver best practice initiatives to improve outcomes for people.

We identified two 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 the report.

People told us that staff were kind and understood their individual needs. We observed people being spoken to in a friendly and polite manner. Staff acknowledged peoples request for help and support. We saw daily menu choices displayed in each communal area and that drinks were always available. One person told us, 'Food is good here'. During our visit we observed a staff member ask a person about their meal preferences. We also observed staff providing gentle encouragement to eat and drink.

We looked at people's individual care plans and observed that each plan had information to confirm that an assessment of needs had been carried out. We spoke with care staff that were on duty. They demonstrated that they knew how care was to be delivered to ensure that peoples wishes and preferences were respected.

We viewed information about available activities displayed around the home. We observed photographic displays of recent activities featuring the people who live at the home. One of the people that we spoke with said, 'It's a lovely place, I am very happy here'.

We looked at records relating to staff recruitment. The records showed us that the provider had effective recruitment and selection processes in place.