Rotherlea

We found the following examples of good practice.

People and staff were cohorted to specific areas of the home to reduce the risk of infection transmission. The home was clean and hygienic with robust processes in place for cleaning high touch areas, communal space’s and people’s rooms. There was an effective laundry system to ensure contaminated laundry was kept separate from other laundry and was washed at a suitable temperature to reduce the risk of the spread of infection.

People were isolated in accordance with government guidance. Staff understood the impact of isolation on people’s wellbeing and thought of creative ways to address this. When people were isolated in their rooms, one-to-one time was utilised to talk or offer therapeutic activities. This included listening to music, using the interactive table for people living with dementia, watching television or painting people’s nails. People living with dementia who found it difficult to isolate were supported by staff who had done all they could to promote social distancing. When required, staff increased observation of people to ensure communal spaces they had visited could be frequently cleaned to reduce the risk of cross contamination.

Staffing pressures as a result of the outbreak were managed effectively. Although the service used agency staff, some permanent staff had picked up additional shifts to support the service when they could. When agency staff were used, the system in place for booking and deployment ensured that agency staff working across multiple homes during the outbreak was minimised and reduced the potential risk of COVID-19 transmission.

Staff told us they felt supported by the management team and were confident in their ability to manage an outbreak. One staff member said their IPC knowledge and skills had “improved massively” and the team had “worked well together” to keep people safe.

Staff wore personal protective equipment (PPE) as required and had undertaken refresher training in infection prevention and control, the correct use of PPE and their handwashing competence revisited. Throughout the inspection we observed all staff wearing face masks and practicing good hand hygiene.

The provider operated effective systems to monitor people and staff vaccinations, and testing requirements for COVID-19. The management team had completed a root cause analysis to understand how the outbreak occurred and had taken action to reduce the risk of reoccurrence. There was a range of policies to support working practices which were regularly reviewed and updated in accordance with current government guidance. Policies included a COVID-19 standard operating procedure, admissions and isolation policies, visiting and vaccination requirements and quality assurance / audit tools. Quality assurance processes were effective in identifying issues relating to IPC practice and when required, actions were taken quickly to resolve.

Rotherlea is situated in Petworth, 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 70 people some of whom are living with dementia, physical disabilities, older age and frailty. At the time of the inspection there were 57 people living in the home.

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

The provider had not always fully considered people’s assessed needs when allocating and deploying staff. People, relatives and staff told us that there was insufficient staffing to meet people’s needs and our observations and findings confirmed this. Medicines management had improved and people received their medicines as prescribed. People received safe care and treatment to meet their assessed needs. There was good oversight of people’s hydration and nutrition to ensure they maintained good health. People were safeguarded from abuse and improper treatment and risks were managed. When there were concerns the registered manager had liaised with external health and social care professionals. People were protected from the risk of infection and staff ensured good infection control was maintained. Incidents and concerns found at the previous inspections were used as opportunities to learn and improve practice.

There are concerns about the provider’s abilities to sufficiently improve the service. The provider’s values were not always demonstrated through their practice. Decisions that had been made had not always considered the impact on people's experiences and the quality of care they received. People, relatives and staff were complimentary about the registered manager and management team. They told us the home was well-led and they had confidence in the registered manager's abilities. The registered manager and her team had worked hard to make improvements to people’s experiences and had plans to improve this even further. They had worked alongside health and social care professionals to improve staff’s understanding and the quality of care that they provided.

We recommended that the provider continued to seek support from reputable sources to ensure that they provided accessible information to meet peoples needs.

Work was on-going to further improve person-centred care and people’s access to sources of stimulation and interaction to occupy their time. Some people spent extended periods of time without interaction or stimulation with others. The provider and registered manager had embraced support they had received from external professionals to help ensure that people’s needs were appropriately assessed and planned for. People had received appropriate end of life care to maintain their comfort.

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 were supported by skilled and experienced staff who demonstrated good practice when supporting people. People had access to external health care professionals and were supported to maintain their health. People had access to sufficient food to ensure they received a balanced diet.

People’s privacy and dignity was maintained, and they were treated in a respectful way. People told us that staff were kind and caring and they were complimentary about staffs’ compassionate nature. Observations showed staff knew people well and they were considerate and caring.

Rating at last inspection and update

The last rating for this home was Requires Improvement. (Published 10 August 2019). There were breaches of regulation. We served two Warning Notices and the provider was required to become compliant. At this inspection, significant improvements had been made in relation to people’s safety and the provider was no longer in breach of one of the Regulations. We continue to have concerns about the provider’s leadership and management and not enough improvement has been made by the provider. They are in continued breach of the Regulation.

Why we inspected

This was a planned inspection based on the previous rating. We had planned to undertake a focused inspection to check the registered manager’s and provider’s progress and the improvements made since we had served Warning Notices at the last inspection for breaches of two Regulations. We found significant improvements in some of the key questions had been made and therefore undertook a comprehensive inspection.

Enforcement

We have found evidence that the provider needs to make further improvements. We have identified a breach in relation to staffing and the provider’s leadership and management. You can see what action we have asked the provider to take at the end of this full report.

Follow-up

We will continue to monitor the intelligence we receive about this home. 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 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 Rotherlea on our website at www.cqc.org.uk.

Rotherlea is situated in Petworth, 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 70 people who are living with dementia, older age or frailty. At the time of the inspection there were 54 people living in the home.

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

Although improvements had been made since the last inspection, people were not always protected from the risk of harm. Medicines were not always administered according to prescribing guidance. Risks to people’s safety had not always been considered or lessened. People requiring modified diets had sometimes been given foods that had the potential to cause them harm. Systems and processes did not always ensure that people were protected from the risk of abuse. People were not always provided with enough to eat and drink to meet their assessed needs.

Although there were continued concerns, the leadership of the home had improved. Systems and processes had been introduced but were yet to be fully embedded to ensure improvements were sustained. The provider and manager had focused on changing the culture, and people, relatives and staff were complimentary about the impact of this. A relative told us, “I’m hopeful that things will get better now there is a new manager, she’s always around and willing to talk to you. The staff seem to be a bit more relaxed.”

Information had not always been provided in the most accessible format. We have recommended that the provider seeks support from a reputable source in relation to this.

There were enough staff to meet people’s needs. People and relatives provided mixed feedback about staff’s abilities and our observations confirmed this. Permanent staff had the skills to meet people’s needs. However, the provider had not assured themselves that agency staff were competent to carry out their roles.

Concerns that had been raised with the manager as part of the inspection were addressed promptly to minimise the risk to people.

People did not always have enough to do to occupy their time. The manager had recognised this and was in the process of introducing new ways of working to improve staff’s engagement and interaction with people.

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

People’s privacy and dignity were maintained. Permanent staff supported people in a warm, friendly and respectful way. People told us staff were kind and compassionate. One person told us, “I think they’re wonderful, they are lovely girls, very friendly and will do anything for you.”

Rating at last inspection (and update)

At the last inspection the service was rated as Inadequate. (Published 9 April 2019). This service has been in special measures since 29 January 2019. At this inspection, although improvements had been made, these were not enough, and the provider was still in breach of regulations.

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

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

Before the last inspection, the provider notified us about a specific incident that indicated concerns about unsafe medicines management for time-specific medicines. At the last inspection we looked at these concerns. Following the inspection, we received further information about the specific incident and we are continuing to look into this outside of the inspection process. As a result, this inspection did not examine the circumstances of the incident, however we looked at medicines management in the wider-context to ensure potential risks were managed.

Enforcement

We have identified breaches in relation to people’s safety and the leadership and management of the service. 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 manager took prompt action, during and after the inspection, to ensure that risks were lessened.

Follow-up

We will continue to monitor the intelligence we receive about this service. 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 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 comprehensive inspection, by selecting the ‘all reports’ link for Rotherlea on our website at www.cqc.org.uk.

• Rotherlea is situated in Petworth, West Sussex and is one of a group of homes owned by a national provider Shaw Healthcare Limited. It is a residential ‘care home’ registered for up to 70 older people who are living with dementia or frailty. At the time of the inspection there were 61 people living in the home. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

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

• Risk were not well-managed and there were concerns about people’s safety.

• One person had not always had access to prescribed medicines to manage their health condition.

• Risks had not been considered for people. One person had experienced a serious scald.

• Staff sometimes lacked understanding about potential risks and about gaining people’s consent.

• People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. The policies and procedures in the home did not support this practice.

• The management of the home had changed since the previous inspection. They showed commitment and enthusiasm to implement the changes needed to improve the care people received.

• People were protected from abuse.

• People were protected by infection prevention and control.

• There were sufficient staff to meet people’s needs.

• People told us that they were happy living at the home, that they felt well-cared for and safe.

• Staff were observed engaging and interacting with people in a kind and compassionate way.

• More information can be found within the full report.

Rating at last inspection:

• At the last inspection the home was rated as Requires Improvement. (Published on 27 November 2018). This home had been rated as Requires Improvement in the last three consecutive inspections. At this inspection on 29 January 2019, we continued to have concerns.

Why we inspected:

• This was an unannounced focused inspection to look at the key questions of Safe, Effective and Well-led. This was because at our last inspection, on 27 September 2018, the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action against the provider and gave them a date to meet the Regulations by. This inspection took place to check that improvements had been made and that they were now meeting the Regulations.

Enforcement:

• The provider had not met the Warning notices that had been issued following the previous inspection on 27 September 2018.

• We continued to have concerns.

• 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.

Rotherlea is situated in Petworth in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Rotherlea is registered to accommodate 70 people. At the time of the inspection there were 60 people accommodated in one adapted building, over two floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people and those living with dementia.

The management of the home had been through a period of transition. The home had a registered manager who had been on long-term leave from work. 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 team leaders and two deputy managers, one of whom was also on long-term leave from work. A manager from one of the provider’s other homes had been managing Rotherlea, alongside their own service. An operations manager also regularly visited and supported the management team.

At the last inspection on 14 and 15 September 2017, the home received a rating of ‘Requires Improvement’. The provider was found to be in breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, the provider completed an action plan to inform us of what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. This was because there were concerns about staff’s understanding and use of the Mental Capacity Act 2005 (MCA). The provider had not always complied with the Deprivation of Liberty Safeguards (DoLS). Staff were not always provided with consistent guidance about people’s specific healthcare needs. Records to document the actions of staff were not always maintained. Areas identified as needing improvement related to following advice that had been provided by external health care professionals.

At this inspection, we found some improvements, in relation to MCA, the maintenance of some records and implementing healthcare guidance, had been made since the previous inspection. However, people were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible. The policies and systems in the home did not always support this practice. This was an area of concern.

One person’s needs had been assessed before they moved into the home. This had shown that they had a history of falls. The provider had failed to ensure that these risks were identified and managed to assure the person’s safety. The person had fallen and sustained a significant injury. This was an area of concern.

There were continued concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Not all concerns that had been identified at the previous inspection on 14 and 15 September 2017, had been addressed. Areas that were identified as part of this inspection had not always been picked-up and acted-upon by the provider’s own quality assurance audits.

Records, to document people’s specific healthcare conditions did not always contain sufficient guidance to inform staff’s practice. It was not always evident how people or their relatives had been involved in contributing or reviewing their care.

We made a recommendation about people’s access to meaningful activities, interaction and stimulation.

People were cared for by sufficient numbers of staff to meet their physical needs. People were protected from harm. Staff knew the signs and symptoms to look for if there were concerns about a person’s care. Reflective practice ensured that lessons had been learned when care had not gone according to plan.

Most risks were managed and people received safe care. People told us they felt safe. One person told us, “I feel safe because there are people around and the bell”. A relative told us, “I feel my relative is 100% safer here”.

Medicines were managed safely. People were protected from infection and staff demonstrated correct techniques to ensure that cross-contamination was minimised.

People had access to healthcare professionals when they were not well. There was a coordinated approach to people’s healthcare. One person told us, “If I wanted to see a GP I would only have to ask a team leader”.

People’s hydration and nutrition was maintained. Comments from people included, “The food is wonderful” and “My food is OK, I have no complaints. If you want more you only have to ask”.

People and their relatives were informed about their care. People told us that staff were kind, caring and compassionate. Comments from people included, “The carers are fine, no problem with any of them” and “They are very pleasant and helpful carers”.

People’s privacy and dignity was maintained. People were supported to remain comfortable at the end of their lives.

People were aware of how to raise concerns and complaints. Residents’ and relatives’ meetings, as well as surveys enabled people to voice their opinions and suggestions about the way the home was run.

People had space to be with others, spend time on their own or enjoy the gardens in warmer weather.

People, relatives and staff were complimentary about the management of the home. People and their relatives told us that they could approach the management if they had queries about people’s care. One person told us, “I don’t know who the actual manager is here. However, there seems to be plenty going on and is run pretty well”. Staff felt valued and appreciated and told us that morale had improved.

This is the third consecutive time that the home has been rated as Requires Improvement. 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 the 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.

Rotherlea is a residential service providing accommodation for up to 70 older people, some of whom are living with dementia and who may require support with their personal care needs. On the day of the inspection there were 56 people living at the home.

Rotherlea is situated in Petworth, 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 comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are also 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, one unit manager and team leaders.

We previously carried out an unannounced comprehensive inspection on 26 and 27 July 2016. Breaches of legal requirements were found in relation to safe care and treatment, the need for consent, sufficiency, support and training of staff and governance. The home was rated as ‘Requires Improvement’.

At this inspection it was evident that improvements had been made. Staff received training and appropriate support and guidance within their roles and quality monitoring systems, to enable the management team to have an oversight of the service that was provided, had improved. Risk assessments had been completed that identified the hazards and measures had been put in place to monitor and mitigate risk. As a result the registered manager was no longer in breach of these associated regulations. Although improved and therefore not in breach, an area in need of improvement related to the implementation of guidance in relation to peoples' healthcare needs. There was a new concern with regards to the lack of records to provide guidance to staff in relation to peoples’ specific healthcare needs and to document staff’s actions. There were continued breaches in relation to MCA and DoLS. Staff lacked understanding and the registered manager had not always ensured that peoples’ capacity was assessed in relation to specific decisions. In addition, applications had not always been made to the local authority to ensure that people were not being deprived of their liberty unlawfully.

People were protected from harm and abuse as they were cared for by staff that knew how to recognise the signs of abuse and what to do if there were ever any concerns. Risks to people were assessed, monitored and mitigated and peoples’ freedom was supported and respected according to their needs. Staff were adequately supported within their roles and had access to training to enable them to deliver safe care to people. People told us that they were happy with the food and drink that was provided. Comments included, “Food good, given too much” and “Food much better, better selection than other home”.

Staff were aware of peoples’ needs and could recognise when people were unwell. People had access to external healthcare professionals to support them to maintain good health. Staff were kind and caring and people and relatives told us that they were happy with the support they received from staff and they were treated with dignity and respect. One person told us, “Staff ask in a nice way, all very good”. Another person told us, “Staff very good, no complaints”. A comment within a recent relatives’ survey echoed these views, it stated, “I cannot fault the care given to my relative. The staff are caring and always meet their needs. I feel that we are supported as a family by everyone from the cleaners to management. I cannot fault my relatives, or my care, in any way’.

People were actively involved in decisions that affected their care. Regular residents’ and relatives’ meetings took place and quality assurance surveys sent, to enable people to share their views. Peoples’ and relatives’ views were respected and acted upon and changes made as a result. The registered manager welcomed feedback and people were made aware of their right to complain.

Peoples’ care was personalised to their needs and staff took time to speak to people and listen to their views. Warm interactions were observed and people had access to meaningful interactions with each other, their relatives and staff. People were able to stay at the home until the end of their lives and were involved in decisions that affected their care at this time. Observations showed that people’s wishes were respected at the end of their lives.

There was effective, on-going quality monitoring to ensure that the service was meeting peoples’ needs.

The culture of the home had improved. People, relatives, staff, the management team and external professionals all commented on how the much the atmosphere had improved. One member of the management team told us, “Rotherlea has drastically improved. It is now a nice friendly, happy place. The residents are happy and for me that is the most important thing”.

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

Rotherlea provides accommodation and care for up to 70 older people, some of whom are living with dementia. At the time of our visit, there were 61 people in residence (27 in the three downstairs units and 34 in the four units upstairs).

The service has 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.

There were not enough staff employed by the service. Although the registered manager had mostly maintained the staffing numbers by using temporary staff, this was having an impact on the care that people received. Staff were under pressure and had little time to engage with people socially or to support them to pursue their individual interests. Staff were ‘borrowed’ from the domestic and activities staff teams to provide care to people. This had a knock on effect on the cleanliness of the home, the ordering of supplies to the kitchen and the provision of activities. Due to staff changes and staff moving between the units of the home, people did not have the continuity of the same keyworker to ensure their wellbeing.

Risks to people’s safety had not been managed effectively. We could not be sure that people received appropriate support at all times to minimise any impact on their health.

Medicines were not managed safely. A new electronic recording system for the administration of medicines had been introduced but some staff had not received training to use it effectively. Stocks of medicines did not tally and staff did not always follow the provider’s policies in how to store, administer and dispose of medicines.

The Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider was not meeting the requirements of DoLS because the registered manager had not applied to authorise the deprivation of liberty for some people using the service. Staff had a variable understanding of the Mental Capacity Act 2005 (MCA). Records did not demonstrate that people’s rights had been protected when they were deemed to lack capacity to make decisions regarding their care and treatment.

Staff did not feel supported by management or that their contribution was valued. Staff had not always received appropriate training, support and supervision to enable them to carry out their duties effectively.

The registered manager had not carried out regular audits to monitor the quality of the service and to make improvements. She told us that she had been working hard behind the scenes to implement an action plan agreed with the provider. We saw that the score resulting from audits by the provider had improved during 2016.

People’s care had been planned but the monitoring in place did not demonstrate that people’s planned support had been consistently delivered. People were referred to healthcare professionals to promote good health. Visiting professionals told us that staff generally made appropriate referrals and followed their recommendations.

People enjoyed the food and were offered a choice of meals. Staff did not use any visual prompts to support people living with dementia to understand the choices available to them. We have made a recommendation regarding adaptations to better meet the needs of people living with dementia.

People spoke highly of the regular staff team that supported them. They told us that they were very kind and that they worked extremely hard. They told us that staff treated them with respect and were mindful of their privacy. Some people were actively involved in planning their care, others told us that they would like to have more of a say.

People felt safe at the home. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

People felt able to raise any concerns and had confidence that any complaints they made would be resolved.

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

The inspection team consisted of an inspector and an expert by experience. At the time of our inspection there were 68 people using the service. We spoke with six of them and relatives of another four in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with a unit manager and eight members of staff.

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe and comfortable in the home. One person said, 'Yes, I'm very happy, I am well looked after and I feel very safe here.' All the visiting relatives we spoke with said their family member was well cared for. They told us they felt assured their family members were safe.

We found the service carried out the necessary checks before staff started work and there was a robust recruitment process in place. There were sufficient staff to look after people safely. Processes were followed to ensure medicines were administered safely. We observed care workers helping people to move about the home safely using wheelchairs, frames and other equipment.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person's relative said, 'Very good. 10/10.'

We found people's care and support were based on thorough assessments and detailed and personalised support plans. The environment people lived in had been adapted and decorated in a way that helped people to live well with dementia. Systems were in place to ensure care was delivered according to people's plans.

Is the service caring?

Relatives of people using the service told us support was provided in a caring way. One said, 'Yes, it's brilliant. They know me, they know mum. Mum has been here two years. I can come in, make myself a cup of tea. I love it. It makes me want to come in.' Another said 'Quite nice, the people are friendly'. People using the service told us they got on well with their care workers and had a good relationship with them. One person said, 'I'm very happy; the people are very kind and look after us well."

Staff we spoke with were motivated to provide high quality care. They had a thorough knowledge of people's needs and how they preferred to have their care delivered. One member of staff said 'I love working with the residents, I treat them like I would my mum, my dad, my grandparents.'

Is the service responsive?

The service responded to changes in people's needs or circumstances. People told us staff responded promptly when they needed assistance.

We found the service assessed people's risks and adapted their care plans accordingly. Staff were aware of people's preferences, backgrounds and interests.

Is the service well-led?

Systems were in place to regularly assess and monitor the quality of service provided. There were processes in place to review and learn from incidents and accidents. People who used the service and their families were able to contribute their views about the service they received.

We spoke with five relatives. They had mixed experiences of the service. One said, 'The whole place is just very nice. The atmosphere is good, the carers are very helpful, caring and approachable'. Another told us, 'They're lovely but I don't think they've got time to care'.

We spoke with eight carers, three team leaders and the manager. Staff told us that they enjoyed working in the home. One said, 'I love it, it's the best job ever'. Many told us, however, that they were finding it increasingly difficult to meet people's needs with the number of staff they had on shift.

We found that people were happy in the home. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. People told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

We found, however, that there were not enough staff in all parts of the home to ensure people's safety and welfare at all times. Where risks had been identified support plans were not always in place or followed. We observed some dangerous moving and handling practice and found that prescribed creams were not properly managed.