Stamford House Care Home

Stamford House Care Home is a residential care home providing accommodation for persons who require personal care for to up to 23 people. The service provides support to younger people, older people and people living with dementia. At the time of our inspection there were 15 people using the service. The care home accommodates people across 2 floors in 1 building.

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

Recruitment practices had improved, but we found historic gaps in employment which had not been addressed. We made a recommendation about this. Staffing levels had improved, and the service had addressed the issues from the last inspection in relation to medicines and safe medicine systems were in place. Environmentally, further improvements had been made and appropriate risk assessments were in place. People were safeguarded from risk of abuse. We found infection prevention control was being appropriately managed and people were supported to have visitors. The service was learning from incidents.

Care plans were much improved, though there was still some minor work needed. We made a recommendation about this. Food stocks were being appropriately managed, and people were supported to eat a balanced diet. Staff received regular supervisions and completed appropriate training. People were supported with their healthcare needs. Some adaptations had been made to the home; however, further work was needed to make it more dementia friendly. The registered managers were working on this. 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 to express their views and were involved in planning their own care along with their relatives and staff. People were treated with dignity and respect and equality and diversity was being considered. Staff were caring and kind and people’s confidential information was stored appropriately.

An activities coordinator had been recruited and activities in the home had improved. Records relating to person centred care were much improved and people were able to make everyday choices. No one in the service was at end of life at the time of our inspection. A complaints procedure was in place and both registered managers knew how to ensure information was made accessible to people.

Audit and oversight had greatly improved, although there were still some small areas in which this could be strengthened. We made a recommendation about this. Necessary referrals were being made and the registered managers spoke about being open and honest when things go wrong. Staff worked in partnership with various agencies to support people and staff meetings were taking place. Surveys had been sent out to people, their relatives and staff and the results had been analysed. The home had a positive culture and staff spoke positively about the changes the new registered manager had implemented.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we made recommendations about activities, appropriately reviewing food stocks and environmental risk assessments and at this inspection we noted improvements in these areas. At our last inspection we also made a recommendation about recruitment and some improvement had been made but there was still further work to do in this area.

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 COVID-19 and other infection outbreaks effectively.

Recommendations

We have made recommendations in relation to recruitment, records relating to person centred care and governance.

Follow up

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

Stamford House Care Home is a residential care home providing accommodation for persons who require personal care for to up to 23 people. The service provides support to older people. At the time of our inspection there were 15 people using the service. The care home accommodates people across two floors in one building.

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

Medicines were not always managed safely. Systems and processes were in place to safeguard people from abuse and people told us they felt safe. The home had made improvements in relation to environmental risks, however, some risk assessments needed reviewing and updating. We made a recommendation about this. Staffing levels were low at times, but the manager was in the process of recruiting new staff. Recruitment practices had improved, however, there was still some improvement required. We made a recommendation about this. Infection prevention and control (IPC) practices were safe and people were supported to have visitors. Some examples of lessons learned were available for us to review.

Peoples care plans did not always contain necessary information and people’s needs had not always been appropriately assessed. The manager told us they would look to make improvements in this area. Staff received support through regular supervisions and appraisals and staff received appropriate training to ensure they had the necessary skills to carry out their role. People were supported to maintain a balanced diet. During the inspection we did find several food items that had not been used within the dates specified by the manufacturers. We made a recommendation about this. Some adaptations had been made to the home to meet the needs of the people living there. Peoples healthcare needs were being supported.

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

People, their relatives and staff were able to express their views and the service supported people to access advocacy services when required. People’s privacy and dignity was being respected and people spoke positively about staff.

People’s records and care plans were not always person centred. End of life discussion were taking place with people when appropriate and staff received training in end of life care. A complaints policy and procedure was in place. There had been no complaints logged since the last inspection. Activities were not regularly taking place. The manager was in the process of recruiting an activities coordinator. We made a recommendation about this. The manager explained how they could access information in various formats should people require this.

Audits were in place, though these were not as robust as they should have been. The provider had increased their oversight of the service, though further oversight was required. The home had internal CCTV in place, though paperwork required reviewing and updating. The manager and provider agreed to disconnect this until all necessary paperwork was in place and up to date. Staff knew how to escalate any concerns and people and staff spoke positively about the management of the service. Necessary referrals were being made and the manager spoke about being open and honest when things go wrong. Staff worked in partnership with various agencies to support people and staff meetings were taking place. Surveys had been sent out to people, their relatives and staff, but the result shad not been analysed. The manager told us they would ensure this was done.

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 8 August 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas, however, the provider remained in breach of some regulations.

This service has been in Special Measures since 12 January 2022. During this inspection the provider demonstrated that some 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

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 COVID-19 and other infection outbreaks effectively.

The provider was in the process of addressing the outstanding breaches and had plans in place to mitigate our concerns.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

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

Enforcement and Recommendations

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

We have identified breaches in relation to person-centred care, medicines and governance at this inspection.

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, which will help inform when we next inspect.

Stamford House Care Home is a residential care home providing accommodation for persons who require personal care for to up to 23 people. The service provides support to older people. At the time of our inspection there were 19 people using the service. The care home accommodates people across two floors in one building.

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

Medicines were not safely managed; medicines records were not always correctly completed, and medicines policies were not always followed.

Practices relating to infection prevention were not always safe. The environment was not always clean and there were gaps in cleaning records. However, adequate stock of personal protective equipment (PPE) was in place and staff were being tested. The home was going through a period of renovation to improve the environment. Although there had been some environmental improvements made since the last inspection, some risks relating to the environment were still of concern. The provider was working to improve this.

People were still at risk of poor pain management and safeguarding concerns were not always escalated when they should be.

The service had not recruited anyone since the last inspection. The home was adequately staffed and the provider had made significant improvements in relation to staff induction and training since the last inspection.

People were not supported to have maximum choice and control of their lives and staff did not 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.

Peoples needs were not always assessed, and peoples care plans did not always contain necessary information. One person who required access to a call bell was not able to, this was raised with the registered manager and rectified by our third day on inspection.

Peoples nutritional needs were not always considered and there were some concerns relating to the food being provided, though people spoke positively about the food. People’s oral health care needs had been considered and people had access to necessary healthcare services.

People were not always treated well and with dignity. People’s confidential information was not always stored and treated appropriately. However, feedback about staff was positive. People were involved in planning their care and people had access to advocacy services when needed.

Person centred care was not always being provided. Care plans lacked necessary information. An end of life policy was in place and staff had completed end of life training.

A complaints policy was in place, we were told there had been no complaints since the last inspection.

The registered manager understood about ensuring information was easily accessible for people. The service employed an activities co-ordinator, though feedback about activities was mixed. People were supported to have visits from loved ones.

Audits were not always robust and did not identify a variety of risks we found. Various documents, policies and procedures required updating. The provider told us they had plans to review these. There was poor record keeping and a lack of continuous learning, though the provider explained how they had supported the registered manager. Necessary notifications had not always been sent to CQC and the local authority. People using the service did not always receive good outcomes, though people and staff spoke positively about the management of the service. Although staff worked in partnership with other agencies this was not a consistent approach. Meetings for staff and people that used the service were taking place and some surveys had been sent out.

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 14 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. At our last inspection we recommended that provider review the deployment of staff. At this inspection we found improvements in this area and staff were seen evenly dispersed around the home.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider still needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to infection prevention and control (IPC), medicines, environmental concerns/risks, safeguarding people, person centred care, failure to send appropriate notifications to CQC, ensuring appropriate nutrition and good governance at this inspection. As the home has not recruited anyone since the last inspection, they are unable to demonstrate that these concerns had been addressed.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review.

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 we re 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.

Stamford House Care Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service is registered to support up to 23 people.

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

Poor management of fire safety and legionella put people at risk. Staff were not all trained in health and safety. The home was clean, but some carpets needed replacing and some areas of the home required refurbishment.

Medicines were administered safely, staff ensured creams were stored safely following the inspection. The registered manager was improving how they managed incidents and accidents. Good practice was not consistently followed when recruiting staff. We have made a recommendation about staffing.

People did not always receive person-centred care and care plans needed further development. New staff had started to work at the home before completing an induction and training, but had now completed an induction course.

There were limited systems in place to monitor the quality and safety of the service provided. The registered manager and provider took steps to mitigate risk during and following the inspection. For example, carrying out fire safety checks and completing risk assessments.

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

Rating at last inspection

The last rating for this service was good. (published 17 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of incidents. A decision was made for us to inspect and examine those risks. We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. 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 Stamford House Care Home 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 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 breaches in relation to environmental safety, incident management, staff training, recruitment, person-centred care and leadership.

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

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 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 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.

Stamford House is a residential care home providing personal care for up to 23 people aged 65 and over in one adapted building. There were 19 people accommodated at the home at the time of the inspection.

We found the following examples of good practice.

• Risk assessments and temperatures were undertaken prior to entry.

• National guidance around coronavirus had been implemented. Personal protective equipment (PPE) was used effectively to safeguard staff and people using the service. We observed clear signage reminding people about the need to wash their hands and information on donning and doffing PPE effectively. Staff received specific training on how to keep people safe from the risk of infection and had received clinical skills training.

• Although local restrictions were in place at the time of the inspection, alternative measures such as video calls and phone calls were utilised to update and maintain contact with family and friends.

• The provider complied with shielding and social distancing rules. People who had returned from hospital were risk assessed and their immediate care and support followed government guidance. This included people having to isolate in their bedrooms.

• We observed the home looked clean and hygienic. We viewed cleaning schedules and observed that high touch areas such as handles, and switches received additional cleaning daily. Environmental, coronavirus and infection control policies and procedures were in place to ensure infection prevention procedures were robust.

Further information is in the detailed findings below.

Stamford House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

During the last inspection of Stamford House in July 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to infection control, cleanliness of the environment and equipment, moving and handling, and monitoring of people’s dietary intake. The service was rated as requires improvement in the safe, effective, caring and well led sections of the report and good in the responsive section. The service was rated as requires improvement overall.

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 ‘is the service safe?’, ‘is the service effective?’, ‘is the service caring?’ and ‘is the service well led?’ to at least good. At this inspection we found improvements in these areas and the service was no longer in breach of the regulations.

Stamford House provided a safe and secure environment. Environmental risks were assessed, people’s vulnerability recognised and safeguards to prevent avoidable harm were in place.

Appropriate measures were in place to prevent the spread of infection. A cleaning schedule showed attention to ensuring tasks were carried out in a timely fashion, and supervision notes and team meetings reminded staff of their duties to ensure a clean and hygienic environment.

People’s diets were closely monitored and records were kept to show people’s daily food and drink intake. There was a plentiful supply of hot and cold drinks, and people told us that they enjoyed the food provided.

Stamford House Care Home is an older type property situated in Rochdale, Greater Manchester. The home is registered to provide accommodation to 23 older people who require support with personal care. There are two passenger lifts to assist movement between the ground and first floor. En-suite facilities are not provided but there are assisted bathing facilities on both floors. At the time of our inspection there were 15 people living in the home.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

Systems in place to manage and administer medicines helped ensure that this was done safely. Attention was paid to people’s health needs with close liaison with doctors, district nurses and other health professionals as the need arose.

There were safe recruitment procedures in place to ensure staff were of the right character to support vulnerable people. Training provided staff with ongoing opportunities to develop their learning. Staff were knowledgeable and knew the people they supported. Regular observation of their performance allowed for on the job supervision, and staff had opportunities to discuss their progress and work performance through supervision and yearly appraisal.

Individual choices were acknowledged and people who lived at Stamford House told us their choices were respected. Where people lacked capacity, the appropriate agreement to provide care and support had been authorised by the local authorities commissioning the service.

The needs and wishes of the people who lived at Stamford House were uppermost, and we saw staff showed genuine warmth towards them. There was a person-centred culture and personal belongings were treated with respect.

Care plans and daily notes provided sufficient detail to guide staff who might be unfamiliar with the people being supported. They gave a good account of needs and wishes, with regular reviews and vigilance to any changes in need. There was evidence of consultation with people and their relatives. When the service received complaints, these were followed up; we saw evidence of investigation and outcomes were recorded. People told us that they knew how to complain but did not need to. One person told us, “Everything is alright here. It’s really good; I’ve got nothing to complain about.”

We witnessed good cooperation and communication amongst staff, who were aware of their responsibilities. People who used the service were stimulated, and had bonded with the staff and formed friendship groups amongst themselves. The home conveyed a content and convivial atmosphere where people felt at home.

There was good day to day management of the service. The management team were respected, visible and supportive to both staff and the people who used the service, ensuring standards of care were maintained.

We saw information was audited but the data gathered could be used to further develop the service and improve the quality of service provision. However, the views of people who used the service were sought and respected. It was clear that Stamford House was their home, and the service was responsive to their needs and wishes.

Stamford House is a large detached home located in Rochdale, which provides care and support for up to 23 people who require residential care only. At the time of our inspection there were 21 people living at the home. Facilities include single rooms with wash hand-basins, two communal lounges, dining room/conservatory and a garden.

At the time of our inspection there was a registered manager in place. 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.

We identified breaches of three of the Regulations of the Health and Social Care 2008 (Regulated Activities) Regulation 2014. These were in relation to infection control, cleanliness of the environment and equipment, moving and handling, risk to the environment of legionella and recording keeping. You can see what action we asked the provider to take at the back of the full version of this report.

Staff understood safeguarding procedures and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

We found that the home environment and some equipment were not cleaned to an adequate standard. The home had not been adapted to cater for the needs of everyone living there. For example people with mobility problems could not access the garden and there was little in the way of adaptations, such as pictorial signage, for people living with dementia.

Checks and servicing of equipment, such as for the gas and electricity were up-to-date. However work identified in a legionella risk assessment in November 2016 had not been carried out.

Medicines were stored correctly and staff who administered medicines had received the appropriate training.

Risk assessments had been completed to show how people should be supported with everyday risks, such as risks to their mobility or nutrition. However, we identified concerns in relation to the recording of people’s food intake.

Staff had undertaken training to provide them with the skills and knowledge required for their roles and received supervision to discuss any issues in relation to their work.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were complimentary about the caring nature of the staff. However, we found that peoples’ dignity was not always respected. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

An activities coordinator encouraged people to participate in a wide range of activities.

People spoke positively about the registered manager and the management of the home.

Complaints were managed appropriately.

There were a range of policies available for staff to refer to for guidance on best practice. There were quality assurance processes in place to monitor the quality of the service and ensure it was maintained and improved. However, these had not identified all the concerns we found during our inspection.

During our inspection visit we spoke with the Registered Manager and the Deputy Manager. We looked at the policies and procedures for supporting people who required assistance to manage their finances, the Statement of Purpose, the care files of three people who used the service, records of financial transactions involving the money of eight people who used the service and the insurance certificate for the safe.

We found that robust procedures in relation to financial matters were not in place. Although the Statement of Purpose included information about the safekeeping of valuable items there was no information about the arrangements in place for people to receive their personal allowance.

We saw that records of the financial transactions involving people's money were up to date and accurate.

We were not shown any records to demonstrate that regular audits of financial matters were carried out. We therefore concluded that such audits were not carried out by the Registered Manager or the Provider.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping.

During our inspection visit we spoke with four people who used the service, two visitors, two care workers, the deputy manager and the registered manager. We also looked at medication and care records, staff training records and audits completed by the manager to monitor the quality of the service provided.

All the people we asked told us they liked living at the home. One person said, "The staff are very kind and treat me well. I have only been here a couple of weeks but it seems very nice. They provide things for us to do and I like to join in the activities. I am quite happy here up to now".

Comments from other people included, 'The staff are all nice people', 'It is clean and tidy', 'The food is good and you get a choice' and 'You could not ask for better care.'

Two visitors told us, "The care home is very good. They keep us informed of any changes and staff are very welcoming to us. Her room is kept clean and there are no offensive odours. The staff really make this place and after all it is good care we want not a fantastic looking place".

We found that a member of staff remained in the dining room at meal times to provide appropriate support for people to eat their meal in a safe and dignified manner.

We saw that all areas of the home including the kitchen were clean and tidy. Equipment such as hoists were stored in designated areas of the home. We saw that damaged furniture had been replaced or repaired.

We noted that records for the management of medication were clear and accurate. This helped to prevent mistakes from being made.

Discussion with two care workers and examination of records confirmed that regular supervision meetings were taking place with the registered manager. They said these meetings gave them the opportunity to discuss work related issues and training.

We found that the registered manager had put in place a system for monitoring the quality of the service provided. Audits completed regularly included infection control, care planning, the environment and health and safety.

We saw that care records for people who used the service were detailed and included directions for staff to follow in order to ensure people's individual needs were met.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Two people who used the service told us they felt safe living at the home. One person said, 'It's a great place to live, you've got your security.' Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Systems were not in place to make sure that managers and staff learn from events such as accidents and incidents. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes.

We saw that significant areas of the home were dirty. This included the kitchen and food storage areas, lounges, dining room and the room where medication was stored.

Although members of staff had received training in the management of medication we saw that medication administration records were not complete and accurate. Although there was no evidence of any medication errors a lack of clear records increases the risk of mistakes being made.

We looked at the care plans of five people who used the service. These plans did not clearly identify the individual care needs of people who used the service or provide clear directions for staff to follow in order to ensure people's needs were met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control and record keeping.

Is the service effective?

People's health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Although care plans were reviewed regularly we saw that the review of one care plan was dated 01/06/2014 which was four days after the date of this inspection. This meant the record was inaccurate and could put the health and wellbeing of the person at risk.

Discussion with care workers and examination of records confirmed that a rolling programme of training was in place so that all members of staff were kept up to date with current practice. However, there was no evidence to demonstrate that members of staff had regular supervision meetings with the manager or had an annual appraisal of their work.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping and supporting workers.

Is the service caring?

People who used the service told they liked living at the home. One person said, 'You won't find many homes as good as this for looking after you.' Another person said, 'Everyone is kind.'

However, at lunch time we observed that people in the dining room were left unsupervised by members of staff after each course of the meal had been served. We saw that one person was cutting food up for the person sitting next to them and then put cutlery into that person's hands. Another person was using a spoon but had difficulty putting food onto the spoon which resulted in food going onto the table. This meant that people were not receiving the support they needed in order to ensure they ate in a safe and dignified manner.

People who used the service and their representatives were given the opportunity to complete annual satisfaction questionnaires.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare.

Is the service responsive?

We were told that a member of staff was employed for two or three days each week to organise activities in the home. These included playing skittles and doing arts and crafts. People were also encouraged to pursue their own interests and hobbies. One person told they enjoyed listening to CD's in their own room.

People knew how to make a complaint if they were unhappy. One person told us they would definitely tell a member of staff if they were unhappy about something.

Is the service well-led?

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

The quality assurance system required further development in order to ensure that all aspects of the care provided at the home were properly monitored. The manager had not identified and addressed the shortfalls we found during this inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

The visitor told us that the staff seemed to know the needs of the people and treated them with respect when offering care. They said 'The staff seem to be caring, plentiful and look after the people well.'

Everyone we spoke with told us they felt safe at the home and the environment was pleasant.

We found that the provider had recruitment procedures in place and followed the appropriate guidelines in ensuring that permanent staff had the correct checks in place before being recruited.

We saw that general the policies and procedures were stored effectively, but there were some areas that required improvement.

Both visitors confirmed staff asked their relatives for verbal consent before providing treatment and personal care. However, both visitors told us that they were not involved in the regular reviews of the care plans.

Neither visitor had any concern in relation to the medication process and felt their relatives were safe living at the home. Neither had any concerns related to the wellbeing of their relatives.

The visitors we spoke with told us they felt there were enough staff around to assist their relatives and other people. They told us that they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns or complaints.