Southlands Place

Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 48 people living in the service when we visited. People who lived at Southlands Place were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, and could show behaviours which may challenge. Most people needed some support with their personal care, eating, drinking or mobility.

Peoples experience of using this service and what we found

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe here, absolutely.” Care plans and risk assessments meant peoples’ safety and well-being were protected. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained and comfortable. The provider ensured that when things went wrong, accidents were recorded and lessons were learned.

Managers and senior staff created a transparent and honest culture for people and staff that was focused on ensuring everyone had the support they needed. The management were committed and enthusiastic about providing support and training for staff to enable them to provide people with the best support possible. The management team consistently reviewed the service through their governance systems and identified ways to improve things for people. People, their relatives and staff were given regular opportunities to be involved in how the service was run by being provided with frequent opportunities to feedback on aspects of the service.

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

Rating at last inspection

At our last inspection we recommended that the provider sought expert guidance regarding oral hygiene practices. At this inspection we found that they had made improvements and the management monitored this daily.

Why we inspected

The inspection was prompted, in part, due to concerns received about the provider’s approach to visiting, responding to concerns and risk of a closed culture. A decision was made for us to inspect and examine the concerns across a range of Caring Homes services.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

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

People who lived at Southlands Place were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people also lived with dementia. Most people needed some support with their personal care, eating, drinking or mobility.

We found the following examples of good practice.

The home was clean and well maintained. There was regular cleaning throughout the day and this included high-touch areas. Staff were vigilant of cleaning switches, keypads and door handles before and after touching them. Housekeepers were knowledgeable regarding current Covid-19 cleaning guidelines. Cleaning schedules and audits were in place.

There were systems in place to ensure that people who had tested positive for Covid-19, were unwell or self-isolating were cared for in their own rooms to minimise the risk of spreading the virus. The premises had been divided into zones /floors to minimise transmission of Covid-19.

The home was currently closed to all visitors apart from those who were on a palliative care pathway and end of life. Staff supported people to remain in contact with their families through phone and video calls.

The policy for safe admissions into the service clearly stated that before people were admitted to the home, they were required to have a negative Covid-19 test and then would need to isolate in their bedrooms for 14 days.

Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Staff were seen to be following correct infection prevention and control (IPC) practices. Hand sanitiser and PPE was readily available throughout the home.

Regular testing for people and staff was taking place. All staff have a weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). In addition, they have their temperatures taken. People have a monthly PCR test with twice daily temperatures and oxygen level checks.

Visitors to the home such as health and social care professionals were asked to complete a health pro-forma and have their temperature taken on arrival. They were also asked to undertake a LFT test.

At present most people chose to spend time in their rooms, and were supported by staff to remain engaged with various activities. Staff told us a small groups of people visited the lounge for coffee and lunch. Seating was arranged to ensure people could enjoy being with their friends but maintain social distancing.

Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 32 people living in the service when we visited. People who lived at Southlands Place were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, and could show behaviours which may challenge. Most people needed some support with their personal care, eating, drinking or mobility.

People’s experience of using this service:

People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “This is a good place to live, I feel safe,” “I am well looked after” and “Staff are pretty marvellous”

• The service had made improvements since our last inspection. This meant people’s outcomes had improved and the breach of regulations met. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. For example, the monitoring of completed behavioural charts that showed aggression towards staff and other people since December 2018 had not been followed up or escalated to the management team for action. This meant that the provider had not had a full oversight of incidents that occurred in the home. We also found shortfalls in the management of some peoples’ pain control and that not all peoples’ social and well-being needs were reflected in peoples’ care plans.

• These required further improvement, however we acknowledge that the shortfalls in respect of incidents were addressed immediately.

We have made a recommendation about seeking expert guidance regarding oral hygiene practices.

• There were sufficient staff to meet people’s individual needs: all of whom had passed robust recruitment procedures that ensured they were suitable for their role.

• There were systems in place to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, accidents were recorded and lessons were learned.

• Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “Staff seem knowledgeable, look after my relative really well,” and “The staff team seems to have really improved.”

• People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave very positive feedback about the food. Comments included, “The food is good,” “Very generous with the rations” and “Good food”

• The environment was comfortable, clean and well maintained.

• People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “We are looked after.”

• People were supported to keep in contact with their families. One person told us, “I text every day, I think I could skype if I needed to, I think there is a laptop I could use.”

• The care was designed to ensure people's independence was encouraged and maintained.

• People and families were involved in their care planning as much as possible. End of life care was planned for and staff received training and

• There was now a happy workplace culture and staff we spoke with provided positive feedback about the management style.

• Referrals were made appropriately to outside agencies when required. For example, GP visits, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

The service met the characteristics for a rating of ‘Good’ in three of the five key questions we inspected, with the responsive and well-led question being ‘Requires Improvement.’ Therefore, our overall rating for the service after this inspection was ‘Requires Improvement’.

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

Rating at last inspection: Requires Improvement. (Report published on 25 March 2019.)

This is the second time the service has been Requires Improvement. However, improvements were seen and the service had met the previous breaches of regulation.

Why we inspected:

• As part of our enforcement action following our prior inspection, we had requested an action plan as to how they were making improvements. This inspection was scheduled to look at their action plan and ensure improvements had been made in line with their action plans.

• All services rated as ‘Requires improvement’ are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and the improvements made.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 38 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, some of these people could show behaviours which may challenge. Most people needed some support with their personal care, eating, drinking or mobility.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

The service was first rated as Inadequate, with five breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed in ‘Special Measures,’ after the inspection of 9, 17 and 18 October 2017. Following that inspection, we followed our enforcement procedures and added a formal condition to the provider's certificate of registration that they must draw up an action plan and submit it to us every month to show what they would do and by when to improve all five key questions to at least Good.

The service was next inspected on 4, 5 and 11 June 2018. The service was again rated as Inadequate and we identified five continued breaches and two new breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, consent to care, safety, safeguarding people from abuse, complaints, good governance and staffing. As a result of the 'inadequate' rating, Southlands Place remained in 'Special Measures.'

Following that inspection, we again met with the provider and also followed our enforcement procedures. We performed this inspection to review progress towards addressing areas identified in the last inspection. The provider had continued to send us a monthly action plan as required since the last two inspections. After the last inspection, we also continued to receive a range of comments from both people and external professionals about the service. We took both matters into account when planning this inspection.

Separate to this inspection, CQC are also reviewing a serious incident for a person in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this review related to the October 2017 inspection.

At this inspection we found the provider had made some improvements and the service was now rated as Requires Improvement, but remained rated as Inadequate under the key question, Well-Led. This was because the provider had still not met three of the five breaches in regulation, which have been identified for the past two inspections. However, due to improvements made, the service is no longer in ‘Special Measures.’

This service has had no registered manager for over 18 months. 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. Since October 2017 there have been three management changes. The provider appointed a new manager; they started in post in June 2018. Their application to become registered manager is being progressed by our registration department. The provider is Caring Homes Healthcare Group Limited, a national provider of care.

The provider's systems for monitoring continued not to identify a range of issues, so necessary actions to address issues had not taken place before the inspection. This included a wide range of areas relating to safety, care and treatment of people and record-keeping.

At this inspection action continued to be needed to ensure the safety and well-being of people. This was because people's safety was not ensured in areas including prevention of pressure damage, nutritional risk and risk of falls. The service also continued not to consistently follow national guidelines to reduce such risks.

As at the last two inspections, some staff did not follow people's care plans when providing care. Some people's care plans continued to be unclear, so did not ensure all staff knew how to provide people with the care they needed. Some people continued not to always receive the care they needed in relation to areas such as dementia care and continence needs.

The provider had taken action to make improvements, including in fire safety, the management of catheters and wound care. Timely referrals were now being made to the local authority where people may be at risk of abuse.

The service was now complying with the requirements of the Mental Capacity Act (MCA) 2005. They were also ensuring they followed their own complaints procedures where people wished to raise issues of concern.

People and staff confirmed staffing levels had improved and the use of agency staff had reduced. Staff were being supported through training and supervision, to meet people’s needs.

People now received a caring approach from staff. Activities provision had been further developed to ensure people’s recreational needs were responded to. Key areas in care such as providing frail people with mouth care had improved.

People told us they liked the meals. Staff ensured people could choose their meals and could also chose where they ate their meals. Where people needed assistance with eating and drinking, staff did this in kind and supportive way.

At this inspection we found continued breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although the service is no longer in ‘Special Measures,’ because the service has not acted in full to ensure the safety of people, ensure their care and treatment needs were met and have effective systems to audit service provision, CQC will be closely monitoring the service. 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.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

The service was last inspected on 9, 17 and 18 October 2017. The service was rated as inadequate at that inspection and we identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, consent to care, safety, safeguarding people from abuse and good governance. As a result of the ‘inadequate’ rating, Southlands Place was placed into ‘Special Measures.’

Following that inspection, we met with the provider and also followed our enforcement procedures. We added a formal condition to the provider’s certificate of registration that they must draw up an action plan and submit it to us every month to show what they would do and by when to improve all five key questions to at least good. The provider sent us a monthly action plan as required. After the last inspection, we also continued to receive a range of comments from both people and external professionals about service provision, which we took into account when planning this inspection.

Separate to this inspection, CQC are also reviewing a serious incident for a person in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this review related to the previous inspection.

At this inspection we found the provider had not made the necessary improvements and the service remained rated as inadequate over all. The provider had not ensured they had met any of the five breaches identified at the last inspection and additionally two further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

This service has had no registered manager for over one year. Since October 2017 there have been three management changes, including a newly appointed manager who had started their post on the same day as our first day of inspection. This manager told us it was their intention to make an application to register with the Commission. 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 provider is Caring Homes Healthcare Group Limited, a national provider of care.

At this inspection we continued to find a wide a range of areas which needed action to ensure the safety and well being of people. People's safety was not ensured in areas such as medicines management, infection risk, wound care, diabetes and prevention of pressure damage. The service also continued not to consistently follow national guidelines to reduce such risks. Additionally, at this inspection we found the provider had not ensured all relevant actions had been taken in relation to fire safety.

The provider’s systems for monitoring continued not to identify a range of areas in need of improvement, so necessary actions to address issues were not taken before the inspection. This included a wide range of areas relating to safety, care and treatment of people, staff support and the management of the service. The provider continued not to identify that some records had not been made, others were not accurate or completed in a timely fashion.

Although issues relating to staffing levels had been raised at the past two inspections, the provider continued not to use robust systems to ensure they could assess if current staffing levels were sufficient and suitable to meet the needs of people living in the service.

Some people continued not to always receive the care they needed in relation to areas such as dementia care, oral care and with their communication needs. Some people's care plans continued to be unclear, so did not ensure all staff knew how to provide people with the care they needed. As at the last inspection, some staff did not follow people's care plans when providing care. People continued not to be consistently involved in developing their own care plans.

The service continued not to follow the requirements of the Mental Capacity Act (2005) by ensuring all relevant people had an assessment of their mental capacity. There continued to be a lack of documentation in relation to best interest decisions for some people.

Procedures for safeguarding people continued to be ineffective. This was because timely referrals had not always been made to the Local Authority to ensure risk of abuse was appropriately considered. A range of staff had not completed training in how to safeguard people from risk of abuse.

Staff continued not to have received training in a range of relevant areas to meet the needs of people living in the service. This included training in people’s specific care and treatment needs such as catheter care and wound care. The provider had also not taken action to ensure all staff were trained in mandatory areas such as how to safeguard people from risk of abuse, fire safety and health and safety. They had also not identified that many staff had not received regular supervision to ensure they were appropriately supported in their roles.

The provider continued not to ensure people were supported to raise complaints and issues of concern. Where some people raised complaints and concerns, the provider was not consistently following its own complaints procedure. Some people’s complaints were not documented in accordance with the provider’s policies.

The service continued not to ensure all people received a caring approach from staff. This was because not all staff treated people with empathy and respect. Other staff were kind and supported people, encouraging their independence and helping them make choices.

We received mixed comments from people about both meals and activities provision. Some people said both meals and activities could do with improvement and others said activities provision met their needs and that they enjoyed their meals. People could choose to sit in different dining rooms and there were a variety of lounges provided, where people could also participate in a range of activities. The service was purpose-built as a care home and the environment met people’s needs. It was maintained at high standards of cleanliness. New staff were recruited in a safe way, following the provider’s policies.

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’. We are considering our enforcement powers in response to the continued breaches and inadequate rating and will publish any action we take when this is concluded

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

There was no 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. A home manager had been appointed in July 2017. She had applied to be registered with us as manager for the service. The provider is Caring Homes Healthcare Group Limited, a national provider of care.

The last inspection of the service was on 17 and 20 March 2017. The service was rated as good, although come aspects of the well-led question required improvement. At that time there were 36 people living at the service and the upper floor had not yet been opened.

We performed this responsive comprehensive inspection because a wide range of issues had been raised with us, including from people’s relatives, staff, external professionals and the local authority. Separate to this inspection, CQC are also reviewing a serious incident for a person, in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found there were a range of areas which needed action to ensure the safety and well-being of people. People’s safety was not ensured in areas such as management of wounds, prevention of pressure damage, diabetes and infection risk. The service was also not consistently following national guidelines to reduce such risks. Staff had not received training in all relevant areas to meet all of the needs of people living in the service to ensure they knew how to reduce people’s risk.

Procedures for safeguarding people were not always effective. This was because timely referrals had not been made to the Local Authority in accordance with policies to ensure risk of abuse was appropriately considered.

The service was not consistently following the requirements of the Mental Capacity Act (2005) by ensuring all relevant people had an assessment of their mental capacity. There was a lack of documentation in relation to best interest decisions for some people and some Deprivation of Liberty Safeguards (DoLS) applications did not include all relevant matters.

People were not consistently involved in developing their own care plans. Some people were not always receiving the care they needed in relation to areas such end of life care, mobility and dementia care needs. Some people’s care plans were not clear, to ensure all staff knew how to provide people with the care they needed. Some staff did not follow people’s care plans when providing care.

The provider and home manager’s systems for audit had not identified a range of areas, so had not taken necessary action to address issues before the inspection. This included areas such as confidentiality of people’s records, some aspects of medicines management and certain aspects of management of people’s urinary catheters. They had not identified that some records had not been made, others were not accurate or completed in a timely fashion.

As at the last inspection, several people raised issues in relation to staffing levels and responses to call bells. The service had not reviewed feedback from people since the last inspection to identify if there were issues where they needed to take action, such as by regular audit of response times to call bells.

Several people raised concerns about their care; many people felt this related to the different numbers of staff who cared for them. Some staff did not effectively support some people’s privacy and dignity or ensure they could make choices about what they wanted to do. Some staff, particularly agency staff, did not always know relevant information about the people they were caring for. The home manager told us they were trying to recruit more permanent staff.

On the first day of the inspection we received mixed comments about the meals and also identified some issues where action needed to be taken. The home manager had taken action to address these issues by the second day of the inspection.

We received mixed comments about the service’s response to complaints and concerns. Some matters may not have been documented. Where matters were documented, they showed the service followed their own policies.

The provider had established systems to ensure staff were trained and supported in their roles during induction, and for areas such as safely supporting people’s mobility and fire safety. All of the staff we spoke with knew how to raise safeguarding alerts if they identified a person might be at risk of abuse. Some staff said they felt supported by management including by supervision and staff meetings.

People were supported by a wide range of activities to meet their individual needs. Activities staff were enthusiastic. They maintained clear records of the benefit to people of activities, so they could ensure people were supported in the way they wanted.

People commented on the caring nature of some staff, often identifying particular members of staff who they liked. Some staff, including some of the agency staff, showed an empathetic, kindly approach to people.

There were safe systems for the storage of medicines, with relevant records being maintained. There were records of maintenance, including safety of equipment and fire safety, these were updated when relevant. There were safe systems for the recruitment of staff.

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 inspection is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service 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 service was purpose built to accommodate 71 people with a wide range of varying needs: ranging from minimal support, to those who have nursing needs and for those who live with dementia. The accommodation for people is situated over three floors but at present only two floors are being used. The residential and nursing floor is on the ground floor with those who live with dementia on the first floor. There are multiple communal areas situated throughout the home with a cinema room, a hairdressing salon and a self-service café. There are accessible gardens in the centre of the service and large safe baloneys on the upper floors.

There were 36 people in Southlands at the time of our inspection, 15 of whom lived with dementia and 21 who required nursing care and support. Not all of the people living in the service were able to express themselves verbally and communicate with us.

This inspection was carried out on 17 and 20 March 2016 by three inspectors. It was an unannounced inspection. Due to a number of complaints received in respect of staffing concerns the comprehensive inspection was brought forward.

The registered manager is currently on long term leave and had previously made a decision to retire giving six months’ notice. The deputy manager was being supported by the area manager until a newly recruited manager comes in to post in April 2017. 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.

People, relatives and staff told us there were insufficient staff deployed to consistently meet people’s needs. We found that the staffing levels had been an issue and this had been discussed at a recent resident and staff meeting. The area manager confirmed that there had been problems but with the recruitment of new staff the problem was in the process of being resolved. We found during the inspection that the staffing levels were sufficient to meet people’s needs and keep them safe.

People’s individual preferences for meaningful activities were currently not being fully met and this had been acknowledged by the provider and actions were being taken to address this.

Whilst complaints were logged and responded to they were not always responded to in a timely manner. We saw also that whilst complaints were either substantiated or not substantiated there were no actions recorded by the registered manager and therefore the provider could not be assured that appropriate action had been taken or that they had an overview of the investigation.

There was a system of monitoring checks and audits to identify the improvements that needed to be made. There were improvements needed to the completion of the audits to ensure that the provider had an overview of the service provided and be enabled to drive improvement.

People’s individual assessments and care plans were reviewed monthly or when their needs changed. There were plans for to involve people at monthly reviews and invite their relatives or legal representatives to participate in reviews that were scheduled. Families told us that they had mixed messages and had not been involved in these reviews as yet. One family had a review however during the inspection which assured us that these were in the process of being arranged. People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were able to spend private time in quiet areas when they chose to.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff had received all essential training and monitored to ensure its completion by all staff within a set time frame. All members of care staff received regular one to one supervision sessions. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. There were thorough recruitment procedures in place which included the checking of references.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed and documented appropriately when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.