Hillbrook Grange

About the service

Hillbrook Grange residential care home providing accommodation and personal care to up to 41 people. The service provides support to older people. At the time of our inspection there were 35 people using the service. Accommodation is provided across two floors accessible via a lift. There are a range of shared facilities including adapted bathrooms, lounge and dining areas and a secure outside space.

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

Improvements have been made to the management of medicines since the last inspection; however, we found people were still at risk of not receiving their medicines safely. Staff had undergone safe recruitment checks prior to working the home. People were cared for by staff who understood how to safeguard people and how to report any concerns. The home was clean and tidy, and people were supported to receive visits from family and friends.

We have made a recommendation about the implementation of individual risk monitoring charts and a recommendation about maintaining up to date staff training.

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.

Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always actioned the concerns we found on inspection. We identified a repeated breach and a new breach of regulations. The management team were helpful and quick to investigate and provide assurances when we fed back our findings during and after the inspection. Staff were complimentary about the manager and people gave positive feedback about the care provided by staff.

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 (26 August 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. This service has now been rated requires improvement or inadequate for four consecutive inspections.

Why we inspected

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

We previously carried out an unannounced inspection of this service on 11 July 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines management and managerial oversight at this inspection.

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

We have made recommendations in relation to monitoring records and maintaining up to date staff training.

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

Hillbrook Grange is a residential care home providing accommodation and personal care to up to 41 people. The service provides support to people aged 65 and over. At the time of our inspection there were 35 people using the service. Accommodation is provided across two floors accessible via a lift. There are a range of shared facilities including adapted bathrooms, lounge and dining areas and a secure outside space.

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

People felt safe. Incidents were investigated and there was oversight to ensure lessons were learnt. Risk assessments were in place to mitigate risk where possible and there were a range of checks to ensure equipment was suitable and safe to use. The home was clean and tidy, and people were supported to receive visits from family and friends. The service had made some improvements and addressed some of the issues from the last inspection, however we found medicines were not always handled safely.

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.

Arrangements for oversight and governance were being followed, shortfalls and concerns were addressed when identified. However, these systems were not sufficiently robust to have ensured medicines were safely managed. People felt able to feedback views and a variety of meetings were being held with staff, people and families. Staff worked with other services to meet people’s needs and the provider was committed to driving improvement within the home.

Individual care plans were in place, although further work was being completed to ensure these contained person-centred and consistent detail on how people wanted to be supported. A range of activities were available to people both in groups and individually, although some people wanted more to do. People felt able to raise concerns.

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 16 August 2021) and there was a breach 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 the provider remained in breach of regulation.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection and to follow up on concerns we had received about staffing levels, the management of medication and overall running of the home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. 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.

The overall rating for the service has remained requires improvement based on the findings of this inspection. The provider took immediate action to address any concerns identified and reduce the risk of harm to people.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

Although improvements were noted we have identified a continued breach in relation to the safe management of medicines at this inspection.

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

Follow up

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

Hillbrook Grange is a residential care home providing personal care to 31 people aged 65 and over at the time of the inspection. The service can support up to 41 people. Accommodation is provided across two floors which can be accessed via a passenger lift. There are communal bathrooms, toilets and kitchen facilities as well as social, dining and garden areas that people can access.

About the service

People told us they felt safe at Hillbrook Grange and staff were aware of and implemented safeguarding procedures. The home was following safe infection control practices. Relevant safety checks had been carried out and people had personalised safety risk assessments in place. Medicines management had improved but there were still shortfalls in safety.

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 and their relatives were positive about the service and told us staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld.

People had access to daily activities and could socialise together. The provider had actioned recommendations from the last inspection relating to the reduction of social isolation. Complaints were welcomed by the new management team and concerns were acted upon. Staff were updating care plans to make them more personalised.

A new manager had been in post for six weeks on the first day of the inspection. The manager was in the process of registering with us. Quality systems and processes were in place but were still embedding. People, relatives, staff and professional visitors had confidence in the changes that were happening at Hillbrook Grange and felt the service had improved. The management team were open and transparent about all aspects of service delivery. The provider had actioned recommendations from the last inspection relating to the CCTV.

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 5 February 2021) and there were multiple 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 improvements had been made however the provider was still in breach of one regulation in relation to medicines management.

This service has been in Special Measures since February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach in relation to medicines management at this inspection.

You can see what action we have asked the provider to take at the end of this full report

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hillbrook Grange is a residential care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 41 people.

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

Medicines were not managed safely which placed people at risk of harm. People were not safeguarded from abuse and other risks to them. Infection, prevention and control procedures did not protect people from the contracting of avoidable infections. The environment was well presented but several health and safety risks were identified.

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. Processes to ensure people were not deprived of their liberty were not always followed.

People did not always receive person-centred care. Care plans had not been reviewed and monitoring records were often incomplete. Complaints were not always responded to in line with the home’s policy. People told us they felt socially isolated and there was a lack of activities. We have made a recommendation about managing social isolation.

The service was not effectively managed and there were limited systems in place to monitor the quality and safety of the service provided. Staff did not always feel supported by the management team. Relatives did not always find the registered manager approachable or proactive. We have made a recommendation about the management of the closed circuit television.

The provider took steps to mitigate risk following the first two days of the inspection. For example, carrying out fire safety checks and risk assessments. There had been some improvement on day three of the inspection but medicines management was still unsafe.

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 7 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safety, person centred-care, response to concerns and infection control. A decision was made for us to inspect and examine those risks.

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

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated 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 Hillbrook Grange 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.

Since the last inspection we recognised that the provider had failed to notify us about the outcomes of multiple applications to deprive a person of their liberty (DoLS). This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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

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.

Since the last inspection, we recognised that the provider had failed to inform us about notifiable incidents. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

You can see what action we have asked the provider to take at the end of this full report.

Special Measures

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.

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

The service is in the Bramhall district of Stockport and is close to local shops and other amenities. Accommodation consists of single occupancy bedrooms located on the ground and first floors. There are two lounges, a quiet lounge/library and a dining room on the ground floor and extensive landscaped gardens adjoining the home. The service can accommodate up to 41 people; at the time of the inspection there were 32 people living at Hillbrook Grange.

At a previous inspection conducted in October 2017 the service was given an overall rating of requires improvement and there was one breach of Regulation 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 in relation to good governance. At this inspection we found the service was now meeting the requirements of this regulation.

Audits, surveys and meetings helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive. There were now systems in place to audit the quality of service provision and additional audits were being developed to enhance the existing governance framework.

At the last inspection there was no registered manager in post. At this inspection we found there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse. The service used the local authority safeguarding procedures to report any safeguarding concerns.

Recruitment procedures were robust which ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was very clean, tidy and homely in character. Staff were trained in the prevention and control of infection to help protect the health and welfare of people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan in place in the event of any unforeseen emergencies.

New staff received induction training to provide them with the skills to care for people. Staff files and training records showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed many good interactions between staff and people who used the service; people and their relatives told us staff were kind and caring.

We saw from our observations of staff interactions with people and from records we saw, that people who used the service were given choices in all aspects of their lives and helped to remain independent where possible. Staff sought consent from people before assisting them.

We saw care plans gave staff sufficient information to care for people safely. Plans of care were individual, person-centred and reviewed regularly to help meet people’s health and social care needs.

Care plans contained a good level of detail regarding people’s life histories, likes and dislikes, preferences and choices. People’s care plans contained a variety of risk assessments which provided guidance to staff to enable them to support people safely.

People were given choices at mealtimes and told us they enjoyed the food provided. People were encouraged to eat and drink to ensure they were hydrated and nourished.

The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

We saw that people could attend activities of their choice and families and friends were able to visit when they wanted. Meetings with people who used the service and their relatives were held regularly.

Some staff were trained in palliative care to offer support to people (and their family members) at the end of their lives. The service did not provide end of life care directly, which was supported by other relevant professionals but people's care files contained end of life care plans, which documented people's wishes at this stage of life where they had been open to discussing this.

The service is located in the Bramhall district of Stockport and is close to local shops and other amenities. Accommodation consists of single occupancy bedrooms located on the ground and first floors. There are two lounges, a quiet lounge/library and a dining room on the ground floor and extensive landscaped gardens adjoining the home. The service can accommodate up to 41 people; at the time of the inspection there were 28 people living at Hillbrook Grange.

At a previous inspection conducted on 13 October 2016 the service was given an overall rating of requires improvement and there was one breach of regulation 11 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 because the registered provider had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This meant people had not always had their capacity assessed when decisions were made in their best interest and applications to lawfully deprive some people who met the criteria for DoLS had not been made. At this inspection we found the service was now meeting the requirements of this regulation; the service was adhering to the requirements of the MCA and staff had a good understanding of how to support people who lacked capacity

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.

People living at Hillbrook Grange told us they felt safe and staff were kind and caring. The staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm.

Equipment used by the home was maintained and serviced at regular intervals.

The service used a dependency tool that was updated every week to reflect changes in people’s needs.

We saw that there were risk assessments in individuals care plans to identify specific areas of concern. The care plans covered essential elements of people’s needs and preferences.

We looked at five staff personnel files and there was evidence of robust recruitment procedures.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences.

The home was clean and there were no malodours. Stockport council had conducted and infection control audit in May 2017 and the service had scored highly in all areas audited.

Staff sought consent from people before providing support

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

Following the last inspection the service had identified the need for more person-centred care planning training and we found that this had been undertaken.

People told us the food at the home was good. There was a four week seasonal menu in use and this was displayed on the wall in the dining room. We found people's nutritional needs were monitored and met.

People’s health needs were managed effectively and there was evidence of professional involvement.

The environment was suitable for people's physical needs.

People who used the service told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.

We found the service aimed to embed equality and human rights though good person-centred care planning.

We saw people were provided with a range of useful information about the home and other supporting organisations.

The service did not provide end of life care directly, which was supported by other relevant professionals.

Care plans contained a good level of detail and had a person centred approach.

The home had been responsive in referring people to other services when there were concerns about their health.

The home employed an activities coordinator and activities on offer were displayed around the premises. When people had undertaken an activity this was recorded in their care file information.

There was a complaints policy and procedure in place. This clearly explained the process people could follow if they were unhappy with aspects of their care.

The home had received a high number of compliments since the date of the last inspection.

The service was registered as a charity and had a board of directors/trustees. Board meetings were held approximately every two months in order to ensure the board were kept informed of issues. Our observations indicated that the directors/trustees worked well with the staff team and were actively involved in supporting them.

Staff had access to a wide range of policies and procedures regarding all aspects of the service.

The service worked in partnership with other professionals and agencies in order to meet people's care needs.

There was a service user guide and statement of purpose in place.

Formal feedback from staff, people who used the service and their relatives was sought through annual quality assurances surveys.

The service had a business continuity plan that was up to date and included details of the actions to be taken in the event of an unexpected event.

Regular audits were carried out in a number of areas, however medicines and care plan audits had not identified the issues we found with the storage of creams, the need to ensure up to date records of their application and other gaps in care plan records.

There was an up to date certificate of registration with CQC and insurance certificates on display as required. We saw the last CQC report was also displayed in the premises and on the provider’s website.

The service had a registered manager in post as required by a condition of registration. 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 undertook this unannounced inspection on the 13 October 2016. At the last inspection on 8 July 2014, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered provider and registered manager had not always recorded when assessments of capacity and decisions made in their best interests had been made. We found there were people who may meet the criteria for DoLS but applications to deprive them of their liberty lawfully had not been made to the local authority. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found audit tools had been obtained and a plan was being developed to have a more systematic approach to quality monitoring. Currently the quality assurance checks were carried out in response to issues and needed development. We have made a recommendation that the registered provider and registered manager follow through with these plans and we will check them at the next inspection. We found there were systems for people to make suggestions and these were listened to and acted upon.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. People had risk assessments which helped to analyse any risk of harm, for example with moving and handling and falls and how it could be minimised. We found staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We found staff were recruited safely with all employment checks carried out prior to new staff starting work. New staff received an induction and shadowed more experienced staff until it was felt they were competent to work alone with people. We found there were sufficient care staff on duty to meet people’s current needs; there were ancillary staff for tasks such as activities, laundry, catering, domestic work, maintenance and administration so care staff could concentrate on looking after people.

We observed staff had a patient and caring approach. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards and in meetings. Staff treated people with respect and maintained confidentiality. Personal records were stored securely.

We found people received their medicines as prescribed and had access to a range of health care professionals in the community, when required to meet their health needs.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. People’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to health professionals took place when required for treatment and advice.

We found people had assessments of their needs and received care that was individualised for them. The care plans had some small gaps in how staff should care for people and we spoke with the registered manager who said they would address this with the staff team.

We found there were activities for people to participate in. These were provided in small and large groups. The activities helped to stimulate and include people and prevent them from being isolated. Some people told us they would like to see more activities on a one to one basis and tailored more effectively to people living with dementia. This was mentioned to the registered manager and they told us they would address this with staff.

The registered provider had a complaints procedure on display. People who used the service and their relatives told us they would feel able to complain and any concerns would be looked into and addressed.

We found the service was clean and tidy. Staff had cleaning schedules and equipment used within the service was maintained so it remained safe to use. The environment was suitable for people’s needs.

to answer five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with 4 people who use the service, 4 visitors, the

registered manager, the registered provider and 4 care staff. We also reviewed records

relating to the management of the home which included, 5 care plans, daily care records,

medical administration records and 4 staff records.

Below is a summary of what we found. The summary describes what people using the

service, their relatives and the staff told us, what we observed and the records we looked

at.

Is the service safe?

The premises were clean, well maintained and had procedures in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage of medication.

We saw safe techniques were used by staff when helping people with mobility difficulties.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A person living at the home told us 'There is always someone around and someone to help you.'

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about people's diagnosed health conditions and also their preferences. This meant they received care that protected their welfare and safety.

People and their relatives told us the food was good and there was a choice at meal times. One person said, "The food here is really good."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "Everyone here is so friendly, and so calm and kind." We observed that staff providing people's care were gentle and encouraging.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person's dignity. One told us, "They (the staff) always knock on the door before entering.'

Is the service responsive?

People's needs had been assessed before they moved to the home. People's records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a general practitioner or district nurse.

People who lived at the home, and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive and her door was always open to them.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager.

Staff had an induction programme and appropriate checks were in place. Staff felt listened to and supported by their manager.

People using the service, their relatives and other people involved with the service had completed satisfaction surveys and records showed action was taken where any improvements were required such as the employment of an activities coordinator.

No one we spoke with had any complaints. We observed that people were relaxed and that the staff team who were on duty at the time of our visit were polite at all times.

We were also able to talk with the Director/General Manager and one of the board members.

We were told 'The home is excellent, couldn't have anywhere better;' 'I am asked what I like and don't like, I can ask to see the doctor and can go to bed when I want and get up when I want;' 'I can't really say I have any complaints; my family are made very welcome;' and 'I feel quite comfortable in talking to the staff if I had any concerns or complaints.'

One of the staff team told us; 'The food is fantastic, the managers never skimps on the food. We can order anything that's required and there is a good budget to work with.' Another person told us that they felt well supported and had no complaints. They also said that they felt comfortable enough to say what they thought and could speak to board members if they wished to.

We looked at three care plans and other records such as staff rotas and personnel files. All were found to be up to date and well organised.