About the service: Grovewood Residential Home is situated in a residential area of Rock Ferry. The home provides personal care for older people. The home is able to accommodate a maximum of 32 people. At the time of inspection there were 18 people living in the home.

People’s experience of using this service:

This inspection found that significant improvements had been put into place by the new manager. People and relatives, we spoke to told us that they had noticed that the home has improved.

During this inspection we found improvements in all areas however additional improvements were required surrounding recruitment, staff supervision and training. However, following the inspection the manager provided us with ongoing evidence that this was continually improving.

We observed support being delivered within the home and saw that people were comfortable in the presence of staff. This indicated that positive relationships had developed between people receiving support and care staff. People told us staff were kind and treated them with respect.

People we spoke with told us that there had been a ‘vast improvement’ since the new manager had been in post and would now recommend the home to others. An external training provider representative also commented on the improvements in the home.

We saw significant improvements had been made to the environment and this was ongoing. We saw the positive impact that this had had on the living conditions for people living in the home. Improvements had been made to the management of the health and safety issues; fire safety, water and building management.

Staff and people spoke very highly of the manager and the work they were doing. Improvements had been made to the management of DoLS and how people's capacity was considered. There were good audit trails of actions taken and why.

People's monitoring of their dietary intake was good, and healthcare was managed well. There were person-centred care plans in place that described what people needed and wanted to keep them safe and well. People told us they felt safe living in the home due to the support they received from staff. Individual risks to people had been assessed and measures were in place to mitigate those risks.

Systems were in place to manage medicines safely and people told us they got their medicines when they needed them.

Systems were in place to gather feedback from people, including meetings or surveys. People and their family members told us they felt confident to be able to raise any concerns they had with the management and that they would be dealt with.

Safeguarding and whistleblowing procedures were also in place for staff to follow. Staff spoken with were knowledgeable about safeguarding procedures and how to raise any concerns they had.

Rating at last inspection: The home was previously rated as Inadequate and was placed into special measures. We had previously found breaches of regulation in regard to consent, safe care and treatment, safeguarding, staffing and recruitment and governance.

Why we inspected: This inspection took place as it was a scheduled based on previous rating.

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.

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

We carried out this unannounced inspection of Grovewood Residential Home on 25 and 26 September 2018. Grovewood 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. Grovewood accommodates up to 32 people in one adapted building.

The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At this time of this inspection, the home did not have a registered manager.

We inspected Grovewood on 26 and 30 October 2017 and found breaches of Regulations 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an improvement action plan to tell us how they planned to address the breaches of regulations but we did not receive an action plan.

In response to concerns CQC received, and the lack of an improvement plan, we inspected Grovewood again on 28 February and 7 March 2018. We found that all of the breaches were repeated. We asked the provider to complete an improvement action plan to tell us how they planned to address the breaches of regulations, and issued a Warning Notice with regard to Regulation 17. The service was rated inadequate and placed in special measures.

During this inspection we found continued breaches of Regulation 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found breaches of Regulations 13 and 20A, and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The premises and equipment were not always maintained in a safe condition, and people were not adequately protected from the risk of infection. Some rooms did not have a consistent supply of hot water. A central heating boiler had been deemed unsafe by British Gas in August 2018 and no action had been taken. The home’s fire risk assessment and personal emergency evacuation plans were out of date. We saw a number of areas that were not adequately maintained. We had many concerns over standards of cleanliness and the age and decay of the building and the furniture in it.

The provider had not ensured that robust recruitment procedures were followed including the relevant checks. We asked the acting manager if any new staff had been recruited since our last inspection and we were told that there had not. We then found that four staff members had been recruited. Two did not have adequate references.

Incidents that had put people at risk had not been referred to the local authority for investigation under safeguarding procedures.

Mental capacity assessments were not in place for most of the people living at the home. This included people who were living with dementia; people who had a ‘do not resuscitate’ order which they had not consented to; and people who had devices fitted to their beds to prevent them from falling out of bed.

Staff had not received appropriate support, supervision and appraisal. In two files we looked at we saw that that the staff had been subject to disciplinary action yet both staff members had only received one supervision session in the last six months and neither supervision session referred to the issues of performance where improvements were required. Supervisions and appraisals had been improved since our previous inspection but were still inconsistently offered.

We saw staff meeting minutes that were very confrontational and did not encourage a learning or supportive culture for staff to develop within. We were very concerned at some of the la

We carried out an unannounced inspection of Grovewood Residential Home on 28 February and 7 March 2018.

We had previously inspected the home on 26 and 30 October 2017 when we found breaches of Regulations 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an improvement action plan to tell us how they planned to address the breaches of regulations. We did not receive an improvement plan. In January 2018 we received information of concern from the relative of a person who had been accommodated at the home. These concerns were investigated by the local authority and found to be substantiated. In February 2018 we received further information of concern from a person who worked at the home.

Grovewood 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. Grovewood accommodates up to 32 people in one adapted building.

The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At this inspection, the acting manager informed us that the person registered as manager was no longer employed at the home.

During our inspection in October 2017 we found breaches of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Fit and proper persons employed because the provider had not ensured that robust recruitment procedures were followed including the relevant checks. During this inspection we found that some progress had been made in setting up a personnel file for each member of staff. However, we looked at ten of the personnel files and only two of them contained all of the information needed to ensure that the person was suitable to work with people who may be at risk of neglect or abuse.

During our inspection in October 2017 we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment. This was because the premises and equipment were not always maintained in a safe condition; the management of medicines was not safe; people were not adequately protected from the risk of infection.

During this inspection we found that regular in-house health and safety checks, for example checks of water temperatures, had not been recorded recently. When we checked the water temperature in the shower room and bathroom we found it was higher than the safe limit.

During this inspection we found that some parts of the building were unclean and on the first day there was no hot water supply in ten bedrooms and two toilets. There were eight rooms with either no bin, or a bin without a lid. The bins without a lid included one bin that had a continence pad in it. We found unpleasant smells in five areas. The floor and walls in the laundry room needed attention so that they could be cleaned thoroughly.

The medicines room had no hand washing facilities and had an extractor fan that was very dirty. Two people were prescribed a controlled medication and the quantities recorded in the controlled drugs register were incorrect for both of these.

During our inspection in October 2017 we found breaches of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing, because staff had not received appropriate support, training, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

Staff training records had not been maintained since our inspection i

We carried out an unannounced inspection of Grovewood Residential Home on 26 and 30 October 2017. The home provides personal care and accommodation for up to 32 people and 29 people were living there at the time of our visit. The home is in a residential area of Rock Ferry within walking distance of local shops and public transport.

We last inspected Grovewood on 6 and 8 September 2016 when we found that the service was good in four of the five key questions. At that inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 because the home was not fully compliant with the Mental Capacity Act 2005.

During 2017, CQC received a number of concerns about Grovewood. On 18 October the provider informed us that the registered manager was currently not working at the home pending an investigation. Two other staff were suspended. The deputy manager was standing in as acting manager.

During this inspection we found breaches of Regulations 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014

The home had six double bedrooms. We spoke with two people who were sharing a room with other people. Neither could not tell us who the person was that they shared with. One person complained about the person they were sharing with and the other said it was “another patient”.

When we looked at their care plans we found no written consents to sharing a bedroom, and one person’s care notes recorded that they liked their own space. Some shared rooms had no privacy screen and the privacy screens in other rooms were dusty, which suggested that they were not used regularly.

On the first day of our inspection there was no cleaner on duty. We saw a very dirty toilet in the en-suite of one of the shared rooms. We saw an overflowing bin in one of the bathrooms. This had no lid and there were used paper towels all over the floor. Carpets needed vacuuming. One shared bedroom was cluttered with far too much furniture which resulted in the fire exit being blocked.

We saw a number of areas that were not adequately maintained. For example a broken window blind in a bathroom; a bedroom with no curtains; an en-suite toilet cubicle that was smelly and the extractor fan seemed not to be working; two toilets without seats; poor carpets in some bedrooms; and rotting window frames at the back of the property. The laundry room was in the basement. New washing and drying machines had been provided but the floor and walls needed attention so that they could be cleaned thoroughly.

Medicines records indicated that people received what was prescribed for them. However, there were some areas where improvements were needed. The medicines room had no hand washing facilities and had an extractor fan that was very dirty. Handwritten entries on medication administration sheets were not always signed, although most were. There were no administration protocols for medication that was prescribed to be given “as required”. This meant that as required medication may not be given consistently. When we looked at stocks of controlled drugs and controlled drugs records, we found two discrepancies involving small quantities.

The acting manager told us that all staff were well trained, but training records had not been maintained to provide evidence of this. Staff supervision and appraisal records were out of date.

We asked to look at staff files for new staff who had been recruited since our last inspection. The deputy manager told us that files were not in place and she was sending for information, including references and a criminal records checks, which should have been in place before the staff started working at the home.

There was a range of quality assurance systems in place to assess and monitor the quality and safety of the service. These had mainly been completed monthly by the registered manager but had not been effective in identify

This was an unannounced inspection carried out on 6 and 8 September 2016. Grovewood Residential Home provides personal care and accommodation for up to 32 older people. Nursing care is not provided. At the time of our visit, 24 people lived at the home.

The home is situated in a residential area of Rock Ferry within walking distance of local shops and public transport. A small car park and garden are available within the grounds. The home is decorated to a satisfactory standard throughout with accommodation provided across three floors. A passenger lift and stair lift enables access to the bedrooms located on the upper floors. Specialised bathing facilities are available and on the ground floor there is a communal lounge, dining room and conservatory for people to use.

During the inspection we spoke with five people who lived at the home, four relatives, three care staff, a catering assistant, the activities co-ordinator, the deputy manager and the registered manager.

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.’

Since our last inspection in 2014, the home has experienced a change in owner (the provider). The previous provider retired and a new provider bought the home is now responsible for the service provided. The new provider still operates as ‘Soundpace Limited’

During our visit, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014. This breach related to the implementation of the Mental Capacity Act 2005.

We looked at three people’s care files. We saw that care plans contained information on people’s mental health needs, decision making ability and preferences in the delivery of care. Care plans contained good person centred information on what promoted people’s mental well-being and clearly outlined to staff the need to gain people’s consent to their care, before it was provided. We found however that people’s capacity to make important decisions in respect of their care had not always been properly assessed in accordance with the Mental Capacity Act (MCA).

For example, some people had deprivation of liberty safeguards (DoLS) in place that prevented them from leaving the home on their own but their capacity to do so had not been assessed prior to this decision being made. This meant there was no evidence that a deprivation of liberty safeguard application was required or justified and meant that the principles of the MCA and DoLS legislation had not been followed to ensure people’s legal consent was obtained. We spoke to the manager about this. They acknowledged that improvements were required to ensure this legislation was consistently adhered to, in relation to people’s care at the home.

During our visit, we saw that people who lived at the home were relaxed in the company of staff. From our conversations with them, it was clear that people who lived at the home held staff in high regard. Relatives we spoke with also told us they were happy with the care provided and that staff were kind and caring.

We saw that people were able to choose how they lived their life at the home for example, what time they chose to get up / go to bed and what they wanted to eat/drink. A range of activities were provided to occupy and interest people and these activities were well attended. It was clear from what we observed that people enjoyed these activities.

We saw that staff took the time to simply sit and chat to people in addition to supporting them with their personal care needs. Staff were warm, relaxed and kind in all of their interactions with people and their relatives. People were supported at their own pac

We inspected the home on 20 October 2014 to check whether the provider had addressed the major concerns which we set out in warning notices issued following our previous inspection in August 2014. At the previous inspection we found that care and support was not always planned and delivered in a way that ensured people's safety and welfare, people were not fully protected against the risks associated with medicines and the provider did not have an effective system in place to regularly assess and monitor the quality of service that people received or an effective system to identify, assess and manage risks to the health, safety and welfare of people who use the service.

The inspection was carried out by one adult social care inspector and a pharmacist inspector over the course of a day. The focus of the inspection was to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what staff told us, what we observed and the records we looked at.

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

Is the service safe?

We found that people using the service were safe because they were protected against the risks associated with use and management of medicines. People received their medicines at the times they needed them and in a safe way. We also found that systems were in place for ordering, administering, recording and storing medicines appropriately.

Risk assessments had been carried out for people who used the service and actions had been identified and implemented to minimise risks to their safety.

Is the service effective?

People who used the service said staff were good at their jobs. Visiting health care staff said staff were helpful and they weren't aware of any concerns about the home.

People were supported to eat and drink to ensure they received a balanced diet.

Is the service caring?

People who used the service said they liked the staff and commented: "The staff are very good" and "The staff are fantastic. I'm so glad I came here". A relative said: "I'm very happy with the care and they call me if my (relative) is unwell".

Throughout the visit we spent time watching how staff cared for people. We observed good interactions between staff and people who used the service.

Is the service responsive?

People's needs had been assessed and considered prior to their admission to the home. Up to date care plans were in place which took account of their needs, and these were reviewed at regular intervals. Staff responded promptly to any concerns they noted in people's health or wellbeing and took appropriate action such as calling the person's GP or specialist nurse. We also saw evidence that the staff enabled people to attend hospital appointments and see the chiropodist and optician regularly.

Staff were knowledgeable about people's life histories, care needs and preferences and took these into account when providing care.

Is the service well-led?

Since our last inspection the registered manager had reviewed the care and support needs and documentation for all the people who used the service to make sure that care plans and risk assessments were up to date and reflected all people's identified needs.

The manager carried out regular checks on medicines and, where discrepancies or concerns were noted, action was taken to address those issues.

A customer satisfaction survey had been carried out to seek the views of the people who used the service and their relatives and all the responses were positive.

A visiting quality assurance officer from the local placing authority said the service had improved since our last inspection.

The inspection team who carried out this inspection consisted of an adult social care inspector and a pharmacy inspector. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three people who used the service, one relative, the registered manager, a team leader, two care staff and two healthcare professionals. We also reviewed records relating to the management of the home which included, four care records, daily written records, medication records, records relating to the care provided by other professionals, staff files and audits. 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?

We looked at four staff files to check that information in relation to the recruitment and selection of staff was adequate. We found that appropriate information in relation to staff member's previous employment, identify and suitability to work with vulnerable people had been checked prior to employment.

We looked at the care records of four people who lived at the home. We found each care record contained information about people’s needs and risks but some care plans and risk assessments had not always been kept fully up to date. Care plans also lacked information about how to care for people with dementia. During our observations, we found that care was not always delivered in accordance with people’s plan of care. This meant people were at risk of receiving inappropriate or unsafe care that did not meet their needs.

During our previous visits to the home in July and December 2013, we had concerns about the way in which medicines were managed at the home. At this visit, we reviewed the medication arrangements at the home again. We found that medications were still not being managed safely or appropriately at the home and placed people at serious risk of harm.

We found that some people’s medication was not given at the right time or at the right dose and in some instances people had not received their daily dose of medication at all. Records relating to the administration, storage and disposal of medication were poor and inaccurate and at times false records relating to the administration of medication were made.

We found that staff had little information on how to administer people’s ‘medications such as painkillers that were prescribed to be given 'as required' or guidance on how and where to apply people’s external creams or products. We saw that some medications at the home were passed their expiry date but were still in use; medication was not always stored securely and not always disposed of appropriately.

We had major concerns about the medication practices at the home and discussed these with both the manager on the day of our visit and subsequently with the provider. We have asked the provider to tell us what improvements they will make to ensure that people receive safe and appropriate care. Following our visit a safeguarding referral to the Local Authority was made in relation to people’s medication issues.

Is the service effective?

On arrival at the home, the manager told us the majority of people would be able to talk to us and communicate their views on life at the home. We observed some people at the home displayed behaviours associated with dementia type conditions and some were unable to communicate in a meaningful way. We spoke with two care staff. We found they had a general understanding of people’s needs but lacked an awareness of people’s mental health issues.

The four people whose records we looked at had dementia but there were no care plans to guide staff on people’s dementia care. This meant there was a risk that staff would not know how to communicate or support the person effectively. Two of the care plans we looked at had not been been fully updated in response to changes in people needs or care. This indicated that staff lacked accurate and adequate information about people’s needs and risks and meant people were at risk of receiving care that did not meet their needs.

We have asked the provider to tell us what improvements they will make to ensure that people receive effective care that meets all of their needs.

Is the service caring?

We spoke to three people who lived at the home and one relative. The majority of people we spoke with said they were happy with the care provided. Comments included “Very nice the girls. Food is very good” and “Lovely young girls here, very willing to do extra work. The relative we spoke with told us “All staff have been really, really nice. We are kept really well informed. I can turn up when I want to”.

All the staff we spoke with spoke fondly of the people they looked after. We observed staff supporting people throughout the day. We saw people were spoken to pleasantly and that staff were kind and supported people at their own pace.

Care records were person centred and contained clear information on people’s daily preferences, likes and dislikes and social interests/hobbies. This showed that people and/or their families were able to express their views as to what was important to them in relation to their care.

Is the service responsive?

Two people and the relative we spoke with confirmed that prompt access to medical/professional support for their medical or health needs was organised when they needed it. Records showed that GPs, mental health services, district nurses chiropody and other health professional were involved in people’s care as and when required. We saw that people’s monthly notes kept a record of people’s appointments/visits with other healthcare professionals and documented the advice given for staff to follow.

Is the service well led?

There were systems in place to collect people’s and/or relative’s views on the quality of the service provided. An annual residents/relatives meeting took place and a satisfaction questionnaire was sent out. This year’s satisfaction survey was in the process of being completed at the time of our visit. A small selection of questionnaires had been returned and showed a general satisfaction with the service.

There were some systems in place to monitor and manage risks to people’s health, safety and welfare but some of the systems were ineffective. For example, accident/incident and environmental audits were undertaken and records showed that where issues had been identified these had been addressed. There were no checks however on the quality of the information given to staff in relation to people’s needs and care. This meant there were no suitable arrangements in place to ensure people’s needs were appropriately assessed and care planned.

We found that there were no robust checks on the management of medication at the home to ensure it was safe. The checks undertaken by the manager did not identify any of the serious concerns identified during our visit in relation to poor record keeping, unsafe administration practice, unsecure storage and the inappropriate disposal of medication.

We also saw that the provider visited the home on a monthly basis to undertake a check on the quality of the service provided but their visits also failed to identify quality issues relating to the management of the service or the safety of people’s care for example with regards to people's medication”.

Overall, we found that the service lacked satisfactory management and leadership in the delivery of the service and that this placed people at risk. We have asked the provider to tell us what improvements that will make to ensure that people received effective care that met all of their needs.

We were concerned during our last visit in July 2013 that medication was not stored, administered or managed appropriately and that there was a lack of quality monitoring systems at the home to identify, assess and manage the risks to people’s health, safety and welfare. We discussed this with the manager in July and an action plan was put into place by the home to ensure improvements had been made. During this visit we reviewed the provider’s progress to see if sufficient improvements had been made.

We reviewed the provider’s medication arrangements. We saw some improvements to the administration of medication had been made, however the home’s lack of accurate record keeping meant people were at risk of being given their medicines incorrectly. This placed them at risk of unnecessary harm.

At our last inspection, the general upkeep and maintenance of the environment was poor and there were no environmental audits in place to check the home was suitable and safe for people to live in. We saw the provider was now visiting the home on a monthly basis to monitor the quality of the service and regular infection control audits were conducted. On the day we visited, the home was cleaned to a high standard and a number of home improvements had been made. Monthly accidents/incident audits were completed to monitor and prevent further accidents/incidents. This assured us there were systems in place to identify people at risk of falls or risks in the delivery of care.

Some people living at the home had communication difficulties due to declining mental health. We spoke to four people who lived at the home and one relative. They said “it's great", “I’ve no qualms about the care" and the staff were “very nice”.

We looked at the care records of three people. We found care plans were personalised to the individual and gave clear instructions to staff on the personal care required by each person based on their assessment of need.

We reviewed three staff records. We saw evidence staff recieved an annual appraisal and were supported in their job role in order to ensure care was provided to people at an appropriate standard. We saw people were treated kindly and with dignity and respect.

Staff we spoke were knowledgable about safeguarding, the signs of abuse and knew who to report concerns to if they suspected abuse. All staff had received safeguarding training in the last twelve months.

Due to concerns raised during our inspection we reviewed the storage, administration and management of medicines at the home. We found the provider did not have suitable arrangements in place to protect people from the risks of unsafe use and management of medication.

The provider had systems in place to monitor the views of people and/or relatives about the quality of the service provided but did not have suitable systems in place to identify, assess and manage the health, welfare and safety risks posed to people who lived at the home.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector joined by an “Expert by Experience” (people who have experience of using services and who can provide that perspective).

We spoke with six people who used the service and a relative when we visited. They all told us they were happy living at the home, were well looked after and treated with dignity and respect. They told us they were able to choose when to get up or go to bed. A relative we spoke with told us:

“Her care is marvellous, she is treated very well”.

People who used the service told us there was a good range of activities provided by the activity coordinator. At the time of the inspection the coordinator was absent, however people expressed that they enjoyed doing activities with the coordinator and other care staff. One person said:

“She (the activity coordinator) organizes all sorts of things for us –things we can all take part in”

People also told us the food choices were good, there was always an alternative if you didn’t like the main meal and there was plenty of food and drink available throughout the day.

We inspected the home on 06 August 2014 to check whether the provider had addressed the major concerns which we set out in a warning notice and compliance actions issued following our previous inspection in May 2014. The warning notice was served in relation to the management of medicines.

The inspection was carried out by two inspectors and a pharmacist inspector over the course of two days. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People did not always receive safe care and support because their needs had not been appropriately assessed and planned for.

Some people who used the service had not received their prescribed medication on time putting their health, welfare and safety at risk.

Systems which were in place to check on the quality of the service did not identify risks to people’s health, safety and welfare and failed to identify that people had not received the care and support they needed.

Is the service effective?

People did not always receive effective care because staff failed to follow people’s care plans and carry out instructions given by other healthcare professionals who were involved in people’s care.

Systems which were in place to ensure people’s health, safety and welfare were not always effective because they failed to identify that people’s care had not been planned and delivered.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people and also reassured people who were anxious.

People who used the service told us they liked the staff. Comments included: “They’re wonderful. They certainly listen to my requests and try to do what I ask” and “The staff are good. No complaints whatsoever.”

Is the service responsive?

People did not always receive the right care and support because staff failed to respond to significant changes in their needs and staff did not provide appropriate care following instructions given by other healthcare professionals.

The provider failed to submit an action plan within the required timescale, detailing how and when they intended to become compliant with the areas of non compliance which we identified during the last inspection visit.

Is the service well-led?

The service had a registered manager.

Checks carried out by the manager had failed to identify or address ongoing concerns about the management of medicines within the home.