This inspection was carried out on 24 April 2018 and was unannounced.

Heathland Court Care Home 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.

Heathland Court Care Home provides care and support for elderly people, some of whom have physical disabilities and dementia. The home can accommodate up to 78 people. On the day of the inspection there were 48 people using the service. The home is situated over five floors with one floor closed for renovations.

At the last inspection carried out on 6 September 2016 the service was rated Good, with Requires Improvement in well-led. At this inspection we found the service was rated Good in all areas.

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

There were safe systems and practices in place to protect people from potential abuse and harm. Care records reflected potential risks to people and staff used these records to support them safely. The service was in the process to recruit more permanent staff in order to reduce the number of the agency staff they used and to ensure consistent care for people. People had their medicines kept and administered safely. Staff were aware of the procedures and took the necessary actions to provide hygienic care for people and to report any incidents occurring at the service.

Manual handling equipment was provided for staff to deliver support and promote people’s independence where possible. Systems were in place to monitor the training courses attended by staff and those staff that were overdue for a refresher course had a date booked for it. Staff had the management teams’ support to discuss their developmental needs and they had dates planed for supervision and appraisal meetings. Staff assisted people to enjoy their meal times. People had access to healthcare professions if their health needs changed and they required a check-up. The service followed the Mental Capacity Act (2005) principals to support people to make important decisions for them.

Staff showed concern to people’s well-being and attended to their care with understanding. People made decisions about their daily routines and staff were respectful of their choices. Staff had time to have conversations with people and people felt they were listened to. Staff encouraged people to care for themselves if they were able to carry out tasks for themselves. People’s relatives felt welcomed at the care home.

People were involved in planning their care and had access to information about them. Care records had personal information about people and how they wanted to be supported. People took part in the activities provided for them and felt the activities were meeting their care and support needs. People knew who to talk to and felt comfortable to raise their concerns if they had any. Systems were in place to support people to stay comfortable at the end of their lives.

The management team had shared responsibilities to deliver what was required for the service. New systems were in place to support staff’s performance and team working practices. The management team had put strategies in place to ensure effective communication between the staff team. Quality assurance systems were used to monitor the services being delivered to people. Internal and external meetings were attended by the management team to gather information on changes taking place in the social care sector.

This inspection took place on 6 September 2016 and 13 September 2016 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in July 2015. At that time we gave the service an overall rating of ‘requires improvement’. We also imposed a requirement notice which we checked during a focused inspection in December 2015. At that visit, sufficient improvement had not been made and we served a warning notice on the provider that they were breaching legal requirements in relation to the safe care and treatment of people. We visited again in January 2016 and found the provider was meeting the regulations we looked at but we did not amend our rating as we wanted to see consistent and sustained improvements made at the service over time.

Heathland Court Care Centre provides accommodation for people who require personal care, nursing care and support with the tasks of daily living. The service specialises in caring for older people living with dementia. At the time of this inspection there were 58 people using the service.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager on our records left the service in September 2015. We were notified at the time by them and the provider. A new manager has since been appointed and has submitted the appropriate registered manager application to CQC.

At this inspection we found the provider had sustained the improvements made at the service in relation to the safe management of medicines. Arrangements for the safe management of medicines in the home were consistently followed and people were supported to take their medicines as prescribed. Staff had maintained appropriate records to reflect this. Medicines were stored safely in the home.

We also found staffing arrangements on the top floor dementia unit had been improved and sustained. The unit was now appropriately managed by a senior member of staff. We observed staff responding to people’s needs and requests for help and support promptly. Some people told us there did not seem to be enough staff to support people in other parts of the home. Staffing levels were planned based on the number of people at the home and their level of dependency. We saw staff were available to support people around the home when needed. Senior staff told us they had recruited new staff to work at the home. They also monitored the time staff took to respond to call bells to investigate those that took too long to answer. They took on board our feedback about the layout of the home and how this could affect people’s perceptions about the availability of staff in the home.

We received mixed feedback about the management of the service. People, on the whole, spoke positively about the home manager and their ‘open door policy’ and we saw the provider was committed to a culture of openness and candour within the home. People had been encouraged to provide feedback about their experiences and suggestions for how the service could be improved through various forums. But people said the home manager should improve their visibility and visit and speak with more people in the home.

Some staff also spoke positively about senior staff and those that did felt well supported by them. They told us, and records confirmed, they received training and supervision to support them in their roles. However some staff felt senior staff did not investigate their concerns or issues when they raised these. We were able to see that senior staff did take appropriate action to address concerns when these were raised. But staff were not always aware of the outcomes. Se

This inspection took place on 2 February 2016 and was unannounced. At our last focused inspection on 22 December 2015 we found the provider was not meeting legal requirements for safe care and treatment of people through the safe management of medicines. We served the provider a warning notice. A warning notice is a formal way of telling the provider that they are not meeting legal requirements and they need to make improvements by a set date.

After the inspection the provider wrote to us to say what action they would take to meet their legal requirement in relation to the breach. We undertook this focused inspection to check the provider had followed their action plan and had addressed the areas where improvements were required.

This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathland Court Care Centre on our website at www.cqc.org.uk

Heathland Court Care Centre provides accommodation for up to 82 people who require personal and nursing care and support. The service specialises in caring for older people living with dementia. At the time of this inspection there were 49 people using the service.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager left the service in September 2015. We were notified at the time. A new manager has since been appointed and is in the process of submitting the appropriate registered manager application to the CQC.

At this inspection we found the provider had taken all the necessary action to improve the management of medicines which meant they were no longer in breach of the regulation.

People received their medicines as prescribed. Our checks of stocks and balances confirmed this. People’s records had been properly maintained by staff which gave additional assurance that people received all their medicines when they needed them.

Staff responsible for supporting people with their medicines received appropriate support from senior managers. They were aware and understood their responsibilities in relation to the safe management of medicines.

Management checks of medicines had been strengthened. Senior staff checked stocks to ensure there were sufficient quantities of medicines to meet people’s needs. They also checked medicines had been ordered and received in time for people to be given these as required. Audits of medicines were carried out daily, weekly and monthly by senior staff to check staff followed the provider’s policy and procedures in place for the safe management of medicines. Issues identified through these checks were dealt with promptly by senior staff.

We carried out an unannounced comprehensive inspection of this service on 7 July 2015 at which a breach of legal requirement was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the safe management of medicines at the home.

We undertook an unannounced focused inspection on the 22 December 2015 to check that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathland Court Care Centre on our website at www.cqc.org.uk

Heathland Court Care Centre provides accommodation for up to 82 people who require personal and nursing care and support. The service specialises in caring for older people living with dementia. At the time of this inspection there were 45 people using the service.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager on our records left the service in September 2015. We were notified at the time by them and the provider. A new manager has since been appointed and is the process of submitting the appropriate registered manager application to the CQC.

At this inspection we found the provider remained in breach of their legal requirement for safe care and treatment of people through the safe management of medicines. The provider had failed to ensure there were sufficient quantities of prescribed medicines in stock in respect of one of the people using the service. As a result this person did not receive medicines at times they needed them which put them at unnecessary risk of harm to their health and wellbeing.

We also found records of medicines administered had not been properly maintained by staff and we could not be assured that people had received all their medicines when they needed them.

We are taking action against the provider and will report on this when our action is completed.

We found the provider had taken some action to improve the way they managed medicines at the home. People’s records now contained guidance for staff on how and when to administer ‘as required' medicines, topical creams and ointments. Meetings had been held with the supplying pharmacy to improve the collection and delivery of medicines to the home. Arrangements to check medicines were properly and safely managed had been improved. Audits were carried out monthly by senior staff. In addition senior staff carried out spot checks on records to identify any issues or concerns about people’s medicines. However given the issues we identified these checks may not have been as effective as they should have been.

This inspection took place on 7 July 2015 and was unannounced. At the last inspection of the service on 11 June 2014 we found the service was meeting the regulations we looked at.

Heathland Court Care Centre is registered to provide accommodation for up to 82 people who require nursing and personal care. People using the service had a wide range of healthcare and medical needs. The home specialises in caring for people living with dementia. The home had recently opened a new dementia unit in March 2015 which was located on the top floor of the home. At the time of our inspection there were 45 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During this inspection we found the provider in breach of their legal requirement to ensure that people’s medicines were available in the necessary quantities at all times. We also identified issues with the proper and safe management of medicines particularly with the recording of medicines that had been administered and a lack of written guidance for staff as to how, when and why some medicines should be administered. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to protect people living at Heathland Court Care Centre, if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. The provider had formal procedures in place for staff to follow to ensure concerns were reported to the appropriate person. Staff could report any concerns they had confidentially and anonymously if they wished to.

There were appropriate plans in place to ensure identified risks to people were minimised. There was guidance for staff on how to reduce identified risks in order to keep people safe from injury or harm in the home and community. Managers ensured regular maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of obstacles so that people could move freely and safely around.

There were enough suitable staff to care for and support people. Managers planned staffing levels to ensure there were enough staff to meet the needs of people using the service. However the way staff were deployed in the home, particularly within the dementia unit, was not always effective and people could be left unattended at times. Managers carried out appropriate checks on staff to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. Staff were supported by managers and provided with opportunities to share their views about how people’s experiences could be improved.

People told us staff were kind and caring. Staff’s priorities were clearly focussed on ensuring that people's care and support needs were met and they had a good understanding and awareness of how to do this. The way staff supported people during the inspection was gentle and patient.

Staff treated people with dignity and respect. Staff spoke with people in a warm and respectful way. They knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff supported people, where appropriate, to retain as much control and independence as possible, when carrying out activities and tasks.

Staff encouraged people to stay healthy and well by ensuring they ate and drank sufficient amounts. Staff monitored people’s general health and wellbeing and where they had any issues or concerns about an individual’s health, they reported these to the appropriate healthcare professionals such as the GP.

Care plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. These plans gave guidance and instructions to staff on how people’s needs should be met. However the quality of information in these records was variable with some records not accurate or up to date with details of people’s current health needs.

People told us the home was welcoming to visitors and relatives. People were supported to undertake activities and outings of their choosing in the home and community. If people had concerns or complaints about the care and support people experienced, there were robust arrangements in place to deal with these appropriately. Where concerns had been raised we saw these were dealt with proactively by managers.

Managers demonstrated good leadership. They sought the views of people, relatives and staff about how the care and support people received could be improved. They ensured staff were clear about their duties and responsibilities to the people they cared for and accountable for how they were meeting their needs.

The provider and the home’s managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. Managers took appropriate action to make changes and improvements when this was needed.

Managers had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

We considered our inspection findings to answer questions we always ask; 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. The summary is based on our observations during the inspection, from looking at records and from speaking with nine people using the service and visiting friends and family members. We also spoke with two senior home managers who were in charge of the home on the day of our inspection, the deputy manager and three registered nurses.

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

Is the service safe?

We asked people using the service, and their friends and family, if people were safe at the home. People told us that they were. One person using the service said, “I think I feel safe. You never know how people will react in an emergency but on the whole I feel confident they would deal with an emergency quickly.” Another person told us, “Yes, I feel safe here.”

As part of their annual customer satisfaction survey the provider asked people using the service if they felt safe. We looked at people’s responses from the last survey in Autumn 2013. The majority of people agreed they felt safe and secure in the home.

However it was apparent from feedback we received, people using the service, and their friends and family, had concerns about staffing levels in the home and the continuity and consistency of care they received. Although people said most staff were “nice” and “caring”, people were less satisfied with the temporary staff that cared for them. We spoke at length with senior staff on the day of our inspection who explained the actions taken by the provider and service to address people’s concerns. It was clear that action had been taken to recruit new, suitably qualified staff to work within the home. On the day of our inspection nine new members of staff were attending induction training. However it was too early to assess whether this would sufficiently address people’s concerns. We will continue to monitor the provider’s progress to maintain a consistent and stable staffing complement within the home.

Any potential risks to people's health, safety and welfare within the home were assessed by senior staff. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury in the home. However the service acknowledged these checks were not carried out as regularly as they should be, in line with the provider’s own standards. The service was taking action to ensure this information was up to date by the end of June 2014.

People were cared for in an environment that was kept clean and hygienic. Staff knew how to maintain good standards of cleanliness and hygiene to reduce the risk of cross infection, as they had received training to do so.

The provider carried out appropriate checks on staff before they started work to assure themselves they were suitable to work at the home. This included carrying out security checks to ensure people were not barred from working with vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This means that people will be safeguarded as required.

Is the service effective?

People using the service and their relatives were involved in planning and developing their care and support. Their views and experiences were used to develop their individual care and support plan. People’s specific needs had been taken into account and staff demonstrated a good understanding and awareness of these.

People using the service were asked for their consent before care and support was provided. Where people were unable to make complex decisions about their care and support their representatives and other healthcare professionals had been involved in making decisions on their behalf which were in their best interests.

Where people needed extra care for specific conditions, we saw short term care plans were put in place to support people to become well again. People’s progress and wellbeing was monitored and evaluated by senior staff to ensure the care and support planned for them was meeting their needs.

Is the service caring?

Most people we spoke with had mixed experiences of staff that worked in the home. From the feedback we received people were less satisfied with temporary staff. People said; “The quality of care is good. Staff vary in that some are very good and considerate but the older ones have less time for most things.”; ” Most staff are nice. The ones that are nice are very caring.”; “One or two of the staff are more helpful than others. Some are caring but some are just doing a job.”; “Nine out of ten staff are caring. The agency staff not so much as they don’t know people so well.” And, “The staff are caring and the ones who have been here a long time know (relative) quite well. But I’m not so sure about agency staff.”

During our inspection we observed friendly and kind interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rush or hurried by staff and could do so at their own pace.

Is the service responsive?

There were appropriate mechanisms in place to monitor people’s general health and wellbeing. Checks of people’s weights were undertaken by staff. These were documented and reviewed by senior staff to identify any potential underlying issues or concerns.

On the whole staff were responsive to changes and deterioration in people’s general health and well-being and took appropriate action in most cases so that people got medical care and attention they needed.

When people made formal complaints about the service we saw senior staff took appropriate action to investigate and resolve these to people’s satisfaction.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

The provider understood the importance of robust quality assurance and carried out regular checks to assess and monitor the quality of service provided.

At our last inspection in October 2012 we identified areas where the provider was not meeting the essential standards of quality and safety. The provider sent us an action plan to tell us how it was going to become compliant with the regulations. We carried out this inspection to review improvements.

At the time of our visit, there were 42 people using the service and we spoke with fifteen of them. We also spoke with two visitors, six members of staff, the registered manager, a visiting area manager and a quality consultant.

Due to their needs, some people were unable to communicate their views and experiences. We used observations to gain an understanding of their experience of care. The majority of people we spoke to said they were pleased with the service. Individual comments included, “I have no complaints. They look after me pretty well” and “the staff are very nice, very pleasant and helpful.”

We saw staff interacting with people in a relaxed, friendly and respectful manner. Comments from staff included, “things are a lot better”; “The manager gets things done” and “everybody helps each other, there’s good teamwork.”

Arrangements had been made to provide people with more opportunities to engage in social and leisure activities. Quality monitoring systems had been strengthened. We saw evidence that when improvements had been identified, they were acted upon. At this inspection there were sufficient numbers of staff to meet people’s needs. However we found that the arrangements for staff supervision, training and development were in need of improvement.

Following our inspection on 4 October 2012, we issued a warning notice as the provider had failed to comply with regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notice. We found that the staffing arrangements had improved.

At the time of our visit, there were fifty people using the service and we spoke with ten of them. We also spoke with two visitors, ten staff, the operations manager and deputy manager.

People told us there had been improvements with staffing and they did not have to wait for attention. Comments included, “Staff are good, we never have to wait too long for help. It’s much better than it was. Sometimes we go upstairs to join in an activity, that’s good. There’s a new lady in charge, you can already see the changes and she really listens to you.” One person described the staff as “absolutely wonderful” and another said, “We’re looked after very well, staff are really professional, very kind”. A visitor told us, “people seem to be quite happy here, it’s been different lately, more staff around.”

Since our last inspection, one of the accommodation floors was no longer in use and the staffing establishment had been reviewed. This meant that staff were being deployed more effectively and able to meet people’s needs. All the staff we spoke to said there had been improvements.

Prior to our inspection we were informed that the registered manager had left and a new manager was due to join later in October. At the time of our visit there were 52 people using the service. We spoke with eighteen people who live at Heathland Court and six visitors which included two relatives. We also spoke with six members of staff, an acting manager and the former registered manager.

We found staffing levels did not meet the individual needs of the people living at the home. People said they often had to wait for attention. On some floors, we saw that people were not always supervised. There were not always sufficient staff to safeguard the health, safety and welfare of people. Structured activities within the home did not provide interest and stimulation for people. On some floors people were not getting enough support to eat their meals.

People told us that the ongoing management changes have had an impact on the service. There had been three different managers in eighteen months. Comments from people included, “there’s no one at the helm,” and “We don’t have any proper management. The staff have to run the place.”

At our last two inspections in September 2011 and March 2012 we identified areas where the provider was not meeting the essential standards of quality and safety. We were concerned that several actions remained outstanding from the provider’s service improvement plan.

We spoke to sixteen people who use the service during our unannounced visits. Feedback about the service was also received from five relatives of people using the service and six members of staff.

Overall comments about the service included ‘an excellent service’, ‘it’s alright – the people are nice’, ‘no complaints’, ‘it’s very nice here’, ‘I like it very much’ and ‘I’m treated well’.

People generally spoke positively about the staff who work at the home and said that they were treated with dignity and respect. Feedback included ‘on the whole very pleasant’, ‘they are always polite’, ‘the staff are brilliant’ and ‘very professional’. One person told us ‘when I see the staff, they’re fine’ but talked about feeling ‘abandoned’ at times.

Fifteen of the sixteen people we spoke to told us that there were sometimes not enough staff on duty to meet their needs. People who use the service said ‘there are not enough staff’, ‘still short of staff’, ‘I sometimes think they could do with more staff’, ‘you have to wait your turn’ and ‘the staffing has not improved’. One person told us that ‘there are not enough staff but the manager keeps saying there are’ and ‘it might look ok on paper but people don’t turn up’.

These views were echoed by all of the relatives and staff members who gave feedback about the service. Relatives commented ‘the people work very hard but there are not enough of them’, ‘there is a real lack of staff’ and ‘there are not enough staff’. Staff members told us that they do their best to provide a high quality of care but felt they sometimes could not achieve this due to a lack of staff numbers. Their feedback included ‘the shortage of staff is the main problem’, ‘not enough staff’, ‘I get home exhausted’ and ‘some days we are struggling on the floor’.

Some people who use the service at Heathland Court Care Centre have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time.

Our observation showed low levels of staff interaction with people who use the service for the majority of time and any engagement or interactions tended to be task orientated. Many of the people spent their time watching what was going on and did not receive any meaningful interactions from staff. An activities co-ordinator came into the lounge for a short period and this immediately resulted in much higher levels of engagement for individuals.

Feedback received about the food provided was generally positive and included ‘excellent – it’s the high point of it here’, ‘the food has improved’, ‘very satisfied’ and ‘eatable though not wonderful’.

The provider supplied us with a service improvement plan following our last visits to the home in September 2011 and we were concerned that these improvements have not yet been delivered. We noted that a new permanent manager was in post and they were being supported by both a regional manager and a manager from another service. An action plan was put in place during our visits and it is crucial that people who use the service and their representatives are able to see improvements in the short term.

Further failures to comply with the essential standards of quality and safety may result in enforcement action by the Care Quality Commission.

We spoke to over twenty people who use the service during our visits to Heathland Court. The comments we received from individuals were generally positive about the service they were receiving. They included ‘I’m very happy here’, ‘very nice – I wouldn’t stay if it weren’t’, ‘it’s the best around here’, ‘it’s good here’ and ‘wonderful’. One person reported that ‘the place is clean and the staff are courteous’.

All of the people we spoke to said that they were generally treated with dignity and respect by staff. ‘They talk nicely to me’, ‘if you want anything, they’ll get it for you’, ‘polite with very few exceptions’, ‘very nice’ and ‘very kind’ were some of the comments received.

Other feedback about the staff who work at Heathland Court included ‘very good people’, ‘no complaints’, ‘admirable’ and ‘the staff are excellent’.

People using the service generally felt there were enough staff on duty to meet their needs although comments varied depending on which floor people were staying on. Individuals using the service on the lower floors said there could be delays in staff responding to call bells. Other comments received referred to the service sometimes being short staffed particularly in recent months.

Comments about the food provided were almost all positive with feedback including ‘I’m quite picky – it’s absolutely delicious’, ‘the new chef has improved things’, ‘I’ve always enjoyed the food’, ‘the meals are very good’, ‘as good as a five star hotel’ and ‘amazing’.

Mixed feedback was received from people we spoke to about the activities on offer. Comments included ‘quite enough going on’, ‘If you want to, you can’, ‘there’s bits of entertainment’, ‘a few singers periodically’, ‘I amuse myself’ and ‘very good’. Other feedback included ‘I just sit here’, ‘not enough going on’, ‘a lot of people are bored but it doesn’t make much difference to me’ and ‘I would enjoy more classes’. One person commented that ‘people are not active here’.

We observed the care and support being provided to people who have dementia on the first floor. Improvements are needed to provide individuals with higher levels of staff engagement, interaction and simulation. Practice here could be much more person centred and focused on ensuring individual wellbeing. Staff additionally need to make sure that the dignity of individuals is upheld at all times.

The registered manager has recently left the service and an acting manager was in post at the time of our visits. The host Local Authority have informed CQC that they have raised a number of issues of concern with the service provider and have requested a formal action plan as to how these are to be addressed.