We inspected St Dominic’s Nursing Home on the 26 February and 2 March 2018. The inspection was unannounced. At the previous inspection of this service in April 2017 the overall rating was requires improvement. The history of the service had demonstrated they had not been able to sustain improvements in the past and we needed to see that as more people come to live at the service, the improvements were continued and sustained.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, caring, responsive and well led to at least good. This inspection found that improvements had been sustained and the overall rating was ‘Good’. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

St Dominic’s Nursing 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. St Dominic’s Nursing Home provides accommodation and nursing care for up to 91 people, who have nursing needs, including poor mobility, diabetes, as well as those living with various stages of dementia.

St Dominic’s Nursing Home is registered to provide care to people with nursing needs, such as Parkinson’s, diabetes, and heart failure, many of whom were also living with dementia. The home was divided into six units, over three floors, Fern, Crocus, Dahlia, Aster, Bluebell and Elderflower. Fern unit was on the lower ground floor and was home to people living with complex dementia needs. Elderflower unit remained closed. There were 53 people living at the home on the days of our inspection.

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 and associated regulations about how the service is run.

This inspection found that the provider had continued to progress quality assurance systems to review the support and care provided. This included undertaking root core analysis on events that affect people at the service and reflective learning from safeguardings, incident and complaints. Root cause analysisis a collective term that describes a wide range of approaches, tools, and techniques used to uncover causes of problems. Audits included those for accidents and incidents, care plans, medicines and health and safety.

The overall rating for St Dominic’s Nursing Home has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People were safe at the service. Staff knew how to identify abuse and understood the safeguarding procedures to follow to protect people from abuse. Risks to people's health and well-being were assessed and managed. There were appropriate risk management systems which ensured staff delivered safe care. People's needs were met in a safe and timely manner by a sufficient number of staff. The provider followed appropriate recruitment procedures to ensure they employed staff who were suitable to provide care. People received their medicines when needed. Medicines were administered and managed safely by staff who were trained to perform that role.

Staff received the training necessary to provide safe and effective care. People were supported to eat a healthy and nutritious diet. Food and fluid charts were completed when risk of poor eating and drinking had been identified. These showed people were supported to eat and drink. Staff and t

We inspected St Dominic’s Nursing Home on the12 and 13 April 2017. The inspection was unannounced.

St Dominic’s Nursing Home is registered to provide care to people with nursing needs, such as Parkinson’s, diabetes, and heart failure, many of whom were also living with dementia. The home was divided into six units over three floors, Fern, Crocus, Dahlia, Aster and Bluebell and Elderflower. Fern unit was on the lower ground floor and was home to people living with complex dementia needs. Elderflower unit is still closed at this time. The home can provide care and support for up to 91 people. There were 45 people living at the home on the days of our inspection.

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 and associated regulations about how the service is run.

At a comprehensive inspection in November 2014 we rated this service as inadequate and took enforcement action. Breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by January 2015. During our inspection in February and March 2015, improvements had been made and breaches in regulation had been met. Due to concerns raised with us we inspected in September 2016 where we found that improvements made in February and March 2015 had not been sustained. People’s safety was compromised in a number of areas. The overall rating for the service was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Seven breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified and we took enforcement action.

In September 2016 people had not been protected against unsafe treatment by the quality assurance systems in place. There were also concerns relating to the management and leadership of the practice, specifically in the well led domain. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. Due to further concerns we received in December 2016 we undertook a focussed inspection to look at peoples’ safety. We found that there had been improvements made. The concerns raised with us were not fully substantiated and that people’s health and safety was at that time assured by the deployment and experience of staff.

On 12 and 13 March 2017 we found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made. The history of the service has demonstrated that they have not been able to sustain improvements in the past. The service has been taken out of special measures and there are no breaches of regulation. We have rated this service as Requires Improvement overall and at the next inspection we will check to make sure the improvements are embedded and sustained. This is because we will need to see that as more people come to live at the service, the improvements are continued.

Care plans reflected people’s assessed level of care needs and were based on people's care needs. However further development was needed to ensure that the care reflected people’s specific changed health and social care needs. Whilst there were activities provided Monday to Friday, they did not reflect everyone’s interests and some people in their bedrooms received little interaction.

Mental capacity assessments whilst undertaken were not always decision specific. A clear rationale for continuous bed rest for individual people needed to be developed to ensure that it was in people’s best interests.

We saw some very nice interactions between people and the staff working in St Do

The comprehensive inspection in November 2014 rated this service as inadequate. At this time we took enforcement action. Breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found significant risks due to people not receiving appropriate person centred care. Where people's health needs had changed considerably, care plans had not been updated. Staff did not have the most up to date information about people's health. This meant there was a risk that people's health could deteriorate and go unnoticed. Risk assessments did not reflect people's changing needs in respect of wounds and pressure damage. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. People had not been protected against unsafe treatment by the quality assurance systems. We also found that training had not been delivered where identified and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by January 2015. During our inspection in February and March 2015, we looked to see if improvements had been made. The inspection found that improvements had been made and breaches in regulation had been met. Due to a high number of concerns raised about the safety of people, the meal service and staffing levels we brought the scheduled inspection forward, so we could ensure that people were safe.

We carried out an unannounced comprehensive inspection of this service on 9,12 and 14 September 2016. The inspection showed that improvements had not been sustained and we found seven breaches of Regulation. The appropriate regulatory response is being considered.

After that inspection we received new information of concerns in relation to people’s health needs not being met and lack of suitably qualified and experienced staff. As a result we undertook a focused inspection 5 December 2016 to look into those concerns and ensure people’s immediate safety. This report only covers our findings in relation to the Safe question. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Dominic’s Nursing Home on our website at www.cqc.org.uk

A registered manager was 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 and associated regulations about how the service is run.

We found improvements in managing people’s health needs, such as wound care, diabetes management and promotion of skin integrity had been made. However we found that some elements of Regulation 12 (safe care and treatment) were not yet embedded in to everyday practice to ensure consistent safe care and treatment. For example, the safe use of pressure relieving equipment.

The staffing levels were consistent but we saw that at times the deployment of staff had impacted on care delivery. For example call bell response times meant people had to wait for assistance. People were not always appropriately supervised in a communal area that had electrical kitchen items left out with trailing wires and hot water. .

The use of agency staff had reduced as new staff had been employed. We were told that experienced clinical leads were due to start full time employment in December 2016.

We met some new staff that had recently been employed and were impressed with their enthusiasm and their commitment to the people they supported. We also found that staff that had worked at St Dominic's Nursing Home over the past year (and more) were committed to the improvements.

It was clear that the organisation was c

We inspected St Dominic’s Nursing Home on the 9,12 and 14 September 2016. The inspection was unannounced.

St Dominic’s Nursing Home is registered to provide care to people with nursing needs, such as Parkinson’s, diabetes, and heart failure, many of whom were also living with dementia. The home was divided into six units over three floors, Fern, Crocus, Dahlia, Aster and Bluebell and Elderflower. Fern unit was on the lower ground floor and was home to people living with complex dementia needs. The home can provide care and support for up to 91 people. There were 73 people living at the home on the days of our inspection.

There was a registered manager in post. A registered manager had recently been transferred from another home in the organisation and was in their third week at St Dominic's Nursing Home. 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 and associated regulations about how the service is run.

The comprehensive inspection in November 2014 rated this service as inadequate. At this time we took enforcement action. Breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found significant risks due to people not receiving appropriate person centred care. Where people’s health needs had changed considerably, care plans had not been updated. Staff did not have the most up to date information about people’s health. This meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wounds and pressure damage. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. People had not been protected against unsafe treatment by the quality assurance systems. We also found that training had not been delivered where identified and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by January 2015.

During our inspection in February and March 2015, we looked to see if improvements had been made. The inspection found that improvements had been made and breaches in regulation had been met.

Due to a high number of concerns raised about the safety of people, the meal service and staffing levels we brought the scheduled inspection forward, so we could ensure that people were safe.

This inspection found that people’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as diabetes, kidney problems, and wounds were not up to date and did not have sufficient guidance in place for staff to deliver safe treatment. The lack of suitably qualified and experienced staff impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. Shortcuts in care delivery were identified particularly in respect of personal care. We also found the provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not always following the principles of the MCA. There were restrictions imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice. There was confusion over whether deprivation of liberty safeguards (DoLS) were in place for people. The management list of DoLS was not up to date or accurate.

The delivery of

Our inspection team was made up of two adult social care inspectors and a CQC pharmacy inspector. We answered 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 have found. The summary is based on our observations during the inspection. We observed the care provided, looked at supporting care documentation, staff records and records relating to the management of the service. The newly appointed manager has been in post for six months and has applied to be registered with the CQC and is referred to as manager in the report.

We spoke individually with the manager, two registered nurses, an activity coordinator, a senior care worker, two care workers and a new care worker who was shadowing, a domestic assistant and the cook. We spoke with twelve people who used the service and four visitors.

Is the service safe?

People were treated with respect and dignity by staff. People told us they were safe in the service. Comments received included, “They help me when I need anything,” and “I have just been happy here. I have been safe and they have looked after me.” One visitor said, “I have confidence in the home, they care.” Another visitor said, “I am not impressed at all, I have had to ask them to do basic care, not good enough.”

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. A compliance action has been set in relation to the management of medicines and the provider must tell us how they plan to improve.

People who used the service, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises. We found shortfalls in the maintenance of some areas of the home. A compliance action has been set in relation to the maintenance of the service and the provider must tell us how they plan to improve.

Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people’s best interests. People had been asked for their consent for any care or treatment.

There was a system in place to make sure that the provider, management and care staff learnt from events such as incidents and accidents, complaints, and concerns.

Staff training was available to access to undertake their roles in the service. We saw that systems to track training and refresher courses had been developed and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.

A recent decrease of staffing levels due to reduced occupancy of the service was noted by us at the beginning of the inspection. Following discussion with the management team we were told the staffing levels would be reverted back within 24 hours to reflect people’s needs and not the occupancy levels. A compliance action has been set in relation to the staffing levels and the provider must tell us how they plan to improve.

Is the service effective?

People’s health and care needs had been reviewed and where possible people and their representatives had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and support needs had been identified.

However, no initial care plans and baseline risk assessment documentation was in place for one person. This had not ensured safe and consistent care had been provided, and up-to-date guidance for staff to meet this person’s needs was not in place for staff to follow. This had meant this person was not receiving the care delivery required and placed them at risk from uninformed staff. We also found incomplete records for fluid and food intake. A compliance action has been set in relation to inadequate care delivery and records and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and offered encouragement when supporting people. Comments received included, “They help me when I need anything. They are very good and kind,” They are pretty good,” “They are very kind,” and “Yes they are very good.” We saw that staff were kind and treated people with respect and courtesy.

People had been not been asked to complete quality assurance satisfaction surveys.

People’s preferences and diverse needs had been identified. People told us care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us that staff discussed any changes to do with their care with them regularly, and that staff were approachable if there were any issues of concern. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. One visitor told us, “They regularly consult with me in respect of my X care as my X cannot tell them anything due to their dementia.” Another visor said, “They haven’t listened to us at all, I have had to keep on asking them to do things to ensure my X is comfortable.”

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. People told us they had not had to raise any concerns, and they were aware who to speak with if they had any concerns They said they felt they would be listened to. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

We were told that there was a strong management team in place that were working together to improve the service. However we found that when the management team was not in the home, care plan documentation had not been completed. We also found shortfalls in the cleaning of the home and clearing of recently vacated rooms.

The service had quality assurance systems to develop and improve the service provided. However we identified shortfalls in medication records care plans and maintenance of the premises that demonstrated the audits were not effective at this time. A compliance action has been set in relation to the quality assurance systems and management of risks and the provider must tell us how they plan to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that the home was continually trying to improve.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. Those that could tell us said, “No complaints.” Another said, “Better lately.“

Care plans and delivery of care for people was person centred. The care we observed was in line with people’s main care plan.

People were supported to eat and drink sufficient amounts of suitable and nutritious food and fluids to meet their needs. The new meal service was still being refined but we were told that the early reviews were positive from the people who used the service and visitors.

There were enough qualified, skilled and experienced staff to meet people’s needs on five of the six units.

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We found that people’s personal records, were not all accurate or updated

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. Those that could tell us said, “They are kind, they treat me well.” Another said “No complaints other than the food. “ A visitor told us, “I don’t know what’s happened, but the food has been below standard this week.” Another told us, “I don’t find it easy to find staff that can give me any answers about the care my relative is getting.”

Care plans and delivery of care for some people was more task orientated than person centred. Not all care plans had been reviewed regularly to reflect people’s health and well-being changes.

People were not always supported to eat and drink sufficient amounts of suitable and nutritious food and fluids to meet their needs.

There were not enough qualified, skilled and experienced staff to meet people’s needs.

The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service had complex needs, which meant they were not able to tell us their experiences. Those who could, told us they were, “Happy and content.” One person told us, "Wonderful staff, but so busy." We also spoke with two visitors during our inspection. One said, "I think the home is very busy, but staff communicate very well." Another visitor said, "Nice home, always clean."

We found there were enough qualified, skilled and experienced staff to meet people’s needs. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People living at St Dominic's had complex needs which meant that some people were not able to tell us their experiences. Those who could, told us they were happy living at St Dominic's. One person told us “it's lovely here.” We spoke with two visitors who told us, "Very kind staff," and "We visit often and the home have always involved us in our relatives care."

During our inspection we found that most people were involved in decisions made about the care they received. We saw that the provider had robust recruitment procedures to follow for new staff. However, not all staff were receiving meaningful supervision. Documentation in people’s care files had not been completed correctly, with gaps and inconsistencies seen.

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service had complex needs, which meant they were not able to tell us their experiences. Those who could, told us they were, “OK and felt comfortable.” One person told us, "They forgot to bring me my tea, but I know they are busy." We also spoke with four visitors during our inspection. One said, "I don't think there are enough staff, they are kind, but always so busy." Another visitor said, "I visit frequently and find the staff polite, but I have to ask for information."

By direct observation we found that call bells were not answered in a timely manner. We also saw that people were left unsupervised in communal areas without access to a call bell. We found that the skill mix and experience of staff had impacted on positive outcomes for people who used the service The provider could not evidence that there were enough qualified, skilled and experienced staff to meet people’s needs.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We looked at records, observed care and spoke to visitors.

People that were able to tell us their views said that the care was good, the food was tasty and that the staff were nice. One visitor told us that they thought people were treated kindly and with respect.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had varying and complex needs which meant they were not all able to tell us their experiences. We spoke to two relatives who were visiting the home.

We were told that peoples’ privacy and dignity was usually respected. One relative said “they try to ensure dignity but sometimes it can be difficult, but they are respectful”. We were also told that “staff are polite and friendly”. One relative said that they felt that clothing could be better looked after as jumpers and trousers shrink.

They confirmed that their relatives’ door was always knocked on before staff entered. Another relative said that the staff tell them what has been happening and informs them of any changes.

People spoken with said the food is good and plenty of it.

A relative said “I can eat with my relative if I want to”, “lots of choice”

We were told by the people who used the service “good food, put on weight since being here” “made some friends” “my wife eats a meal with me and that’s nice”.

People told us that they liked their rooms and that they were cleaned regularly.

Some people we spoke with were able to tell us that they enjoyed living at St Dominic’s, and were happy. We were told by one person “everyone is very nice” “I am really happy here” and “the food is always very good”. Other comments included never really enough staff when you want them.

We carried out an unannounced comprehensive inspection at St Dominic’s Nursing Home on the 24 and 29 November 2014. Breaches of legal requirements were found and we took enforcement action against the provider. We issued a warning notice in relation to the care and welfare of the people, assessing and monitoring the quality of service provision and respecting and involving service users at St Dominic’s Nursing Home. As a result we undertook a focused inspection on 27 February and 4 March 2015 to follow up on whether the required actions had been taken to address the previous breaches identified, and to see if the required improvements, as set out in the warning notice had been made.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 24 and 29 November 2014

We inspected St Dominic’s Nursing Home on the 25 and 29 November 2014. St Dominic’s Nursing Home is registered to provide care to people with nursing needs, such as Parkinson’s, diabetes, and heart failure, many of whom were also living with dementia. The home was divided in to five units over three floors, Fern, Crocus, Dahlia, Aster and Bluebell. The top floor, Elderflower unit was closed for refurbishment. Fern unit was on the lower ground floor and was home to people with complex dementia needs. The home can provide care and support for up to 91 people. There were 57 people living at the home on the days of our inspections.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

At the last inspection in September 2014, we took enforcement action against the provider and issued a warning notice in relation to the care and welfare of the people at St Dominic’s. We also asked the provider to make improvements in the areas of respecting and involving people, consent to care and treatment, care and welfare and quality assurance. An action plan was received which stated they would meet the legal requirements by 31October 2014. Whilst we found improvements had been made in some areas there were still areas of significant concern and some actions were not yet embedded in practice. We were still concerned about the care and welfare of people living at St Dominic’s and how the service was managed. This is reflected in the enforcement actions we have taken which can be seen at the back of this report.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments some people had made. People’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was not readily available on people’s preferences.

Not everyone we spoke with was happy with the food provided. We found lunchtime to be chaotic with some people not receiving their lunch until 1:40pm. The dining experience was not a social and enjoyable experience for some people. People were not always supported to eat and drink enough to meet their needs.

People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from a registered nurse.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room.

Feedback had been sought from people, relatives and staff. ‘Residents’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents and accidents were recorded, but not consistently investigated.

Staff told us the home was well managed and there were good communication systems in place between all levels of staff. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and plenty of opportunity to request advice, support, or express views or concerns. Their comments included “Much better– we are now working as a team. We support each other.”

Focused Inspection on 27 February and 04 March 2015.

After our inspection of 13 and 14 November 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to care and welfare, assessing and monitoring the quality of service provision, respecting and involving people and meeting people’s nutritional needs.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found significant improvements had been made and they had met the breaches in the regulations.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked reflected the positive comments people made.

People were safe. Care plans reflected people’s assessed level of care needs and care delivery was person specific or holistic.

The delivery of care was based on people’s preferences. Care plans contained sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was available on people’s preferences.

The provider had recruited a chef and kitchen team and the meals were prepared in the home. The main meal service was staggered which ensured that people received the assistance they required. The dining experience was a social and enjoyable experience for people on all units.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for meal times and were seen to enjoy the atmosphere and stimulation.

Feedback had been sought from people, relatives and staff. Residents and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents and accidents were recorded, and consistently investigated.

Staff told us the home was well managed and robust communication systems were in place. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and plenty of opportunity to request advice, support, or express views or concerns. Their comments included “Really good, nurses’ work with us, we work as a team, really supportive manager.”