We carried out an unannounced inspection of Thornton Lodge on 26 March 2018.

Thornton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered with CQC for 34 older people, including care for people living with dementia.

Thornton Lodge is situated in Salford, Manchester and close to local amenities with good access to public transport and motorway networks. At the time of our inspection there were 30 people living at the home.

At the previous inspection in July 2017 we identified six breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance and staffing. We served a warning notice for regulation 12; safe care and treatment and regulation 17; good governance. The home was rated inadequate overall and in the key question safe and well-led. The home was also rated as requires improvement in effective, caring and responsive.

As a result of the findings at our inspection in July 2017, the home was placed in special measures and kept under review. Following the inspection and enforcement action taken, the provider sent an action plan to show what they would do and by when to meet the regulatory requirements and improve the overall rating.

The inspection in March 2018 was undertaken to determine the improvements that were needed had been made. Although we found the provider had made significant improvements in several areas, we did find continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; Regulation 12; safe care and treatment, Regulation 17; good governance and Regulation 18; staffing. We also identified a breach of Regulation 11; need for consent. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection, there was a manager in post who had not yet been registered with the CQC, however we saw evidence that this application had been submitted and their application was on going. 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.

Although people and their relatives were positive about the management of safety concerns, we identified continued concerns with the management of risks. We found discrepancies in the care records and the documentation could not be relied upon to determine people’s needs were being met in line with their requirements.

There was a system in place to manage people that had specialist dietary needs but records needed strengthening to determine the foods provided were in line with their assessment.

The home had a system in place to determine the required staffing levels and although we observed staffing levels had increased since our last visit. We noted staffing levels were still not consistently maintained at weekends to the same ratio as within the weekdays.

The home had suitable safeguarding procedures in place and staff demonstrated they knew how to safeguard people and follow the alert process.

The environment had improved since our last inspection and there was an identified action plan for works required. Funding had been secured but there was no identified timeframe for completion. The home was clean and had recently been awarded 96% on the infection control audit.

We found people’s food preferences were catered for and people were provided sufficient quantities of quality food to eat. We observed the meal t

This comprehensive inspection was unannounced and took place on 31 July 2017.

At our last inspection on 13 March 2017, the home was rated as requires improvement in the key questions of effective, responsive and well-led. The home was rated as ‘good’ in safe and caring. This meant the overall rating was ‘Requires Improvement.’ We brought the inspection forward due to concerns received regarding the standard of care provided to people at Thornton Lodge.

During this inspection, we found six breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, safe care and treatment, premises and equipment, good governance and staffing. We served a warning notice for regulation 12; safe care and treatment and regulation 17; good governance. You can see what other action we took at the end of the full version of this report.

Thornton Lodge Care Home provides 24 hour nursing and /or personal care for up to 34 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.

At the time of the inspection there was no registered manager in post. The previous registered manager left on 11th July 2017 and the new manager took up post on 25th July 2017 and intended to register with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that there was not enough suitably trained and experienced staff on duty to meet people’s social, emotional and physical needs. Staffing levels were not calculated using a formal calculation based on the needs of people using the service. During the inspection, we observed staff were ineffectively deployed which resulted in people being left for prolonged periods of time and their care needs not being met timely. Following the inspection, the provider contacted us to inform us that a formal dependency tool had been implemented to calculate staffing requirements. This will be followed up at our next inspection to determine that staffing has been provided in line with people’s assessed needs.

We identified serious concerns regarding risk management that we immediately fed back to the provider. We found risk assessments were not in people’s care files but stored electronically with only nursing staff and senior care staff having access to the electronic system. This meant care staff did not have access to the identified risk in order to mitigate the risks and provide safe care.

People were not protected from the risk of aspiration and were given foods by staff which could cause them to choke. We observed the food provided to one person had been identified as a food the person was to avoid when they had been assessed by SALT (Speech and Language Therapy). We saw this person had also been given food not consistent with their assessed needs on days prior to the inspection indicating that this was not an isolated occurrence. We saw ‘Resource’ which is a thickening agent left accessible to people on the nursing floor which presented the risk of people consuming this accidently and placing themselves at risk.

Staff recruitment was robust, with appropriate checks carried out before staff began working at the home.

The environment did not meet good practice guidance for supporting people living with dementia. The upper floor was small and could not accommodate the number of people living on the nursing floor in the dining room or lounge area. The residential floor had a large and spacious lounge, dining area and an additional large quiet room. However, only two people were supported from the nursing unit downstairs to the residential unit to access these areas

Thornton Lodge Care Home provides 24 hour nursing and /or personal care for up to 34 older people, including care for people with dementia. It is close to local amenities with good access to public transport and motorway networks.

The inspection took place on 13 March 2017 and was unannounced. An inspection was carried out in December 2015 when the home was rating Requires Improvement in three areas and overall. There was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to poor record keeping. A further focused inspection was undertaken in March 2016 when only the domain of responsive was looked at. At the focused inspection the service was found to have improved in regard to record keeping, but we were unable to evidence sustainability at this time. At this inspection records were seen to be complete and up to date.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service told us they felt safe. Staffing levels were sufficient to meet the needs of the people who used the service and were based on a dependency tool.

There was a safe system of recruitment in place. This helped ensure staff employed were suitable to work with people who were vulnerable.

Safeguarding policies and procedures were in place at the service. Medicines were managed safely and health and appropriate safety measures were in place.

The induction programme was robust and on-going training was comprehensive and included relevant areas of learning.

Most of the people who used the service were living with dementia. The environment required improvement so that people would be better able to orientate themselves around the premises, to their own rooms and communal spaces and to time, day and date.

Nutritional and hydration requirements were documented and addressed, special diets were catered for and a kosher diet could be sourced for those who wished to have this. The dining experience could have been improved with better presentation of tables and the addition of condiments and napkins.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring and we observed friendly and polite interactions throughout the day. Staff respected people’s privacy and dignity.

Relevant information about the service was given to people who used the service and their families. Where people had expressed them, their wishes for when they were nearing the end of their lives had been documented. The service endeavoured to care for people in the home if that was their wish.

People’s choices, wishes and preferences were documented within the care files. However, some preferences, such as times of rising and retiring were not always adhered to.

There were a number of activities on offer for people and special occasions were celebrated at the home.

Complaints were documented and responded to appropriately and we saw a number of compliments received by the service.

People told us the management at the home were very approachable and helpful.

We saw evidence of a number of audits and checks within the service. Monitoring and analysis of the audits helped identify themes and drive improvement.

The service was involved in a number of local initiatives to help improve the health and well-being of people in the home.

We carried out an unannounced comprehensive inspection of this service on 01 December 2015. During that inspection we found one breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breach of regulation.

Thornton Lodge Care Home provides 24 hour nursing and or personal care for up to 36 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.

At the time of our visit, there was no registered manager in place, though the current manager had been in post since April 2015. Their application to register with Care Quality Commission (CQC) was currently being processed. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thornton Lodge Care Home on our website at www.cqc.org.uk.

During our last inspection, we found the service had failed to maintain accurate, complete and contemporaneous records for people who used the service. This was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance.

During this inspection we found the service was able to demonstrate they were meeting the requirements of regulations. We looked at a sample of five care files and found that on the whole, records were accurate and complete. We found care plans accurately reflected people’s current needs.

We found issues that had been recorded in the daily diary such as referrals to other health care professionals were suitably transferred and recorded in people’s individual care files, together with the reason for the referral. During our visit we found where challenging behaviour had been assessed, suitable care plans, risk assessments and monitoring records were now in place. Where checks such as weight monitoring was required, records we looked at were accurate and up to date.

The manager explained the service was in the process of introducing a new electronic records system and that records were currently being transferred and updated. It was anticipated that the process would be completed within the next four week. We were shown how the service intended to fully utilise the system throughout the home by the manager, who told us that computer terminals would be located in both the nursing and residential unit for staff to use.

This was an unannounced inspection carried out on the 01 December 2015.

Thornton Lodge Care Home provides 24 hour nursing and or personal care for up to 33 older people, including care for people living with dementia. It is close to local amenities with good access to public transport and motorway networks.

At the time of our visit, there was no registered manager in place, though the current manager had been in post since April 2015. 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.

When we last inspected this service in March 2015, we found the service had breached three regulations relating to the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. As part of this inspection, we checked to see what improvements had been made.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that care plans did not always accurately reflect people’s current needs. We looked at a number of risk assessments including nutrition, oral health, bed rails, skin integrity where monthly reviews had been undertaken. However, we found relevant issues relating to people’s care were not always being updated in care files.

We found that issues noted in the diary were not always transferred to the person’s clinical records, for example we found one entry where a referral had been made to the Abbott PEG (Percutaneous Endoscopic Gastrostomy) nurse. The reason for the referral was also recorded in the diary, but this information had not been included in the person’s care plan.

We saw that in one instance the tissue viability nurse had been advising on a PEG site for a person who used the service, however staff were not recording on-going improvements as they happened or monitoring for prevention of the problem. We found there was an informal ‘change of syringe’ used for PEGs every Friday by the nurse, but again this was not documented.

This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), good governance, because the service had failed to maintain accurate and complete contemporaneous records for people who used the service.

During our last inspection in March 2015, we found that people who used the service had not been protected from the risks associated with the safe recruitment of staff. We found the provider had made improvements and was now meeting the requirements of regulations in relation to employment of fit and proper persons. People were now protected against the risks of abuse, because the home had appropriate recruitment procedures in place.

During our last inspection we found that people had not protected from the risks associated with not having sufficient numbers of suitably qualified staff on duty. During this inspection, we found the provider had made improvements and was now meeting the requirements of regulations in relation to ensuring there were sufficient numbers of staff on duty to meet people’s needs and keep them safe.

We found the service undertook a range of risk assessments to ensure people remained safe. Risk assessments provided guidance to staff as to what action to take to ensure people remained safe.

On the whole, we found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely. We observed staff checking people’s medications with medication administration records (MAR) and calling people by their name before offering the tablets.

During our last inspection in March 2015, we found that people who used the service had not been protected from the risks associated with the appropriate support, training and professional development of staff. As part of this inspection, we found the provider had made improvements and was now meeting the requirements of regulations in relation to the professional development of staff.

Staff we spoke with said they received an induction when they started working at the home, had enough training available to them and felt well supported to undertake their roles. We confirmed this by looking at training records.

All staff we spoke with confirmed they received supervision and appraisals, which we verified by looking at supervision records and an electronic supervision matrix.

From reviewing care files, we found that written consent from people who used the service or their representatives was not always obtained. We spoke to the manager who told us they would review all care files and ensure that the appropriate written consent was recorded.

When we undertook our last Inspection in March 2015, we found the home environment was in need of redecoration and upgrading. On the day of our visit, we found that the environment remained significantly unchanged, however a large team of decorators were in situ decorating the communal hallway throughout the home. Significant improvements were still required around flooring and furniture, which we were told formed part of the improvement programme.

We have made a further recommendation on environments.

We found people had access to healthcare professionals to make sure they received effective treatment to meet their specific needs. Care plans contained professional communication records, which detailed engagement with other health care professionals such as bladder and bowel, speech and language therapist (SaLT), dieticians, GP’s, district nurses and tissue viability teams.

We found that individual nutritional needs were assessed and planned for by the home.

People and relatives told us staff were kind and the quality of care provided was good.

Throughout our inspection, where we observed interaction between staff and people who used the service, we found it kind and respectful.

People and relatives told us they were involved in making decisions about their care and were listened to by the service.

The home was part of the North West End of Life Care Programme known as Six Steps to Success. This programme was intended to enable people to have a comfortable, dignified and pain free death.

During our last inspection in March 2015, we made a recommendation that the service seek advice and guidance from a reputable source to ensure people had opportunities to take part in activities they enjoyed and met their personal preferences. We found that the service now employed a full-time activities co-ordinator. Throughout our visit, we saw the activities co-ordinator enthusiastically engaging in activities with people who lived at the home.

Care plans provided guidance on a number of areas of care and treatment, including consent and mental capacity, mobility, nutrition, skin integrity, communication and incontinence. Though people told us that they were involved in determining the care their loved one’s received, this was not clearly documented in their care plans.

We found that the service routinely listened to people to address any concerns or complaints. We found the provider had effective systems in place to record, respond to and investigate any complaints made about the service. We also looked at minutes from bi-monthly resident and relatives meetings that took place.

During our last inspection in March 2015, we found the registered person did not have appropriate arrangements in place to monitor the quality of service provision or regularly seek the views of people who used the service. During this inspection we found that the service was on the whole meeting the requirements of this regulation, however not all audits undertaken were effective.

We found the service undertook a range of audits and checks to monitor the quality of services provided. These included regular fire systems checks, weekly medication audits, environmental checks, infection control, monthly falls audit, safeguarding and supervision. However, we found that care file audits failed to identify our concerns around maintaining accurate and complete contemporaneous of records of people who used the service.

Both people who lived at the home together with their relatives and staff consistently told us that the service was well managed following the appointment of the manager.

The home had policies and procedures in place, which covered all aspects of the service. The policies and procedures included; safeguarding, whistleblowing, behavioural management and medication.

This unannounced inspection was carried out on the 03 March 2015.

Thornton Lodge Care Home, formerly known as Broughton Court Care Home at the time of our inspection, provides 24 hour nursing and or personal care for up to 36 older people, including care for people with dementia. It is close to local amenities with good access to public transport and motorway networks.

There was no registered manager in place at the time of our inspection, though the provider told us a new manager had been appointed and would be registering with Care Quality Commission (CQC) shortly. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the last inspection carried out in September 2014, we identified concerns in relation to infection control, care and welfare of people and the management of medication. As part of this visit we checked to see what improvements had been made by the home to address these concerns.

We checked to see whether staff had been safely and effectively recruited. We looked at four personnel files of staff who had been recruited since December 2014. We found that appropriate criminal records bureau (CRB) disclosures or Disclosure and Barring Service (DBS) checks had not been undertaken. We also found that suitable references relating to good character had not always been obtained. Without robust recruitment procedures people may be put at risk of harm.

We found the registered person had not protected people from the risks associated with the safe recruitment of staff. This was in breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to fit and proper persons employed.

We looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. We found there were not enough staff on duty to effectively meets the needs of people who used the service and keep them safe.

We found there did not appear to be any clear strategy for dealing with the numbers of people waiting for their lunch on the nursing unit. This meant people had to wait unreasonable periods of time before they received their meals. 

One member of staff told us; “We have one resident who needs one to one care, because he has been at risk of falling, which means the staffing numbers during the day is not enough. If we didn’t have that need then three staff would be enough.”

During our inspection we observed that the senior carer while administering medication and supporting people, was constantly interrupted by the phone, which meant they had to leave the lounge to answer the phone situated in an office along the corridor. This meant only one member of staff was available to supervise and support people in all other areas of the building.

We found that the registered person had not protected people from the risks associated with not having sufficient numbers of suitably qualified staff on duty. This was in breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing.

During the inspection we checked to see how the service ensured that staff had the required knowledge and skills to undertake their roles. From reviewing training records and speaking to staff, minimal training or no training or refresher training had been delivered by the provider since acquiring the service in August 2014. It was also not clear to us, what, if any training these new staff members had received. We saw no documented evidence of any induction training undertaken.

We looked at supervision and annual appraisal records and spoke to staff about the supervision they received. Supervisions and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner. We found that no supervision had been undertaken by the service since August 2014.

We found the registered person had failed to ensure that staff received appropriate support, training and professional development. This was in breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to staffing.

We found that since the new provider had acquired the service, very little in the way of quality assurance auditing had been undertaken to monitor the quality of service provision. We saw that no auditing had taken place in respect of staff personnel files, infection control or staff training requirements and supervision.

We found that limited medication audits had taken place. Where medication audits had taken place these were ineffective. We found that no competency or spot checks had been undertaken with staff to ensure that medicines were administered correctly.

It was not clear to us how the service regularly sought the views of people to comment on the quality of services provided. We found no satisfaction questionnaires had been circulated to people who used the service, relatives and visiting professional to seek feed-back on the quality of the services provided.

We found that the registered person did not have appropriate arrangements in place to monitor the quality of service or regularly seek the views of people who used the service. This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.

You can see what action we told the provider to take at the back of the full version of this report.

One visiting health care professional told us they had no concerns about the safety of residents living at the home. A visiting relative told us; “She is definitely safe here.” Another relative said “Since the new owner, everything is better and different, much improved. The owner said he would look after my parent as if it was his own parent and he has. My X is very happy here, he told me he feels very safe here.”

During our inspection, we checked to see how the home protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We found bedrooms and bathrooms clean and free of any unpleasant odours. We checked mattresses and bedding and found them to be clean and hygienic. We saw staff wearing appropriate aprons and gloves when providing care and treatment.

We found that medicines were administered as prescribed and that staff we spoke with could describe peoples’ medicinal needs. However, we had concerns over the management of medicines for people on short stay respite care.

We found the home was in complete need of upgrading and redecoration, which was acknowledged by the provider and subject of the improvement programme intended for the premises. Though the home did not specialise in care for people living with dementia, a number of people who used the service had varying degrees of dementia.

We have made a recommendation about environments used by people with dementia.

There was a choice of meals and we saw staff asking people what they would like. The atmosphere in the dining room was relaxed and calm. People were allowed to take their time and were provided with support when required.

Both people who used the service and their families told us that staff were caring and compassionate. We observed people’s privacy and dignity was respected at all times, with staff knocking on doors before entering rooms.

People and families told us the service was responsive to any needs or concerns they had. One relative told us; “Any concerns and I would speak to the owner as I know he listens to what I have to say.” Another relative said “If I had any concerns and I have had, I would speak to the senior carer or the owner. Since the owner has taken over things have really improved.”

We found that regular reviews of care and treatment needs and risk assessments were undertaken. Staff we spoke with demonstrated a good understanding of each person’s needs and the care and support required.

The provider told us the service employed an activities coordinator who attended the home three times a week. People told us that activities did take place and that people were taken out on shopping trips. One relative told us; “Every Monday, Wednesday and Friday they do singing, exercises and games with them. People who can do things do get involved. My X really used to really enjoy joining in with the singing.”

We have made a recommendation about the service ensuring people have opportunities to take part in activities.

Both people visiting the home and staff told us that the home maintained a positive culture which was open and inclusive. People spoke of the provider’s genuine desire to improve the quality of service for people living at the home, which included the environment.

Staff we spoke with had a good understanding of their roles and responsibilities. They told us they believed there was an open and transparent culture within the home and would have no hesitation in approaching the provider about any concerns.

During this inspection, though some improvements had been made, we found that generally little had changed since our visit in September 2014. We discussed our concerns relating to governance at the home and the programme of improvements. The provider told us that following the recent replacement of the boiler system and together with the newly appointed manager, they were confident that progress would be resumed in respect of the planned improvements programme and governance of the service.

Broughton Court Care Home provided 24 hour nursing and or personal care for up to 36 older people, including care for people with dementia. The home was divided into two units with the residential side located on the ground floor with a nursing unit located on the first floor. When we undertook our inspection, 26 people were living at the home, eleven of whom required nursing care with 14 living within the residential unit.

A new provider had recently acquired the home in August 2014 and the manager had just been appointed having been in post since 18 August 2014. The Manager identified the home as being work in progress and advised that they were working closely with the provider to agree a manageable and sustainable way forward to improve the quality of the home and service provided to people.

We were told a major improvement programme of refurbishment and decoration had been agreed to improve all bedrooms, bathrooms and communal areas both within and outside the building. Care plans, training, policies and procedures together with documentation was also being reviewed by the new manager.

During our visit we spoke to four people who used the service, nine relatives and friends and six members of staff.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission together with a specialist advisor in nursing. They addressed our five standard 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. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; “I’ve been elsewhere so I can compare. I have no concerns about the staff or place. Any issues and they put it right straight away.”

Systems were in place to make sure that the service and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager was able to demonstrate a good understanding of the legislation though most staff had a limited understanding of the legislation and no recent training had been undertaken.

Equipment was well maintained and serviced regularly therefore people were not put at any unnecessary risk.

The registered manager set the staff rotas and ensured suitable numbers of trained staff were available to meet the needs of people who used the service. We were informed staffing levels and rotas were currently being reviewed by the service.

We found the service had some policies and procedures in place to make sure that unsafe practice was identified and people were protected. We were told that the service was currently reviewing all policies.

During our inspection we had concerns regarding the personal hygiene of some people and cleanliness of the home.

We found that medication was not managed safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to hygiene and cleanliness and the safe administration of medication.

Is the service effective?

We found people’s health and care needs were assessed with them, and that they or their representatives had been involved in determining what care and support they needed, though this was not always clearly demonstrated in care files.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed they were always made to feel welcome and that visiting times were flexible.

During our inspection we had concerns that the service was not always effectively meeting the needs of people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to effectively meeting peoples’ needs.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff supporting people in a kind and caring manner.

People commented; “Individual care is excellent.” “I’m really grateful for this place, they really look after her and me.” “The new manager is really helpful and the girls are really good.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and had been provided in accordance with people’s wishes.

Is the service responsive?

There were a very limited range of activities available at the home to stimulate people mentally and physically. We were told that availability of activities were currently being reviewed by the new manager.

People knew how to make a complaint if they were unhappy. The service had procedures in place to deal with complaints.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

On the whole, the service had some quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service continuingly improved.

Staff told us they were clear about their roles and responsibilities within the home.