We carried out this unannounced comprehensive inspection on the 12 April 2018 after receiving concerns that people were not receiving the care and support they needed. There was a high use of agency staff and that the service lacked leadership and direction. Following this inspection it was judged these allegations were not substantiated. The last comprehensive inspection took place on the 28 February 2017. The service was meeting the requirements of the regulations at that time.

Trengrouse is a ‘care home’ that provides nursing care for a maximum of 41 adults, with a range of health care needs including dementia, nursing and mental health. At the time of the inspection there were 36 people living at the service. 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.

Trengrouse is situated in the town of Helston. It is a purpose built single storey building with a range of aids and adaptation in place to meet the needs of people living there. It is close to the centre of Helston with links to public transport. There are three separate lounges radiating from a central hub, with peoples rooms leading off from the various lounge areas. All rooms were single occupancy. There was a main dining room but also small dining areas in each lounge. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a central patio area and a garden which people could use if they were being supported.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the possibility of harm whilst helping people to be as independent as possible. Records included evidence of reviews to make sure changes were being monitored and responded to. Care plans included information about people’s general health and who was involved in the person’s care and welfare.

Some people’s health needs meant they needed to have their food and drink intake monitored to ensure they received sufficient each day. We found the records for monitoring were not always complete. Three records recording people’s food and fluid intake on a daily basis did not include the amount expected on a daily basis. This was recorded in the main care file but had not been applied to the records used by staff. This meant staff were not reminded of the daily amount required which had the potential to affect their judgements. We have made a recommendation about this.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, general practitioners (GP) and speech and language therapists (SALT). Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs and there was less reliance on agency staff to ensure people were familiar with those staff providing care and support.

The way medicines were managed was safe. Staff responsible for the administration of medicines had the necessary competency and skills required. Medicines were stored securely and safely.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. There was a wide range of training available to all staff which met the diverse needs of people being supported. Staff were supported through formal supervision.

Staff were supported by the registered manager through regular updates called ‘stand up meetings’. These kept the staff team up to date with any changes and provide any essential information that might be needed to be shared to support peoples care and welfare.

Some areas of the environment

Trengrouse is a care service which provides accommodation for up to 41 people. At the time of the inspection 36 people were living at the service. People who live at Trengrouse require general nursing care due to physical and mental health needs. Most people were living with dementia. Trengrouse is a purpose built single storey building with a range of aids and adaptation in place to meet the needs of people living there. It is close to the centre of Helston with links to public transport.

This unannounced comprehensive inspection took place on 28 February 2017. We previously carried out a focused inspection on 11 November 2016. This was in response to anonymous concerns received that the service was not adequately staffed and not always meeting people’s continence needs. It was alleged that there were strong incontinence odours because people were not regularly provided with personal care. At this inspection the provider had taken action to address these issues and the service was now meeting the requirements of regulation.

People and relatives all spoke positively about the service. They said that people were safe living in the service and that staff were kind, friendly and treated people well. They told us that the registered manager and staff were approachable and they felt listened to.

People received care and support from enough staff to ensure they received prompt and attentive care. Staff had time to chat with people as well as meeting their care and support needs.

People received their medicine on time and in the format prescribed for them.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS).

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place.

Staff treated people fairly and with dignity and respect. Staff knew people well and good positive relationships had developed between people and staff. People’s diverse needs were taken into account and reasonable adjustments were made to the way the service was delivered to meet those individual needs.

The premises were safely managed. Recent improvements had been made to the environment to make it more pleasant and homely. Further refurbishment work was planned to replace carpets and improve decoration.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews. Nursing care plans were comprehensive and regularly updated.

Activities were provided by the activity coordinator during weekdays. There was a written and pictorial record of activities which had taken place.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff and resident meetings to seek the views of people about the service.

Trengrouse is a care service which provides accommodation for up to 41 people who require nursing care. At the time of the inspection 38 people were living at the service. People who live at Trengrouse require general nursing care due to physical and mental health needs. Most people were living with dementia. Trengrouse is a purpose built single storey building with a range of aids and adaptation in place to meet the needs of people living there.

We previously carried out a focused inspection on 30 June 2016. The previous inspection was carried out in response to anonymous concerns that the service was inadequately staffed and people’s needs were not being met. We were not able to substantiate the concerns and found the service was meeting the requirements of the regulations. However, we could not improve the overall rating for the service from 'requires improvement' because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We carried out this focused inspection on 11 November 2016. This inspection was in response to further anonymous concerns received that the service was not adequately staffed and not always meeting people’s continence needs. It was alleged that there were strong incontinence odours where people were not regularly provided with personal care.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trengrouse on our website at www.cqc.org.uk

At the time of this inspection the service did not employ sufficient numbers of staff to meet peoples’ needs. However, we found the registered manager had used agency staff appropriately to cover these staff shortages. A targeted recruitment campaign had also been completed which had led to the appointment of eight additional staff. This meant that although the service was short staffed people's care needs had been met and appropriate action taken to address and resolve this issue. The registered manager told us they always ensure the rota was fully covered before leaving the service.

There were seven people who were required to have one to one care from individual staff and all had their own staff member present on the day of this inspection. The staff who covered the one to one shifts were from another agency. Many of these staff had worked at the service for a long period of time and were very familiar with the service and the people who lived there. This meant there was continuity of support for people from familiar faces.

Staff recorded when people were provided with personal care, including pads changes. We reviewed five people’s records and found they had all been provided with regular personal care and pad changes.

We found there were concerns regarding the condition of some parts of the premises. For example, strong incontinence odours pervaded some areas of the service. One bathroom had a broken toilet seat and where the door lock had been removed there was a hole in the bathroom door. Another bathroom was clearly marked with a pictorial sign of a bath, but no longer contained a bath as it had been removed. This bathroom was accessible by people living at the service and contained a bag of soiled laundry, a broken paper towel holder, a chair, a cushion and trailing water pipes. One person’s bedroom had a blocked sink which was full of water. None of these issues had been reported to the manager or the maintenance person. This meant there was not a robust process for staff to report any faults to the maintenance person and such issues were not addressed in a timely manner.

Staff told us they were happy working for the service and felt well supported by the registered manager. There were staff meetings held to seek their views and experiences of the service provided and share information. Staff were provided with supervision and appraisals. The registered manag

Trengrouse is a care service which provides accommodation for up to 41 people who require nursing care. At the time of the inspection 40 people were living at the service. People who live at Trengrouse require general nursing care due to physical and mental health needs. Most people were living with dementia. Trengrouse is a purpose built single storey building with a range of aids and adaptation in place to meet the needs of people living there.

We previously carried out a comprehensive inspection of Trengrouse on 23 February 2016. At that inspection we identified a breach of the legal requirements. This related to the way the service was being staffed. We issued one requirement and told the provider to take action to address the breach of the regulation. We also found the service was not always effective because there were not enough staff supporting people with their lunchtime meal where they required help. The provider sent the Care Quality Commission an action plan following the publication of the report. We checked to see if the service had made the required improvements identified at that comprehensive inspection.

We carried out this focused inspection in response to anonymous concerns that the service was not adequately staffed to meet people’s needs. This included staff not having time to respond to people’s complex needs. It was also alleged the way staff supported people to move was not safe. People’s continence needs were not being met.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trengrouse on our website at www.cqc.org.uk

The service is required to have a registered manager and at the time of our inspection 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 2008 and associated Regulations about how the service is run.

During this inspection we found the way the service was staffed had been reviewed and changes made to shift patterns. Dedicated staff were available in the communal areas of the service during the day to oversee people who may be at risk due to their complex needs. There was a reliance on the use of agency staff. However a recent recruitment drive had employed six care staff. These staff were not yet working in the service as they were currently undergoing checks to ensure they were safe to work with vulnerable people.

Some people displayed needs which challenged others. Where this occurred staff responded in a calm and professional manner. The instances we witnessed resulted in staff managing the situation’s to ensure the person and others were safe. However, not all staff had received formal training in how to manage these situations. The registered manager confirmed this had been recognised and they were currently arranging the training with the organisations training department. The training was planned for in forthcoming months.

Where people required help to move around the service there was a range of suitable equipment to support staff to do this safely. Staff had received training to ensure moving people was carried out using approved techniques. Staff told us, “They (Cornwall Care) make sure we are up to date without moving and handling courses” and “There are times when we have to act immediately to keep the person safe.”

Where pressure mats were being used to monitor people’s movement in their rooms they were all in working order and people who required them had been assessed using ‘Best Interest’ meetings and the service had applied for authorisation under Deprivation of Liberty Safeguard (DoLS).

The design of the service had been improved by making changes to the way seating was provided in lounge

We carried out this unannounced comprehensive inspection of Trengrouse on 23 February 2016. The previous comprehensive inspection in October 2014 found there were breeches of regulations because there were not enough staff available to support people, staff were not being supported in their roles, there were no meaningful activities taking place for people living with dementia and the views of people using the service were not being sought. We carried out a focused inspection to see what actions had been taken to address these breeches of regulations in April 2015. The service had improved all areas other than ensuring meaningful activities were available to people living with dementia.

Trengrouse is a care home which provides accommodation for up to 41 people who require nursing care. At the time of the inspection 37 people were living at the service. Most people who lived at Trengrouse required general nursing care due to illness. Most people were living with dementia. Trengrouse is a purpose built single storey building with a range of aids and adaptation in place to meet the needs of people living there.

The service is required to have a registered manager and at the time of our inspection 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 2008 and associated Regulations about how the service is run.

Most people had complex needs and were not able to tell us about their experiences. We spent time in areas of the service to observe how people’s needs were being met. There were not enough staff available to support people throughout the morning period. People were not supervised in lounge areas for periods of time. Some people became distressed and were responded to only when staff passed through the lounge. The service had identified the minimum numbers of staff required to meet people’s needs. However the way staff were allocated around the service at lunchtime meant some people had to wait for some time before they received their meal. The service was in the process of recruiting more care staff.

Accidents and incidents were recorded by staff in people’s records. These incidents were regularly audited by the manager and overseen by the organisations clinical lead. Care plans showed that where a risk had been identified there was guidance for staff on how to support people appropriately in order to minimize risk and keep people safe.

People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure peoples safety. Care records included details of people’s choices, personal preferences and dislikes.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff had a good understanding of what might constitute abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

The medicines system was well organised, and people received their medicines on time and there were safe systems for storage. People had access to a general practitioner (GP), and other medical professionals including a dentist, chiropodist and an optician. Where referrals for further investigation were made by a GP, staff had made sure records were regularly updated so there was a clear audit trail for any prescribed treatment. A health professi

We carried out a comprehensive inspection on 15 October 2014. Breaches of legal requirements were found. This was because there were not always sufficient numbers of staff employed. This meant staff did not have the time to carry out their roles to meet people’s needs. Staff were not always available in areas where people required support at mealtimes. Staff were not being appropriately supported. For example, staff did not receive regular supervision or appraisal. People did not have access to a range of activities suitable to meet their individual needs. For example, the service did not provide planned activities to people, most of whom required activities designed for people with dementia. The registered provider was not seeking the views of people using the service or persons acting on their behalf. For example, people’s views were not being actively sought in order to measure the standards of care being delivered.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. As a result we undertook a focused inspection on 29 April 2015 to check they had followed their plan and to confirm they now met legal requirements.

Following the comprehensive inspection of 15 October 2014 the Care Quality Commission received information about concerns in relation to the service. As a result we also looked into these concerns regarding whether staff had the knowledge to respond effectively in an emergency situation. Also whether staff had the competency to operate clinical equipment and the systems in place to ensure all clinical equipment was regularly checked and could be operated when needed. Finally, did people have access to members of the management team when they needed to speak with them.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trengrouse on our website at www.cqc.org.uk.

Trengrouse is a care home with nursing for up to 41 predominately older people. The majority of people were living with dementia. Some people had physical or sensory disabilities. At the time of the focused inspection on 29 April 2015 there were 39 people living at the service.

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

At this focused inspection we found the registered provider had made improvements to staffing levels to ensure there were enough staff throughout the day and night time periods to meet the needs of people living at the service.

Staff were positive about their work. Suitable arrangements had been put in place to ensure staff were being supported in their roles to develop their knowledge and skills.

A designated activities co-ordinator had been given the responsibility to oversee a suitable programme of activities for people who lived there. This included planned activities as well as responding to individual people’s individual choices. The service had recently introduced guidance to implement activities specifically designed for people living with dementia in residential care. This programme was still being developed and therefore evidence of the effectiveness of the guidance was limited at this inspection.

The service had looked at ways to ensure people’s views were being sought and responded to. This was promoted through more visible information at the entrance to the service, encouraging people to provide feedback about their experiences. Relative meetings were being held regularly which had been responded to well and information fed back through the service development meetings. Weekly staff ‘drop in’ sessions were being held to enable staff to discuss any issues with the registered manager.

Nursing staff had undertaken training in emergency first aid and resuscitation. Nursing staff had also undertaken competency tests to use clinical equipment in the service in order to respond to medical emergencies which may occur at the service.

We could not improve the rating for Safe, Responsive and Well Led from Requires Improvement because to do so requires consistent good practice over time. We will check this during out next planned Comprehensive inspection.

This was an unannounced inspection which took place on the 15 October 2014.

Trengrouse is registered to provide care with nursing for up to 41 people. The service provides care with nursing for people with nursing needs and people living with dementia. The service had a manager registered 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.

The deputy manager and staff members were clear about their roles and responsibilities and were committed to providing a high standard of care and support to people who lived at Trengrouse. However people’s views about their experience of the service were not being sought which meant the service was limited in how they measured the standards of care and treatment.

We found staffing levels were not always adequate to provide the support people required. We saw the staff members on duty did not have time to spend socially with the people and could not undertake tasks supporting people without feeling rushed. For example people were not assisted with their meals in a dignified way because staff were assisting more than one person at a time. Some people told us they had to wait a long time for staff to respond to them. One person told us they had been waiting a long time before a member of staff assisted them.

Staff supervision and appraisal had not been taking place for a six month period. Staff told us there

was access to the manager should they wish to report anything but they were not having support to talk through their roles or individual training needs.

We observed staff supporting people were caring and respectful. People responded positively to staff interventions. Staff acknowledged people’s privacy and dignity when delivering personal care and support. However, by not having enough staff to support people with meals meant their dignity was compromised.

Activities were not taking place to meet the needs of people living with dementia. Time constraints for staff meant they did not have the time to deliver suitable activities designed for people with dementia. Staff were not familiar with activities specifically designed for people with dementia. We have made a recommendation about staff training on the subject of dementia.

There was no formal process to seek people’s views in relation to the running of the home. People told us their views about the service had not been sought through surveys but that they could express what they thought by speaking with staff and managers.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt their relatives were safe and secure. One person told us, “I feel confident when I leave that (My relative) they will be well looked after and safe until I get back.” Safeguards were in place for people who may have been unable to make decisions about their care and support.

We found medicine procedures in place at the service were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place.

The service met people’s nutritional needs and there were good links with other health and social care professionals. A number of health and social care professionals told us the service worked with them and responded to recommendations and guidance provided.

There were suitable systems in place to ensure people’s rights were protected and appropriate ‘best interest’ assessment took place where necessary. Other agencies told us the service made appropriate referrals to ensure restrictive practices did not occur without a Deprivations of Liberty Safeguard (DoLs) taking place.

People had access to a concern/complaints system which people thought was responsive. People told us they felt listened to and their concerns had been acted upon. They told us this gave them confidence to raise issues when they needed to.

We found a number of Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

This was a responsive inspection because we had received information of concern regarding this home Trengrouse. The concerns related to poor continence management, concerns regarding staff support and staffing levels due to a number of staff leaving the service.

The inspection team consisted of two inspectors. We observed care and support, looked at care plan records and also observed staffing levels within the home. We looked at systems in place to support staff and also the quality monitoring systems the provider had in place. We spoke with the registered manager and deputy manager as well as a number of nurses and care staff working in the home. In addition we observed interaction between staff and people living at Trengrouse as well as speaking with some of the people using the service. Some of the communication with people was limited, due to their individual levels of dementia as well as other cognitive disorders.

Information we gathered during the inspection helped answer our five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service Safe?

We looked at staffing levels in the home to ensure they were safe to meet the needs of people living there. We saw there were both nurses and carers on duty providing nursing care and support to people living there. Staff told us that it is a busy home and there were times when they felt under pressure, however they all told us that it was a job they liked and generally there were enough staff in place to meet the needs of people using the service.

Is the service effective?

We looked at records relating to the care and welfare of three people living at Trengrouse. We did this to evaluate how people’s continence needs were being met and managed. This was due to concerns being expressed that the continence management system was not supporting people effectively. We found there were adequate continence products available for the assessed needs of individuals. We identified an occasion when an order had recently been missed resulting in the manager requesting additional supplies from other services for a brief period. The responsibility for ordering the products in a timely manner had now been delegated to individual staff members and would be audited by the management team to ensure its consistency.

Is the service caring?

We spent time in communal areas around the home to observe how staff were responding to people’s needs. We saw staff taking time to sit with people. In one instance a member of staff spent time assisting a resident to eat their lunch. We observed they did this in a sensitive manner by sitting with them, talking with them throughout and ensuring they took their meal in the persons own time. The staff member told us, “This is what I like doing spending time with residents, it’s the best way to get to know them”.

Some people required one to one care. This meant a designated member of staff is with the person for a specified number of hours as contracted by other health agencies. We saw staff with people receiving one to one care and support. Staff were patient and sensitive to their needs. One comment included, “One to one’s are hard but very rewarding”. Another staff member told us, “It is a challenging job at times but I really like this work it’s so rewarding”.

Is the service responsive?

The service worked with other agencies including social services and other healthcare professionals to make sure people received care and support in a consistent way. This meant people received the right care and support to meet their individual needs and remain as independent as possible.

Is the service well led?

The service had a registered manager and deputy manager in day to day control of the home. In addition the organisation, Cornwall Care provided senior management support. This meant there were systems in place to monitor the service.

Staff told us that in general they were clear about their roles and responsibilities. This helped to ensure people received a good quality service at all times. However not all staff felt their role and responsibility was always recognised by the management team. The management team told us they had systems in place including supervision at all levels and staff meetings, for individual staff groups to ensure all staff felt valued. However they accepted there might be occasions when some staff were not satisfied with the support available and would take this information back to the senior management team.

We saw evidence of staff at all levels having the opportunity to attend regular meetings. These meetings were minuted and we saw examples of staff receiving clear direction and being informed of changes occurring in the service. This meant staff had the information they required to carry out their individual roles and participate in the service development.

Some of the people we spoke with were not able to comment about the service they received because of their health care needs. We did speak with two visitors whose relatives lived at Trengrouse, the manager and two nurses. We saw people talked with staff during personal care and when being assisted.

We saw care plans directed staff as to the care and support people needed. We saw risk-assessments and assessment tools were in use and reviewed. Activities were routinely available and care records described people’s lifestyle at Trengrouse, although there was room for improvement. We were told some people enjoyed trips out in the home’s minibus, and we saw photographs of recent activities.

There were enough staff on duty to provide personalised care that met people’s preferences.

Records were up to date, accurate and stored securely.

We had only passing conversations with people who resided at Trengrouse House, due to people’s care needs at the time of the inspection. We did speak with a visitor, whose relative lived at Trengrouse, and nine care workers (including one nurse).

We saw people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw people assisted by staff and equipment being used properly, for example, wheelchairs with footrests in place.

We saw care plans were inconsistent in the detail provided and did not always direct staff as to the care and support people needed. We saw risk-assessments and assessment tools were not always reviewed.

Activities were not routinely available and care records did not describe people’s lifestyle at Trengrouse. We were told some people enjoyed trips out in the home’s minibus.

Trengrouse adhered to robust recruitment practices in order to protect people.

There were not enough staff on duty to provide personalised care that met people’s preferences.

Staff were supported in their work with training and supervision.

We had only brief, limited conversations with people who resided at Trengrouse House, due to people’s care needs at the time of the inspection. We used our SOFI (Short Observational Framework for Inspection) tool for approximately 1 hour in the main lounge/dining area. The SOFI tool allowed us to spend time watching what was happening and helped us record how people spent their time, the type of support they got and whether they had positive experiences. We saw people’s privacy and dignity was respected and staff were helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.

During our inspection, we found people’s privacy dignity and independence were mostly respected. People’s views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

The home was clean and the staff followed infection control guidelines.

Medicines were administered safely and staff were guided by the homes medicines policy and procedure.

We reviewed all the information we hold about this provider, carried out a visit on 10 April 2012, talked with people who use services and visitors, talked with staff, checked the provider’s records, and looked at records of people who use services.

We had only brief, limited conversations with people who reside at Trengrouse House, due to care needs at the time of the visit. We talked to staff and used observations and information received before and after the visit to decide whether the service meets peoples’ preferences and choices. We observed that privacy and dignity were respected during our visit. We saw that people get visitors frequently, and we talked to one visitor to the home. We were told that they were happy with the staff and the care provided to their relative. They said they had confidence in the registered manager and would not hesitate to voice any concerns if they had any.