Beacon House

People’s experience of using this service and what we found

People told us they were happy with the care they received, they felt safely cared for by staff who knew them well.

We identified 2 issues with medicines management which were immediately addressed by the manager to ensure people’s safety. The manager was aware staff recruitment files lacked some required information, which they had already identified and were seeking. Some aspects of people’s care records required improvement and this was addressed during the site visit.

There had been 3 managers of the service since January 2022. Governance processes had not been operated effectively prior to the new manager starting to ensure issues were identified and addressed for people. The new manager had started to take actions to address this, but it will take further time to complete them and to embed the new processes.

There were sufficient staff. People’s feedback was positive overall, but some felt on occasions they had to wait for staff to attend when they requested. People’s care was provided safely and people had any equipment they required. People were protected from the risk of acquiring an infection. Processes and practices were in place to safeguard people from the risk of abuse. Processes were in place to identify, review and learn from safety incidents.

The manager was taking actions to ensure people’s views were sought regularly and acted upon. Professionals confirmed staff worked well with them.

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

Rating at last inspection

The last rating for this service was good (published 22 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beacon House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People had been supported to keep in touch with their families throughout the COVID-19 pandemic. Staff provided support where necessary so people could phone or video call their families. The provider was allowing outside visits from family and friends and the expectations and procedures for visitors to the service were clear. This process was being updated from the 8 March 2021 and the provider was implementing changes to ensure visits were safe for people, staff and friends and families.

Beacon House had received very few professional visitors to the home, however we saw robust infection control procedures in place. Visitors were received into the reception area on arrival where they were provided with guidance, personal protective equipment (PPE) and health screening was completed. Each visitor also had their temperature checked by staff on arrival.

The registered manager ensured they were up to date with the latest guidance and practice for infection prevention and control. They had developed policies and procedures in response to the coronavirus pandemic. The guidance and information for staff was clear with detailed safe systems of work for the home. Daily cleaning checks and regular infection prevention and control audits were seen. At the time of the inspection, we had no concerns about the level of cleanliness in the home.

There were mechanisms in place to support staff, risk assessments had been completed with people who use the service and who were identified as facing higher risks. Staff were regularly tested for COVID-19. People who lived at the home had received their first vaccination in January 2021.

People were supported in a person-centred way, when implementing the changes and procedures required to minimise the risk of COVID 19 in the home. We heard of examples of how people had been supported with real compassion and understanding.

Since the last inspection a new manager had been appointed who had registered for the regulated activity of personal care and accommodation. Following this inspection, the registered manager has also applied to register for the regulated activity of personal care so they could provide this care to people living in the bungalows if required. 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 the last inspection in December 2017 we identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two new breaches. The service remained in special measures and we met with the provider to confirm what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At this inspection we found the requirements of these regulations had been met, four of the key questions have now been rated as good and safe has been rated as requires improvement with no breaches of regulations. Safe recruitment practices had been followed and relevant action was taken during the inspection to ensure long-standing staff updated their Disclosure and Barring Service checks. The premises and equipment had been regularly maintained and checked to ensure they were safe for people’s use. Audits and surveys were now effective and where issues had been identified action had been taken to address them for people and to drive service improvements. The registered manager understood what they were required to report and had ensured relevant notifications were submitted.

This service has been in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall. Therefore, this service is now out of special measures. The provider has continued to work with CQC within the terms of their existing voluntary agreement to ensure that all new admissions have first been reviewed and agreed by CQC.

Risks to people had been identified and managed safely. The registered manager acted during the inspection to introduce a falls risk assessment to enable them to be able to demonstrate consistency in how they assessed falls risks to people. They were acting to ensure people’s risk assessments were reviewed monthly as described in their care plans. These actions still need to be embedded in staff’s practice.

Staff had undertaken relevant training to enable them to safeguard people from the risk of abuse. There were adequate numbers of staff to provide people’s care. People received their medicines safely from trained and competent staff who followed the medicines guidance provided. The service was visibly clean and staff followed the infection control guidance provided. Processes were in place to ensure learning took place following incidents.

The registered manager has ensured that staff have access to relevant good practice guidance. Staff reported they felt well supported in their role, through the processes of induction, training, supervision and appraisal provided for them.

People were provided with a choice of meals and enjoyed their eating experience. People were monitored to ensure they did not become malnourished or dehydrated. Processes were in place to ensure people’s healthcare needs were met and the effective sharing of information when they transferred between services. A programme of refurbishment of the service was underway.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind and caring to people. They knew them well and showed an interest in their welfare and comfort. People were asked for their views about their care and their choices and decisions were respected. Staff were heard to speak to people in a respectful manner. People’s privacy and dignity were upheld during the provision of their care. Staff ensured that people could be as independent as they wished.

People told us the service was responsive and that staff understood their needs. Staff had a good understanding of people’s care needs. The registered manager was in the process of making improvements to people’s care plans, but the process still needed to be completed and embedded. People were provided with a varied range of both internal and external activities for their stimulation. People were provided with details of how to make a complaint if they wished.

Staff had undertaken end of life care training and the provider had already identified that further work was required to ensure all new people had been consulted about their end of life wishes.

There was a positive culture within the service that was person centred and open. Processes were in place to enable people, their relatives and staff to express their views on the service and these were listened to and acted upon. The service was looking outwards and making links locally to support staff in their role. Staff worked in co-operation with a range of services and professionals in the provision of people’s care.

Beacon House did not have a registered manager in place as required on the day of the inspection; the interim manager had left their post on 30 November 2017. There was an assistant manager and a head of care in post, whilst the provider recruited to the role of registered manager.

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

When we previously inspected this service in May 2017, we found four continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and identified one new breach. We again rated the service as 'Inadequate' overall. The service remained in special measures and the provider was required to continue to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these audits and any actions taken or to be taken as a result, which they have provided.

This service remains in Special Measures as although the key question of safe is no longer inadequate the key question of well-led remains inadequate. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

The provider had ensured that the required pre-employment information was available for new staff recruited. However, they had not ensured that all of this information was available for each of the longer-term staff in post as required to demonstrate their suitability for their role with people.

Measures had been taken in relation to the safety of the environment. However, the light fittings in the bathrooms did not all conform to legal requirements to ensure people’s safety nor did all of the windows. Although the provider has started the process to rectify these issues since the inspection, they have yet to complete the works to ensure people’s safety.

Not all notifications of reportable incidents had been submitted to CQC as required. We had not been informed of four medicine errors, which staff had correctly reported to the local authority under safeguarding procedures.

At this inspection, we found improvements had been made to the processes used to assess, monitor and mitigate risks to people's health and safety and to identify issues that required improvement. However, not all audits were fully effective; data gathered on the service was not always consistently used to monitor trends over time and to identify areas for improvement. Where actions were identified, there was not always written evidence to demonstrate the required actions had actually been completed to improve the service for people.

Safeguarding systems, processes and staff training were in place to safeguard people from the risk of abuse. The provider had made the relevant alerts to the local authority as required when they suspected a person might have been experienced abuse. Legal requirements in relation to safeguarding people had been met.

Risks to people had been assessed and measures were in place to manage identified risks. Legal requirements in relation to moving and handling people and post-falls management had been met.

Sufficient improvement had been made in relation to medicines to meet legal requirements but staff medicine competency assessments which had been started, still needed to be completed, for people’s safety.

Sufficient staff were rostered to provide people’s care in a safe and timely manner. The provider tried to ensure continuity for people when agency staff were booked to cover vacant staff shifts.

Processes and staff training were in place to protect people from the risk of acquiring an infection.

Processes were in place to inform staff about any incidents and to ensure any required changes were made for people’s safety. Staff were kept updated about safety information received from outside the service.

Staff had been provided with training and support relevant to the care needs of the people they were caring for, to ensure they had the correct knowledge and skills to support people effectively.

The service remains subject to a voluntary agreement not to admit new people to the service without the prior agreement of CQC; no one new has been admitted since the last inspection. The service has obtained and was using evidence-based guidance to deliver effective outcomes for people. For example, recognised guidance tools were used to identify and manage potential risks to people.

People were supported to ensure their eating and drinking needs were met. Any risks to them from weight loss or dehydration were assessed and addressed. People were supported to retain their independence with eating and staff supported those who required this assistance.

Professionals we spoke with told us there were good working relationships with the service and that staff sought their guidance as required. People had been supported by staff to ensure their healthcare needs were met.

The adaptation and design of the environment was suitable to meet the needs of the people currently accommodated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Further work is required to ensure staff have a sound understanding of the application of the mental capacity act in relation to the completion of assessments and their day-to-day work.

Staff treated people kindly and compassionately, and cared about their welfare. Staff had supported people to dress in the manner to which they were accustomed and which reflected them as an individual. People were involved in making decisions about their care and their decisions were respected by staff. People received their care at their pace. People were able to have visitors come to see them as they wished. People’s privacy and dignity were upheld during the provision of their care.

People received personalised care that was responsive to their individually identified needs. People and their representatives were involved in planning their care and care plans were kept under regular review. People were supported to take part in a range of activities.

Processes were in place to enable people to make a complaint where required. No written complaints had been received since the last inspection, so we could not assess how effectively they had been managed.

People had been consulted about their wishes for their end of life care and relevant documentation had been obtained with regards to their wishes.

Staff and professionals spoken with felt significant improvements had been made to the service for the benefit of people under the leadership of the interim manager. However, there were anxieties about the future leadership of the service and how consistency in management of the service could be assured for people.

A recent staff meeting set out the expectations of staff and their responsibilities. Further work is required to ensure staff receive instruction on the provider’s purpose and values.

There were processes to engage people and staff. However, there was not always clear written evidence of how peoples’ feedback had been acted upon to improve the service provided.

The service has worked closely with health and social care quality teams in order to address the areas of improvement required from the previous two inspections. However, they need to be able to demonstrate in the longer term their resilience and capacity to embed the changes made to date and to manage without this level of input from external quality teams. The service is now looking outwards and is working closely with a variety of healthcare professionals to improve people’s care.

At this inspection, we found improvements had been made and three of the previous breaches in Regulations had been met. However, the service had not yet managed to fully meet the legal requirements of two of the other Regulations and we identified two new breaches.

Beacon House provides care for up to 23 people living with differing stages of dementia. There were 15 people living at the service on the days of our inspection. Accommodation was provided over three floors of a converted residential dwelling, with a passenger lift that provided access to the second floor and a stair lift to the top floor. The service also has six bungalows on site but at the time of our inspection no one living in the bungalows required personal care.

Beacon House did not have a registered manager in place on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home manager’s application to be registered was being considered at the time of the inspection.

When we previously inspected the service in September 2016 we found six of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘Inadequate’ overall and the service was placed in special measures. To support the provider to make the necessary improvements we imposed three conditions on their registration in respect of the regulated activity, accommodation for persons who require nursing or personal care they carry on at Beacon House. The provider was required to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these and any actions taken or to be taken as a result.

At this inspection we found planned improvements had not been made or sustained. We found four ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one new breach. We found whilst the service had been in ‘Special measures’ not enough improvement was made within this timeframe and at this inspection there was still a rating of inadequate in the key questions; Is the service Safe? and Is the service Well-led? with an overall rating of ‘Inadequate’. We will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found although the provider had taken some action and engaged an external consultant to drive improvements in the service this had not resulted in people always receiving safe care and the service still lacked the leadership to improve the quality of care provided to people.

We found an effective governance system to monitor the quality of the service and identify the risks to the health and safety of people was still not in place. A regular programme of effective audits had not been completed in relation to the management of people's medicines, infection control practices, health and safety, and quality of care records. The provider had not identified the areas of concern we had found. As a result, action had not been taken to improve the quality of care and ensure the safety of people.

We found people's safety was being compromised in a number of areas. Risks to people in relation to the use of medicines, and moving and positioning equipment had not always been assessed and risk management plans in place were not sufficient to enable staff to keep people safe.

People's care records did not include all the information staff would need to know about how to provide people's care and when people received care this was not always recorded. Staff and the managers could therefore not judge from people's records whether people had received their care as planned and their medicines as prescribed.

Recruitment arrangements were still not safe. All the information required to inform safe recruitment decisions was not available at the time the provider had determined applicants were suitable for their role.

Staffing levels were sufficient to meet people’s needs but staff were not always supported through induction and training and there continued to be a lack of supervision and effective performance management.

People were not always protected from abuse as staff were not identifying safeguarding concerns. Some safeguarding issues had not been escalated and investigated by the management team and reported to relevant agencies.

Decisions about people's care had been guided by the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity. However, when decisions were made in people's best interests it was not always recorded how these decisions had been made in consultation with those who knew people well. The provider had requested appropriate authorisation when placing restrictions on people and had met the requirements of the Deprivation of Liberty Safeguards.

Some improvement was needed to ensure the arrangements in place for people and relatives to provide feedback about the service would be taken into consideration when making improvements to the service.

People were treated with dignity and respect. Some improvement was still needed to ensure people living with dementia were always communicated with in way that would support their understanding and enhance their daily decision making and participation in the service.

We identified four continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one new breach. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Beacon House provides care for up to 23 people living with differing stages of dementia. There were 18 people living at the service on the days of our inspection. Accommodation was provided over three floors of a converted residential dwelling, with a passenger lift that provided access to the second floor and a stair lift to the top floor.

Beacon House did not have a registered manager in place on the day of the inspection for both their registered activities. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had started their application to be registered with the Care Quality Commission to ensure the provider would meet their registration requirement to have a registered manager in place.

The manager had been absent from the service for two months and returned to work on 12 September 2016. During their absence the deputy manager, senior care workers and the provider were responsible for the day to day running of the service. We found at the time of our inspection a comprehensive and effective governance system to monitor the quality of the service and identify the risks to the health and safety of people was not in place. A regular programme of audits had not been completed in relation to the management of people’s medicines, infection control practices, and quality of care records and the manager, deputy manager and provider had not identified all the areas of concern we had found. As a result limited action had been taken to improve the quality of care and ensure the safety of people. The manager, deputy manager and provider were unclear about their overall responsibility to meet and sustain all the legal requirements of a registered person to ensure the safety and welfare of people.

We found people's safety was being compromised in a number of areas. People had not received the support they needed in accordance with national best practice guidelines to mitigate their risk of choking. People were at risk of injury when receiving moving and handling support and when people had developed pressure ulcers they had not always received the support and treatment they needed to prevent their health from deteriorating.

People’s care records did not include all the information staff would need to know about how to provide people’s care and when people received care this was not always recorded. Staff and the managers could therefore not judge from people’s records whether people had received their care as planned and their medicines as prescribed. The managers' and provider’s knowledge of the service was not up to date and communication in the service was not sufficient to ensure people would receive the care they required when their needs changed.

The provider’s philosophy at Beacon House was that each resident should live as full and independent a life as possible. However, people living with dementia did not always receive the support they needed to remain independent, express their wishes and make sense of their environment. We made a recommendation to support the provider to improve the communication between staff and people living with dementia.

People’s privacy and dignity were not always respected. From observing staff interactions with people it was clear the values of the service were not yet fully embedded into practice as care was at times task based rather than person centred, for example when moving and handling tasks were undertaken. We saw poor practices which were undertaken by some staff but not challenged by other staff.

Decisions about people’s care had been guided by the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity. However, were it was deemed to be in people’s best interest to restrict their freedom to keep them safe their rights had not been protected. The provider had not requested appropriate authorisation when placing restrictions on people and had not met the requirements of the Deprivation of Liberty (DoLS) safeguards.

Recruitment arrangements were not safe. All the information required to inform safe recruitment decisions was not available at the time the provider had determined applicants were suitable for their role.

Some improvement was needed to ensure the arrangements in place for people and relatives to provide feedback about the service would be taken into consideration when making improvements to the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

We found six of breaches 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.

During this inspection, we found that the provider had taken positive action and ensured that recruitment of new carer workers were safe and robust.

We looked at the recruitment file of a newly recruited care worker. The records showed that the provider had taken action to carry out the required checks. These checks were to ensure that people employed for the purposes of carrying on the regulated activity were of good character. Checks included verifying applicants' identity, obtaining a full employment history and evidence of previous training.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. The provider operated effective systems to identify, assess and manage risks to the safety and welfare of people. We looked at four people's care records and saw that detailed instructions were available to staff to ensure they knew how to meet people's needs and keep them safe.

Incidents and accidents had been appropriately reported and recorded. Where trends had been identified, for example, one person had increased falls, we saw that the provider had taken action to prevent these incidents from reoccurring.

The provider did not operate an effective recruitment and selection process. Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who lived in the home. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

We spoke with six people, one relative and one friend of people who lived at the home. They were complimentary about the care received. Comments made by people included 'the staff here are wonderful' and 'when I ring my call bell they came as quick as they can'. The manager attended regular Clinical Commissioning Group (CCG) meetings and utilised external resources to ensure that care workers' practice was in line with current guidance. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. All four staff we spoke with could describe in detail the care required by one person who was at risk of developing pressure sores. This was in line with their care plan and guidance from the district nurse.

Is the service caring?

People were treated with consideration and kindness. All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed. Staff had a good understanding of how to communicate and present information to people with dementia to enhance their involvement in activities and decisions. People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People's needs had been assessed before they moved into the home. We saw that care plans had been reviewed monthly to ensure that the home could respond to people's changing needs swiftly. Records showed that health professionals like the GP and district nurses were contacted in a timely manner when staff had identified that this support was required. People's views were taken into account when activities and menus were planned. We also saw that a new snack menu and walled garden had been developed following people's feedback.

Is he service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. An annual quality survey was undertaken and included feedback from professionals, people and their relatives. This year's survey had been sent out in March 2014 and the provider was waiting for questionnaires to be returned. Records seen by us showed people were complementary about the service and any identified shortfalls were addressed promptly. The relative we spoke with confirmed that they had been listened to. The manager undertook several audits to assess the quality of care being delivered. We saw the action taken following a night spot check and the audit of falls.

Staff and people we spoke with were complementary about the manager. One care worker told us 'She has a lot of knowledge and experience. She is always about and gives good advice if you are not sure how to support someone'.

We spoke with four people who used the service, three members of staff, the registered manager and a visiting community nurse.

People told us they liked living at this home and the staff always helped them. We found through observation that staff treated people with kindness and assisted them with the care they required. We found people and/or their relatives had been consulted and had been involved in making decisions regarding their care.

People told us they felt safe at this home. We found staff had been trained to respond appropriately to protect people from the risk of abuse.

People told us there were enough staff to help them. We found the registered manager had improved the staff levels which had enabled staff to provide more activities and allowed staff to provide the care people required.

People had been asked their opinions regarding the service and these had been acted upon.

People told us they usually really liked the food and that they could choose according to their preferences including wine with their meals. We observed that staff assisted people with their meals, however sometimes this was task based rather than positive interactions. An example of this was that staff stood up whilst assisting people and they did not spend time talking to people to ensure they were ready for more food.

People told us that sometimes they felt there were not enough staff, however, they did say they did not have to wait a long time for assistance.People all said they enjoyed the range of activities they could participate in and especially going for walks in the well kept gardens.We observed people taking part in a music and movement session and staff spent time with people chatting and listening to music.

Two relatives told us their family member had settled in well recently and they felt the staff kept them informed. They commented that the home was clean and there were never any unpleasant odours.

We found that the home had not adequately assessed or planned peoples' needs and medication was not always given safely. People were not adequately safeguarded and the quality assurance system was not effectively used to make improvements.