Archived: Thornton Hall and Lodge

Thornton Hall and Lodge is registered to provide residential care and support for up to 96 people. The home is purpose built and the accommodation is in four units over two floors. Two of the units within the home are designed to support people living with dementia. The home has aids and equipment to help people who are less mobile and the first floor is accessible by a passenger lift and staircase. During the inspection, there were 79 people living in the home.

At the last inspection in March 2017, we identified breaches of Regulations in relation to how consent to care and treatment was sought, the management of medicines, risk management, care planning and systems in place to monitor the quality and safety of the service. The service was rated as ‘Requires improvement’ and we issued warning notices in relation to Regulation 12; safe care and treatment and Regulation 17; good governance. During this inspection we looked to see whether improvements had been made but found many of the same concerns and the warning notices had not been met.

At the last inspection we found that medicines were not always managed safely. During this inspection we found that sufficient improvements had not been made and the provider was still in breach of regulation regarding this. Medicines were not always stored appropriately as the temperature of the clinic rooms was too high and that some items requiring refrigeration were not stored in the fridge. We found discrepancies in the stock balance of controlled medicines and systems to ensure medicines were always available, were not effective. Some people’s allergies were not clearly recorded and guidance was not always in place for medicines prescribed as and when required.

Records we viewed showed and staff confirmed that they had completed medicine training and had been assessed as competent to administer medicines in the home.

At the last inspection we identified concerns regarding risk management. During this inspection we looked to see if improvements had been made; however we found the same concerns and the provider was still in breach of regulation regarding this.

We saw that risk assessments had been written but not all identified that risks had been fully assessed and clearly recorded and not all had been updated, as people’s needs changed. Some emergency evacuation plans were not accurate and the environment was not always safely maintained as not all fire doors closed properly and chemicals were not always stored securely.

In March 2017 we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we found that adequate improvements had not been made and the provider was still in breach of regulation regarding this. We found that assessments were not always completed when required, such as when people were receiving covert medicines. It was not always clear that relevant people had been involved in best interest decisions and records indicated that it was not assumed people had capacity until an assessment showed otherwise. We did however observe staff seeking consent from people before providing support.

At the last inspection we found the provider was in breach of regulation as care plans did not always provide sufficient detail regarding people’s care needs and were not always updated when people’s needs changed. During this inspection we found that insufficient improvements had been made and the provider was still in breach of regulation regarding this. Not all care plans provided sufficient, consistent information to enable staff to support people effectively and were not always updated as people’s needs changed. This meant that staff may not have sufficient information to enable them to support the person safely and effectively.

At the last inspection we identified a breach in regulation regarding how the service was managed. During this inspection we looked to see if improvements had been made and found there were still concerns regarding the management of the service. Completed audits did not identify all of the concerns highlighted during inspection and when audits did identify areas that required improvement, it was not always clear whether actions had been addressed. This showed that the audit systems in place were not effective and the provider was still in breach of regulation regarding this.

We found that there was not always sufficient numbers of staff on duty to meet people’s needs in a timely way and the provider was in the process of recruiting more staff.

Meetings took place to enable people and their relatives to provide feedback regarding the service, however people did not feel that action was always taken based on their views. Questionnaires were available but there was no evidence when these were last completed.

We made a recommendation regarding this in the main body of the report.

Staff files evidenced that not all safe recruitment practices were adhered to, however all staff had a disclosure and barring service check to help ensure they were suitable to work with vulnerable people.

Staff were knowledgeable about adult safeguarding and how they would report any concerns and people told us they were supported to stay safe in the home.

A system was in place to ensure that applications to deprive people of their liberty were made and monitored appropriately.

New staff completed an induction that was in line with the requirements of the care certificate and regular training was available to all staff. A schedule of supervisions had been implemented to help support staff, but not all staff had received an appraisal.

People were supported by the staff and external health care professionals to maintain their health and wellbeing. People told us they received appropriate care from health professionals in a timely way.

We looked at how people’s dietary needs were met within the home and found that staff were knowledgeable regarding people’s needs and specialist aids were available to assist people to eat independently. People living in the home told us they liked the food available to them and they had a choice of meals.

People spoke highly of the staff and told us staff were kind and caring and treated them with respect. Most relatives we spoke with agreed that staff were caring. Although feedback regarding the approach of staff was positive, the provider had failed to address issues within the service which had been raised at previous inspections and continued to pose risk to people living in the home.

We observed people’s dignity and privacy were respected by staff in a number of ways, such as staff knocking on people’s door before entering their rooms. If people were presenting with behaviours that could compromise their dignity, staff quickly supported them to somewhere more private.

People also told us that they were encouraged to maintain their independence and most staff knew the people they were caring for well, including their needs and preferences. People told us they were supported to meet their religious needs.

Relatives we spoke with told us they were kept informed of any changes to their family members needs and were involved in reviewing their plan of care. Care files included information on people’s preferences in relation to their care. This helped staff to get to know people and provide support based on their preferences.

Feedback regarding activities was mixed. An activity coordinator was employed in the home and we saw an activity schedule on display. Records showed that although people’s preferred activities were known, they were not always met by the service.

People had access to a complaints procedure within the home and we found that complaints made had been investigated and responded to.

There had been a frequent change in the management team at Thornton Hall and Lodge over the previous two years and it was clear that this had had an impact on people living in the home and staff. A new manager had started in post on the first day of the inspection and had begun the process to register with the Commission. 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.

The provider had notified the Care Quality Commission (CQC) of events and incidents that had occurred in the home in accordance with our statutory requirements. We also saw that the rating from the last inspection was clearly displayed within the home and on the provider’s website as required.

Many of the concerns identified during this inspection had been raised with the provider at previous inspections. This showed that the provider had failed to take appropriate action that would mitigate these risks and maintain improvements.

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 un

Thornton Hall and Lodge is registered to provide care and support for up to 96 people. The home is purpose built and the accommodation is over two floors. The home has aids and equipment to help people who are less mobile. The first floor is accessible by a passenger lift and staircase. During the inspection, there were 83 people living in the home.

During this inspection we found that 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 the comprehensive inspection completed in February 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, good governance, need for consent, and protecting people from abuse and improper treatment. The home was rated as ‘inadequate’ overall and we placed the service in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

At the last comprehensive inspection undertaken in September 2016, the provider was still not meeting legal requirements and breaches of Regulation were identified in relation to safe care and treatment, staffing, nutrition and hydration, good governance and person centred care. The service remained in special measures following that inspection.

During the last inspection we found that medicines were not always managed safely. During this inspection we looked at the systems in place for managing medicines in the home and found that there were still concerns regarding medicine management and sufficient improvements had not been made. Expired medicines were in use, safe administration practices were not all followed as photographs of people were not available for accurate identification and allergies were not all reflected on medicine records. People did not always receive their medicines as they were prescribed and clear guidance regarding PRN (as required) medicines was not always available. The provider remained in breach of regulation regarding this.

During the last inspection we found the provider to be in breach of regulation regarding risk management. During this inspection we looked at care files which showed staff had completed some risk assessments to assess and monitor people’s health and safety. These assessments were reviewed regularly; however they were not always completed correctly. We also found that not all identified risks had been thoroughly assessed. Records we viewed showed that falls were not always recorded appropriately to enable risk to be assessed and managed.

Systems were in place to check that call bells and sensor mats were working. When people require the use of both a call bell and a sensor mat, adaptors are required to enable both to be used at the same time. We found that these were not always in place. We raised this with a staff member who arranged for an adaptor to be fitted in the room immediately. The provider remained in breach of regulation regarding risk management.

At the last inspection the provider was in breach of regulation as there were not sufficient numbers of staff on duty to meet people’s needs. During this inspection we looked at how the home was staffed and received mixed feedback from people living in the home and their relatives. The registered manager told us that vacancies had been appointed to and staff were awaiting checks to be completed before they started in post. Our observations showed us that call bells were answered quickly and there were sufficient numbers of staff to support people during lunch time. We found that there were adequate numbers of staff on duty to meet people’s needs in a timely way. The provider was no longer in breach of regulation regarding staffing.

At the last inspection we found that people did not always receive meals in line with their assessed needs. During this inspection people we spoke with enjoyed the food available. A pictorial menu was available to assist people to make decisions regarding meals. The chef and other staff members were aware of people’s dietary needs and preferences. Records we viewed showed that when there were concerns regarding people’s intake, this was monitored and advice sought from the dietician when necessary. The provider was no longer in breach of this regulation.

At the last inspection we found that staff were not supported in their role through regular supervision or an annual appraisal. During this inspection staff told us they felt well supported and could raise any concerns they had with the management team. Staff told us and records showed that staff received an induction and regular supervision sessions. Annual appraisals were evident within some of the staff files we viewed. Staff also told us that they completed training and shadowed more experienced staff when they first commenced in post. The provider was no longer in breach of this regulation.

At the last inspection we made a recommendation that the provider reviewed their systems to ensure best interest decisions were clearly recorded in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we looked to see whether the provider was adhering to these principles. We found that applications to deprive people of their liberty were made appropriately.

When able, people provided consent to their care and treatment. When people were unable to provide consent mental capacity assessments were completed, though they were not always completed accurately. Best interest did not clearly reflect that relevant people had been involved in making those decisions. Consent was not always gained in line with the principles of the MCA.

At the last inspection we identified a breach of regulation in relation to records not being stored securely. We also found that people’s dignity was not maintained by staff. During this inspection we found that records containing people’s private information were stored securely and people living at the home told us staff were kind and caring and treated them with respect and we viewed examples of this during the inspection. The provider was no longer in breach of this regulation.

At the last inspection we identified concerns regarding the provision of person centred care. During this inspection staff we spoke with told us they knew the people they were caring for well and this was demonstrated during the inspection. Care files reflected people’s preferences and a life history was available which provided information regarding the person’s background and experiences. They also contained a preadmission assessment which meant the service could meet people’s needs from the time they moved into the home.

Staff told us they received handovers at each shift change and they received enough information about people to meet their needs. Relatives we spoke with agreed that they were kept informed of any changes to their family member’s health or wellbeing. The provider was no longer in breach of regulation regarding person centred care.

Care plans we viewed were not all detailed and reflective of people's current needs.

We looked at how staff were recruited within the home and found that safe recruitment practices were followed.

People told us they felt safe living in the home and their relatives agreed. All staff we spoke with were able to explain how they would report any concerns they had. A policy was in place to guide staff on actions to take in the event of any safeguarding concerns and details of the local safeguarding team were available to staff.

The provider had taken steps for people living with dementia, towards the environment being appropriate to assist them with orientation and safety.

People we spoke with told us their relatives and friends could come to see them at any time. For people who did not have family or friends to represent them, advocacy services were advertised.

People told us they enjoyed the activities available within the home. A new cinema room had been developed and feedback regarding this was positive. There was a schedule of planned activities which we saw advertised around the home.

Records showed that resident and relative meetings took place regularly. There was a complaints procedure in place and this was displayed within the home. A log of all complaints received was maintained and we found that they were investigated appropriately.

At the last inspection we found that safety checks introduced following the outcome of an investigation were not maintained. During this inspection, records showed that these safety checks were completed daily.

Communication systems in place were not always effective to ensure people’s care needs were known and met by staff at the last inspection. During this inspection we found that staff we spoke with knew the people they were supporting and told us that they received regular updates if people’s needs changed.

The audits in place at the last inspection did not identify the issues we highlighted. During this inspection we found that audits were completed regularly, however they did not identify all of the concerns we highlighted and a number of actions identified had not been acted upon. This meant that the systems in place to monitor the service and dr

Thornton Hall and Lodge is registered to provide care and support for up to 96 people. The home is purpose built and the accommodation is over two floors. The home has aids and equipment to help people who are less mobile. The first floor is accessible by a passenger lift and staircase.

During the last comprehensive inspection which completed in February 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, good governance, need for consent, and safeguarding people from abuse and improper treatment and we issued warning notices in these areas. The home was rated as ‘inadequate’ overall. We placed the service in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

During this inspection, there were 88 people living in the home.

There was no registered manager in post, however a manager had been appointed and had been in post for four weeks at the time of the inspection. The manager had made an application to CQC to become the registered manager, however, we have been advised since the inspection that the manager has left and will not be applying to become the 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.

During the last inspection we found that medicines were not always managed safely within the home. During this inspection, we found that although the systems in place regarding covert medicines had improved, sufficient improvements had not been made and a number of concerns were identified regarding medicine management.

Staff we spoke with were aware of the safeguarding process and how to raise any concerns they may have. People we spoke with told us they felt safe living in Thornton Hall and Lodge.

A new system had been implemented to record and report incidents and accidents. This enabled the manager to review the accidents and incidents and ensure all appropriate actions had been taken.

We found that although a number of risk assessments had been completed, not all risks had been assessed and some assessments had not been completed accurately.

Arrangements were in place for checking the environment and equipment to help ensure it was safe. However, not all checks were maintained regularly, such as those for sensor mats.

We looked at how the home was staffed. Staff rotas we viewed did not always reflect staffing levels described by management. Some relatives and people living in the home raised concerns about staffing levels and most staff we spoke with agreed that there were not always enough staff on duty. Our observations showed that there were not enough staff on duty to meet people’s needs.

During the last inspection in February 2016, we found that incidents that had occurred within the home that should have been reported to the safeguarding team had not been. During this inspection, we found that this had improved and a new system had been introduced to help ensure all relevant referrals were made.

We looked at how staff were recruited to the home and found that safe recruitment practices were followed in line with the provider’s recruitment policy.

We received mixed feedback from people regarding the quality and choice of meals available.

We found that although referrals to other professionals were made when needed, advice received from these specialists regarding diet was not always known or followed by all staff.

During the last inspection we found that applications to deprive people of the liberty had not been made for all people that required one. During this inspection we found that the home’s systems had improved and all people that had been assessed as requiring a DoLS application, had one submitted to the local authority for consideration.

At the last inspection, we found that people’s consent was not always gained in line with the principles of the MCA. During this most recent inspection, we found that some improvements had been made and mental capacity assessments were completed appropriately, though best interest decisions were not always clearly recorded.

Most staff received an induction when they commenced in post, however records showed that systems were not in place to ensure staff received supervisions and appraisals to support them in their role.

Training was available to staff and systems were in place to monitor when staff were due to complete refresher training.

We observed the environment of the home and found that the provider had taken steps within the home for people living with dementia, towards the environment being appropriate to assist people with orientation and safety.

People living at the home told us staff were kind and caring and treated them with respect. We found however, that people’s dignity was not always maintained and comments from some staff were not always respectful.

Records regarding people’s care and treatment were not always stored securely in order to maintain people’s confidentiality.

Care plans we viewed showed that when able, people and their families had been involved in the care planning process.

People’s needs in respect of their religion and beliefs were considered by the provider. The home had a room which was used as a chapel and a member of the local clergy visited each week to perform a service for those people unable to travel to the church service.

We observed relatives visiting throughout all days of the inspection. The manager told us visitors were always welcome in the home, encouraging relationships to be maintained. Relatives told us they could visit anytime and could spend time with their loved ones in private.

For people who had no family or friends to represent them, contact details for a local advocacy service were available and were on display within the home for people to access.

Relatives told us they were kept informed of any changes to their loved one’s health and wellbeing. Staff told us they were informed of any changes within the home, including changes in people’s care needs through daily handovers, though they often did not have time for verbal handovers between staff.

Care plans informed staff of the support people required. The care plans were reviewed regularly; however there was no record that people had participated in the reviews of their planned care. We found that planned care was not always evidenced as having been provided.

We found that not all staff we spoke with knew people’s current needs, especially if they had changed recently.

An activities coordinator was employed within the home and a schedule of activities had been devised, however feedback regarding activities was mixed.

New systems had recently been introduced to assist the manager in gathering people’s feedback.

A complaints procedure was available; however information on how to make a complaint was not clearly displayed within the home for people to access. The outcome of complaint investigations was not always clearly recorded.

The provider had systems in place to monitor the safety and quality of the service, though these audits did not highlight the concerns identified during the inspection. Actions were not always recorded.

Safety checks introduced following the outcome of an investigation were not maintained.

Improvements had been made regarding incident reporting and new systems had been implemented to help ensure appropriate actions were taken following any incidents within the home, though these were not maintained by all staff.

We found that as well as resident and relative meetings being held and quality assurance surveys issued, staff meetings also took place. These meetings however, were not frequent and not all staff we spoke with were aware of them.

The manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory requirements. This meant that CQC were able to monitor information and risks regarding Thornton Hall and Lodge.

Most staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had. Having a whistle blowing policy helps to promote an open culture within the home. Staff told us they were encouraged to share their views regarding the service.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Thornton Hall and Lodge is registered to provide care and support for up to 96 people. The home is purpose built and the accommodation is over two floors. The home has aids and equipment to help people who are less mobile. The first floor is accessible by a passenger lift and staircase. During the days of inspection, 87 people were living in the home.

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.

People living in the home and their relatives, told us Thornton Hall and Lodge was a safe place to live. We found that although some safeguarding referrals had been made, there was no effective process in place to ensure all safeguarding referrals were made to maintain people’s safety. Staff had received training in relation to safeguarding.

Medicines were not always managed effectively to ensure people received their medicines as prescribed. Covert medicines were not administered in line with current legislation.

People living in the home and relatives we spoke with, told us there were adequate numbers of staff on duty to meet people’s needs. We observed people receiving support in a timely way during the inspection. There was an effective process in place to assist the manager in making safe recruitment decisions.

Risk assessments had been completed to assess and monitor people’s health and safety, as well as the environment. People had risk assessments completed in areas such as falls, nutrition and evacuation in the event of an emergency.

Safety checks of the building and equipment had been undertaken to ensure the home remained in a good state of cleanliness and repair.

Accidents were recorded, though actions taken were not always clear. A new process had been implemented to ensure staff acted appropriately in the event of an accident.

Not all staff had a clear understanding of which people had a Deprivation of Liberty Safeguards (DoLS) authorisation in place. Appropriate DoLS referrals had not been made for all relevant people. This meant that people may be having their liberty restricted unlawfully.

We observed staff seeking people’s consent before providing them with support. Care files showed that when able, people consented to their care and treatment plan. When people were unable to consent, an assessment of their mental capacity was completed, but these did not provide clear information regarding the decisions and best interest recommendations as multiple decisions were recorded on one assessment.

People received support from appropriate health care professionals in order to maintain their health and wellbeing, including online advice from a virtual nurse computer system.

Staff were supported in their role through induction, regular supervisions and an annual appraisal. Most staff had completed mandatory training online; however a number of senior staff had not undertaken DoLS training.

People told us staff were kind, caring and treated them with respect. We observed people’s dignity being maintained and people received support in a timely way.

Staff knew the people they were supporting well, including their individual preferences and choices. Care files provided information regarding people’s preferred daily routines and some had a completed life history, enabling staff to understand people and their experiences.

A chapel was available within the home in order to meet people’s religious needs. Services were held regularly and clergy from the local church also visited.

We observed relatives visiting during the inspection and they told us there were no restrictions on visiting. This encouraged relationships to be maintained.

Not all care files reflected that people had been involved in their development. All people we spoke with told us they were happy with the support they received.

The quality of information available within care plans varied. Some were detailed and reflected the needs and preferences of the individual; however others contained conflicting and inconsistent information about people’s care needs. Care plans were not in place for all identified needs.

People told us they could choose how to spend their day and reported an increase in activities available recently. For people who chose to spend time in their rooms, call bells were available to ensure they could summon support from staff when required.

People had their views heard through the use of quality assurance surveys and resident and relative meetings. There was a complaints procedure in place and this was displayed within the home.

The quality and safety of the service was monitored through completion of audits by the manager and operational manager. These audits did not identify the concerns highlighted during the inspection. This meant that the process was not effective.

Not all incidents requiring the home to notify the care quality commission had been made.

There was a registered manager in place and people told us the home was well run and felt able to raise any concerns with the manager. People told us they believed they would be listened to.

Staff felt well supported by the manager and attended regular team meetings to enable them to share their views.

Staff were aware of the homes whistleblowing policy and told us they would not hesitate to raise any concerns.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, relatives, staff, a visiting health care professional and looking at records.

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

Is the service safe?

People told us they were treated with respect and that they felt safe living at the home.

The home has policies and procedures in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards [DoLS]. These are safeguards in law under the Mental Capacity Act 2005 to make sure that any restrictions placed on people's liberty are assessed and monitored to ensure their rights are maintained and any action is taken in the person's 'best interest'. Staff had been trained to understand when an application for assessment by the local authority should be made and this had been carried out at the appropriate time for a person who lived at the home.

There were sufficient numbers of staff available during our inspection. We did note however that there was a busy period during the morning and this had the potential to affect the care provision for people who lived at the home. The manager informed us they were introducing a risk assessment which would help to decide whether staffing levels were sufficient and in accordance with people's assessed needs.

Is the service effective?

People's health and social care needs were assessed with them and/or with their relatives. People had a plan of care which reflected their current needs. People we spoke with were happy with the standards of care and support they received. A person said, 'I get the help I need.' It was clear from our observations and with talking with staff that they had a good understanding of people's needs and how they wished to be supported.

Is the service caring?

Our observations showed people who lived at the home were supported by kind, polite and attentive staff. Staff supported people with their individual care needs and also encouraged people to be independent. We saw people were not rushed as care and support was given at a pace to suit the individual.

Is the service responsive?

People had access to external health care professionals to help monitor their health and wellbeing. People told us the staff were prompt in making health appointments for them.

At the time of our inspection people were joining in with different social activities. The home offered a good range of social events and hobbies and these were based around what people liked to take part in and what was important to people. A person told us how much they enjoyed the music and dancing.

Is the service well-led?

People and relatives we spoke with told us their views were respected by the staff. The development of more social activities had been taken on board as a result of listening to people. Residents' and relatives' meetings were held so that people were able to provide feedback about the home.

Staff had a good understanding of their role and responsibilities and how the home was monitored. The service had a quality assurance system, which included the completion of internal and external audits [checks] on how the service operated. Any shortfalls had been addressed promptly. This helped to demonstrate the service had effective monitoring systems in place and was seeking to continually develop the service.

One person told us 'I feel safe living here. I have no complaints at all, if I was unhappy I would speak to the manager.' Another person told us 'It (the home) is a well run place and the staff are very kind and respectful, I don't know how they do their job it is a long day for them.'

In the entrance there was a notice board to inform people who live in the home and their representatives of the planned weekly activities, resident's meeting and other information on health matters. The complaints policy was also displayed and fire safety instructions. There was an emergency file kept in the office to support the home's business continuity plan should they have an emergency situation.

We viewed the care files of seven people living at the home and found them to be well organised with a person centred approach. There was also a reviewing process in place to monitor and reassess people's care needs.

We spoke with two members of staff who told us they felt well supported by the management and their peers. They said they worked well as a team.