The Chilterns

The Chilterns is a residential care home, that can accommodate up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 13 people living at the service, who needed support with their mental health, or living with a learning disability.

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

People told us they were not always happy with the staff supporting them. When safeguarding incidents occurred, care plans and risk assessments had not been updated to reflect any changes in risks to the person. Care plans and risk assessments did not always contain the information necessary to inform new or agency staff on how best to support people. Incidents between people had reduced as a result of people moving on from the service, and a review of staffing. Accident and incident analysis were being carried out by the manager but needed improvements to ensure learning was documented on people’s care plans.

Medicines management was not always safe. The relevant supporting documents were not always used to inform staff of where and how to apply medicated patches. Body maps were not in place to inform staff of where to apply medicated creams.

Checks and audits were being completed but had not always identified and resolved issues identified during this inspection. The culture within the service had improved, but there were still areas needing further improvement. The manager acknowledged there were still improvements to be made.

Staffing levels had been reviewed and a dependency tool was now in place to support how many staff were needed on each shift. We observed there to be enough levels of staff to meet people’s needs.

There had been some improvements to the environment of the service. The service was clean and there was a maintenance schedule to make improvements that were still needed, such as decorating parts of the service.

People had been involved in the service, with their opinions sought and acted on. For example, sporting events were made into activities for people, with projectors and themed meals. Restrictions placed on people had been reviewed, and there were no longer restrictions placed on everyone. For example, one person had a key fob enabling them to leave and return to the service as they chose to.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting mostly maximises people’s choice, control and independence

Right care:

• Care was mostly person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff mostly ensured people using services lead confident, inclusive and empowered lives

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

Rating at last inspection and update:

The last rating for this service was inadequate (published 24 May 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made however the provider remained in breach of regulations. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

This service has been in Special Measures since 24 May 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We carried out an unannounced inspection of this service on 25 March 2021. Breaches of legal requirements was/ were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, fit and proper persons employed, safeguarding service users from abuse, premises and equipment, need for consent, good governance and notification of incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to well-led. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment, safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Chilterns is a residential care home, that accommodates up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 19 people living at the service, who needed support with their mental health, or living with a learning disability .

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

People were at risk from themselves and each other. Incidents occurred between people, one person told us they did not feel safe in their own home. The provider had not learnt from these incidents, and similar incidents re-occurred as a result placing people at harm. Staff did not have the skills, knowledge or training to deal with the very complex needs of people they were supporting. There was a lack of guidance for staff to follow, and where guidance was put in place it had not always been shared with agency staff. People had been unlawfully restrained by staff. Staff placed unlawful restrictions on people.

Risks relating to people’s health had not been managed; people were at risk of constipation and were not supported to manage this safely. Staff lacked the knowledge of how to support people when incidents occurred, for example when people sustained head injuries and as a result there was a delay in seeking medical advice.

Infection prevention control measures were not adequate. The service was not clean and well maintained; there were various holes in walls and doors and skirting boards and walls were dirty and in need of decoration. One staff member was observed frequently without a face mask, not in line with government guidance regarding the prevention of Covid-19.

There was a lack of leadership and oversight from the provider. Audits and governance systems had failed to identify unsafe practices raised in this inspection. The quality of audits completed was poor. The provider failed to identify that they were not meeting their regulatory responsibilities. Safeguarding incidents were not always raised with the local authority safeguarding team. Statutory notifications were not raised with the CQC, and the service was not complying with the Mental Capacity Act.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had unnecessary restrictions placed on them, which infringed their human rights. Staff used punitive measures to restrict and control people’s personal belongings.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence.

Right care:

• Care was not person-centred and did not promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives.

This meant people were placed at harm; had unnecessary restrictions placed on them and did not receive person centred care. The provider had not acted or taken any measures to mitigate the risk of harm to people or support people to live with choice or independence.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 1 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about incidents between people, allegations of abuse and staff competencies. A decision was made to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this report.

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

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed, premises and equipment, consent, notifications and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Chilterns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Chilterns accommodates up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 20 people living at the service.

There was no registered manager in post. The previous registered had left the service in July 2018. There was a manager in post who had started at the service on 1 August 2018 and would be registering with the Care Quality Commission. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected The Chilterns in August 2017 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice in relation to staffing numbers. At this inspection, there was a continued breach of Regulation and three new breaches of Regulation.

At our last inspection, the service was rated ‘Requires Improvement’ overall with effective, caring and responsive being rated as Good. At this inspection, improvements had not been made and there continued to be breaches of regulation. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

At our last inspection, there were not always sufficient staff to meet people’s needs and enable them to always attend activities when they wanted. At this inspection, there continued to be times when there were not enough staff and people were not able to go out when they wanted.

Potential risks to people who had recently moved to the service, had not been consistently assessed and detailed guidance was not available for staff to follow to mitigate the risks. Some people displayed behaviour that may challenge the service or could become very anxious. Staff told us that they felt that they did not always know how to support these people. People were at risk of not receiving consistent support when they needed it. People who had lived at the service for a long time had detailed risk assessments and plans for staff to follow and support them so they remained safe and these had been effective.

Staff had met with people before they moved into the service, a comprehensive assessment was completed. The assessment covered all aspects of people’s lives including their social, cultural and sexual orientation. This was used to develop a detailed support plan, however, recently this had not happened and people who had moved to the service did not have person centred care plans that gave details of their choices and preferences. People who had lived at the service for a long time, had person centred plans that they had agreed to. The service had not supported anyone at the end of their lives, the service did not include end of life wishes in people’s support plan.

Medicines were not always managed safely. Systems that were in place to identify when errors had been made had not been completed correctly and had not been effective in identifying shortfalls found at this inspection. Checks and audits had been completed on all aspects of the service including care plans. Shortfalls had been identified and an action plan put in place, but these had not been followed up and the shortfalls continued at the inspection.

The buildings had been adapted to meet people’s needs, however, the dining room had been out of use since February 2018, as the ceiling had fallen down. People told us that they were unable to eat their meals together. People and staff had to go outside to enter the other buildings as they were not able to go through the dining room. Checks were completed on the environment and equipment used by people to keep people safe.

There was a training programme in place, however recently, not all staff had completed all the training that was available. There was a stable core staff team who knew people well and had completed the training previously and could describe how they supported people. Staff had received supervision and told us they felt supported by the manager. Staff were recruited safely.

People were encouraged to plan their care and express their views. 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.

People were supported to make complaints about the service, these were investigated following the provider’s policy. People were involved in finding a resolution and the action taken to stop it happening again. Incidents were recorded and analysed to identify patterns and trends. This information was discussed in multi-disciplinary meetings and used to develop strategies and plans to mitigate the risk of them happening again.

People were supported to learn new skills such as cooking to increase their independence. People took part in activities and these were used to increase people’s independence and confidence. People were encouraged to maintain a healthy and balanced diet. People told us how they had lost weight and stopped smoking. People were treated with kindness and compassion; strong relationships had been formed between staff and people.

Staff worked with other healthcare professionals to enable people to have the support they needed to live their lives to the full. Staff knew how to recognise the signs of abuse and knew how to report any concerns they may have. They were confident that the manager would deal with the concerns appropriately. The manager had reported concerns to the local safeguarding authority and worked with them to resolve the concerns.

The manager had a vision for the service; for ‘The Chilterns to offer a range of psychological and skills based interventions to support service users to reach their full potential and maximise opportunities to live an independent life.’ There was an open and transparent culture within the service, people knew the manager and were comfortable in their company.

People and staff attended meetings and completed surveys to give their opinions on the service and improvements that could be made. The manager understood the need to continually improve the service and attend local forums to keep their knowledge up to date.

People were supported to keep their rooms clean and tidy. Communal areas were clean and odour free, staff used personal protective equipment when required to protect people from infection.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

At this inspection a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and three additional breaches were identified. You can see what action we have asked the provider to take at the end of the report.

The Chilterns is formed of three separate buildings on the seafront with gender specific accommodation of various types, including single rooms and single occupancy self-contained flats. The service is registered for a maximum of 26 people who live with mental health conditions and or a learning disability. Some people are in transition from a secure environment, some people are there on an informal basis and some people are restricted under the Mental Health Act. At the time of the inspection there were 19 people living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We last inspected this service in July 2016. We found shortfalls in the service. The provider had failed to ensure that timely care planning and risk assessing took place, staff had not received appropriate training and supervision necessary for them to carry out their role and the provider had failed to make sure people received person centred care that reflected their personal preferences.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made. There was, however, a new breach of regulation.

There were not sufficient staff consistently on duty, to keep people safe. People told us they were treated with dignity and respect.

Staff received training appropriate to their role. Staff had received supervision, however, some staff had not received supervision as often as the registered manager would like, there was a plan in place to address this. Staff were recruited safely and received an induction when they started working at the service.

Each person had a detailed support plan. Potential risks to people’s health and welfare had been assessed including behaviours that may challenge. There was guidance in place for staff to follow to be able to manage the risk, however, some wording required clarity. Support plans were reviewed regularly, people were involved in the review of their support. The support plan gave details of people’s preferences and choices about how they liked to be supported.

Communication between the registered manager and staff was not always effective. Staff did not have an understanding of how decisions about people’s support had been made. Changes to people’s support was decided by the multi-disciplinary team. When changes to people’s support had not been successful, staff had felt the registered manager had been responsible.

Staff had mixed views about whether they were supported by the registered manager. Some felt they could not approach the registered manager while others felt that there were able to talk to the registered manager at any time. The registered manager told us that without a deputy manager in post it was difficult to give staff the support they needed.

People received their medicines safely. Staff were trained to administer medicines and their competencies were assessed. Some people were prescribed ‘as and when’ medicines, there was guidance in place for when these medicines should be given. Some medicines had not been available due to problems with ordering them, staff were managing the situation.

Staff understood how to protect people from abuse and the action they needed to take to keep people safe. People told us that they felt safe living at the service. Staff were confident that the registered manager would take appropriate action when concerns were raised. Staff knew they could go to agencies outside the service if they felt concerns were not being dealt with.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made without capacity were only made in their best interests. Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using the service by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority.

People were informed about their healthcare and encouraged to actively involved. People were supported to have as much choice and control over how they lived as possible. Staff understood the legal restrictions that were in place for some people, staff supported people to be as independent as possible within these restrictions.

People were supported to maintain good mental and physical health, they had access to healthcare professionals when needed. The registered manager and staff had good working relationships with other health and social care professionals.

People were supported to maintain a healthy and balanced diet. Staff supported people to lose weight if that is what they wanted. People were supported to be as independent as possible with preparing and cooking their meals.

People were supported to take part in a variety of activities. Staff supported people to go out into the community. There was a range of activities available to help people develop their skills and independence, to promote their confidence.

People were encouraged to express their views about the service. The registered manager followed the provider’s complaints procedure and investigated all complaints received. The registered had raised complaints on behalf of people with outside agencies, when people had raised an issue.

People told us that they felt supported and listened to. There was warm, supportive relationships between staff and people. Staff felt they worked well as a team and the service had a person centred approach to supporting people living at the service.

There were regular staff and house meetings for staff and people to give their views about the service. Each meeting started with updates on the issues raised at the previous meeting and what had been done. Surveys had been sent to people and staff. The response from staff had been compiled by the provider, but the results had not been broken down into services, so the registered manager had not been able to address any issues.

The registered manager and provider had completed regular audits and checks on the quality of the service being provided such as fire safety, medicines and infection control. Environmental risk assessments had been completed to identify and manage risks. When shortfalls had been identified action plans were completed. Emergency plans were in place for staff to follow in case of an emergency such as fire or flood.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the reception.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.

The Chilterns is formed of three separate buildings on the seafront with gender-specific accommodation of various types, from shared to single occupancy in self-contained flats. The service is registered for a maximum of 26 people who live with mental health conditions and /or a learning disability. Some people are in transition from a secure environment, some people are there on an informal basis and some people are under Mental Health Act sections or Community Treatment Orders. At the time of the inspection there were 19 people living at the service.

The service is run by a registered manager who was present 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 and associated Regulations about how the service is run. The registered manager was supported by a registered mental health nurse and team leaders. The service had been in the day to day control of an acting manager for the previous six months while the registered manager took on an area manager role; however, they were not present at the time of the inspection.

There had been a plan in place to ensure staff were up to date with their training, however, the acting manager had not followed this and staff had not completed refresher training when it was due.

People’s records were reviewed every six months and some had been updated as changes had happened, however this had not been consistently done. People’s confidentiality was respected; conversations about people’s support were held privately and care records were stored securely. The provider told us people’s personal information may not have been safeguarded and this was being investigated.

When people were transitioning into the service this was done in a structured way. However, there were no transitional support plans or risk management plans in place for people who were at the service for a short stay.

Staff understood how to protect people from the risk of abuse and the action they needed to take to keep people safe. Risk assessments gave staff guidance, which was followed in practice, to reduce the risks to people.

People told us they felt safe living at The Chilterns. Staff were confident to whistle blow to the registered manager and were confident that the appropriate action would be taken. Staff said they would not hesitate to contact other organisations outside the service if they needed to.

The provider had a recruitment and selection policy which was followed to make sure staff were of good character and safe to work with people.

People received their medicines safely and told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Improvements were needed relating to the storage and administration of some medicines.

People were supported by sufficient numbers of staff who knew them very well. All qualified professionals were receiving clinical supervision by a clinical supervisor independent to the service. Staff completed an induction when they started working at the service. Staff were encouraged and supported to complete adult social care vocational qualification for their personal development.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including how they spent their time. Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported especially relating to healthcare treatment. They put these into practice effectively, and ensured that people’s human and legal rights were protected.

People were supported to maintain a healthy and balanced diet. Staff supported people in a ‘healthy eating group’. This focused on projects related to healthy eating and environmental projects related to food.

People were supported to maintain good mental and physical health and had access to health care professionals when needed. Staff had strong working relationships with health professionals, such as, GPs, psychiatrists and the local mental health team.

People said the staff were caring and they were able to approach staff to talk about their feelings or concerns. People were involved with the planning of their care. Staff were familiar with people’s life stories and were knowledgeable about people’s likes, dislikes and preferences.

People told us staff understood the support they needed and staff were responsive to their needs. People said that they received the support they needed when they wanted it and they trusted the staff.

People told us they were encouraged to be as independent as possible and supported to learn new skills. People were able to identify their own areas of strength and development and were supported by staff to improve their independent living skills in areas, such as cooking and gardening.

People and staff told us the service was well-led. Staff said they felt supported, that the registered manager was approachable and that they worked closely as a team. There was a positive, person centred and open culture at the service. Staff and people had developed strong links with the local community.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Regular quality checks were completed on key things, such as, fire safety equipment, medicines and infection control. Environmental audits were carried out to identify and manage risks. Reports following the audits detailed any actions needed, prioritised timelines for any work to be completed and who was responsible for taking action. However, shortfalls identified during the inspection, such as inconsistent record keeping, care planning and risk management had not been highlighted during the audits arranged by the provider. Emergency plans were in place so if an emergency happened, like a fire or a flood, the staff and people knew what to do.

People said that they felt listened to, their views were taken seriously and any issues were dealt with quickly. People told us they did not have any complaints about the service or the support they received from the staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.