Menwinnion Country House

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

The service has had a history of non-compliance in regulatory requirements since 2016. We last inspected the service in December 2020. At that time, we had concerns regarding the management and oversight of the service. The well led domain was judged inadequate. The service was judged requires improvement in the management of medicines, assessing people’s capacity, staff training and managing behaviours which may challenge. The service was rated overall requires improvement.

At this inspection we found the provider had taken action to improve all these areas.

Since the inspection in December 2020 the service had a registered manager in post. The provider had reviewed how the service was managed and increased senior roles. This included creating additional roles. For example, deputy manager and leadership roles. This had enabled the management team to focus on developing the service and meeting legal requirements. The operation of the service was overseen by the nominated individual who was responsible for supervising the management of the regulated activity.

The way people’s medicines were managed had improved. Systems and oversight had been developed in order to ensure medicines were managed safely. We made a recommendation at this inspection for further information to be included in records were medicines were required as needed. This would support staff to understand why the medicines were being administered.

At the last inspection we found staff had not received training to support their knowledge and skills in managing behaviours which might challenge, understanding consent and how to safeguard people. At this inspection we found training had been reviewed and a system was now in place which showed all staff received the relevant training. This had helped to develop staff skills and knowledge to support people safely and recognise triggers which might affect people’s behaviour. Our observations on inspection confirmed this.

At the last inspection people’s capacity assessments had not been appropriately assessed under the principles of the Mental Capacity Act 2005 (MCA). At this inspection managers and staff had received training in the MCA and understood how to respond to issues around capacity and consent. At this inspection we found people were supported to have maximum 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.

Previously we found care plans were not written in a way which supported staff to recognise some people’s level of need and risks. They were not person centred. At this inspection we found the registered manager had reviewed all care plans. They were person centred and included information to support staff to recognise and respond to individual needs and risks.

People were supported to eat balanced diet and drink enough to keep hydrated.

Staff had an induction when they started their jobs; and they were supported through regular training and supervision to deliver their roles effectively.

People told us staff were kind and compassionate to them. People were treated with respect and dignity. People received care and support that met their individual needs. People’s end-of-life wishes were documented in their care plans and followed. People were engaged in activities to occupy them.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities.

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 26 May 2021) and there was a breach of regulation. We issued conditions of registration which included a requirement for the provider to complete a monthly action plan. The provider met that condition which showed action was being taken to meet the regulatory requirements.

Why we inspected

This was a planned inspection based on the previous rating.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Menwinnion Country House is a residential care home providing personal care to 36 people aged 65 and over at the time of the inspection. The service can support up to 40 people in one adapted building.

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

Staff had not been provided with appropriate guidance and training on how to support people whose behaviour could be challenging. Information about possible triggers had been identified by some staff but not included in people’s care plans. Some staff were fearful of supporting one person and had begun to use inappropriate language to describe the person. This exposed the person to an increased risk of harm.

Staff did not understand local safeguarding procedures and had not received training updates in this topic. Medicines were not safely managed. People had not always received their medicines as prescribed and the service did not have appropriate systems in place detailing when ‘as required’ medicines should be used.

People’s capacity had not always been appropriately assessed following the principles of the Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions had been assessed once but these assessments had not been update or reviewed when their needs changed.

People were highly complimentary of the service’s food menus and staff had a good understanding of people’s nutritional needs and preferences.

The provider had not taken action to make improvements and address the issues identified at our last inspection in relation to the management of medicines, behaviour that challenges other people and systems for assessing people’s capacity to make decisions and choices. Issues previously identified in relation to recruitment practices had been resolved and all necessary pre employment checks had been completed.

There was a lack of stable leadership at the service as there had been three changes of manager since our last inspection. The new acting manager had been appointed six weeks prior to the inspection as a deputy manager. They had subsequently agreed to take on the role of acting manager following the previous manager resignation.

The provider’s quality assurance processes had identified that the service was not providing good quality care but had failed to drive improvements in the service’s overall performance.

People felt well cared for and were complimentary of the staff team and the quality of support they received. Feedback from relatives was also positive and comments received included, “I feel safe and comfortable. If I need anything they do their very best, nothing is too much trouble” and “Home is first class. Treatment is wonderful”.

Rating at last inspection

The last rating for this service was requires improvement (published 23 October 2019). At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 02 September 2019 breaches of legal requirements were found.

We undertook this focused inspection to check that improvements had been made and to confirm they now met legal requirements. This inspection was focused on the key questions of Safe, Effective and Well-led only.

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 remained requires improvement.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to how risks to people are managed, people’s mental capacity, staff training and skills, and governance.

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.

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

Menwinnion Country House is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 40 people in one adapted building.

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

People did not always receive their medicines in a safe way and medicines management systems could have put people at risk. Staff did not always have the correct guidance or skills to support people with complex or challenging needs. People’s records did not all contain up to date information about risks to them, or how to help reduce them. Staff had not always been recruited safely.

People’s capacity had not always been assessed following the principles of the Mental Capacity Act 2005 (MCA). People were not supported to have maximum choice and control of their lives and staff did not always 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. The manager did not have an understanding of the accessible information standard. We have made a recommendation about this.

There was not a person-centred culture throughout the service. Records did not show that people were regularly offered a shower or bath. People did not always receive prompt or appropriate responses to their requests.

People’s care plans did not consistently reflect people’s holistic needs. Changes to people’s needs were not updated promptly in their records. People did not have meaningful end of life care plans in place that detailed their preferences for their care at this time.

Not all people received the support they needed to stay cognitively and physically active. There was a programme of activities available; but there was no evidence to show people with more complex needs, who would not benefit from these, had been consulted about how staff could tailor support to their individual needs.

The provider had not ensured the quality of the service was monitored effectively. Concerns found during the inspection had not all been identified through the provider’s governance processes.

People felt cared for and valued the relationships they had developed with staff. Relatives told us staff were professional, welcoming and kind. People’s care plans described how staff could help people develop or maintain their independence. People and relatives told us staff respected people’s privacy and dignity.

No people, staff or relatives raised concerns about ill treatment of people or staff. People and relatives told us they would feel confident raising concerns or a complaint. Staff understood how to report safeguarding concerns. Staff told us they felt supported and received sufficient training. People and relatives gave positive feedback about the staff team.

Rating at last inspection

The last rating for this service was Good (published 23 June 2017). The rating for ‘well led’ was required improvement as there was no registered manager in post.

At this inspection a manager was in the process of registering with the commission.

Why we inspected

The inspection was prompted in part due to concerns received about a culture of bullying at the service and that people and staff were threatened by the senior management. We also received concerns about the environment, medicines management, recruitment and a lack of person-centred care. A decision was made for us to inspect and examine those risks.

People and staff did not raise any concerns about the culture of the service. We have found evidence that the provider needs to make improvements in other areas. Please see the safe, effective, responsive 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 full report.

Enforcement

We have identified breaches in relation to how risks to people are managed, staff recruitment, people’s mental capacity, person centred care and governance.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

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

A previous comprehensive inspection of this service was completed in January 2016. That inspection found that although the service was providing good ‘care’ it required improvement in four of our five key question areas. A number of breaches of the regulation were identified.

In July 2016 a focused inspection was completed to check the required improvements had been made. The focused inspection found significant improvements had been made in most areas but further improvements were required as the service remained in breach of the regulations in relation to the training and induction of staff.

Menwinnion Country House is a large detached building located within its own gardens in the far west of Cornwall. It is registered to provide accommodation and personal care for up to 40 people who do not require nursing care. On the day of this inspection 35 people were using the service. Some people were living with dementia.

The service is required of have a manager who is registered with the Care Quality Commission. Registered managers like registered providers have responsibilities for ensuring the service meets the requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was no registered manager in place at the time of this inspection. This means that it is not possible to the service to achieve a ‘good’ rating in relation to our question is the service well led.

The service was being provided with effective leadership by the acting manager with support from the provider’s nominated individual and training lead. Staff were well motivated and told us they were confident the acting manager would take action to address and resolve any issues they reported. Staff comments included, “You can go to them with anything and they are as good as gold”, “The manager is very approachable. If I have a query I just ask them” and “The manager is doing really well, I can’t fault her.” While people and their relatives also reported they had confidence that action would be taken to address any issue they reported.

People were constantly complimentary of the care and support they received at Menwinnion Country House. They told us, “I would recommend it” and “It’s very good, the Queen couldn’t be treated better than we are.” People were relaxed and comfortable in their home and we observed numerous examples of people laughing and joking with care staff and managers. One person joked, “The staff are awful” before smiling and stating, “I think they do a really good job.”

Relative also praised staff for the compassion with which they provided support and one person’s relative said, “Their attitude is the main thing. Good staff with the right attitude.” Visiting health care professionals told us, “The staff are very good, very attentive” and “I can honestly say they are one of the better residential homes.”

Staff knew people well and understood there individual care needs. People’s care plans were sufficiently detailed and informative and staff told us, “There is enough information in them”. We observed staff supporting one person to manager their anxiety, effectively using techniques described within their care plan. Prior to the inspection managers had identified that daily care and activities records could be improved and had provided staff with additional guidance on record keeping.

There were sufficient numbers of suitably qualified staff on duty on the day of our inspection and rotas showed these staffing levels were routinely achieved. The service had two part time care staff vacancies at the time of our inspection and was in the process of advertising them. Recruitment processes were robust and designed to ensure new staff were suitable for employment in the care sector.

The service employed a part time activities coordinator and people told us there were enough activities available within the service. People’s comments included, “There is enough to do if you want to do it” and “I’ve just had my nails done.” Relatives told us, “They have all sorts of events, sports day, Wimbledon days, They try to bring fun into the place.” During the afternoon of our inspection people enjoyed a tea dance in the service’s dining room. One person said, “I can’t dance …… but I do enjoy it.”

All new staff completed induction training, spent time getting to know people and shadowed experienced care staff before being permitted to provide care independently. Staff told us they received regular training updates and notices in the service staff areas showed a number of training courses had been arranged in March and April. Staff comments included, “I have quite a few courses coming up”, “They are always repeating training” and “We get quite a bit of training.”

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Staff respected people’s choices and acted to ensure their privacy and dignity was protected. One person’s relative told us, “I love the fact that they knock before they come in, That’s your space and they respect that.”

People and their relatives understood how to make complaints but told us this had not been necessary as any minor issues they raised were promptly dealt with, One person’s relative who had raised a minor issue told us, “They take their responsibilities very very seriously. If you raise a concern you do not feel you are persona non grata.”

There were effective quality assurance systems in place and appropriate action had been taken to address and resolve issued identified during previous inspections. People feedback was valued and the results of the service most recent quality assurance survey had been consistently positive and complimentary.

This report only covers our findings in relation to those requirements identified during our previous comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Menwinnion Country House on our website at www.cqc.org.uk.

Menwinnion Country House is registered to provide care and support to up to 40 people. The service does not provide nursing care. On the day of our inspection there were 39 people, some of whom were living with a diagnosis of dementia, living in the service. The service is a detached rural house within its own gardens where accommodation is provided on two floors. The building was appropriately decorated and well maintained.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At this inspection we again found that the service did not have a registered manager. Since our previous one of the service’s managers had left and the deputy manager had been promoted to the role of care manager. The care manager was now responsible for the day to day management of the service and was now based full time in the service’s office. The provider recognised current management arrangements were insufficient and was actively recruiting for additional managerial roles. The providers nominated individual was based in the service on an almost full time basis and the training lead had also visited the service each week to assist with the process of reviewing and updating people’s care plans. The care manager told us, “The director’s ring and visit regularly and I know I can ask for support” and “I can’t ask for any more support.”

Staff told us that the service was now more organised and we saw all staff had received formal supervision since our last inspection. Staff comments included, “[The manager] is brilliant, she is really organised and does not stress. She sorts things out” and “[The manager] is good at what she is doing, everything is running along smoothly.”

At our inspection in January 2016 we found staff training had not been regularly updated, that staff had not received regular supervision and new staff had not completed formal induction training. During this inspection we found that all staff had now received formal supervision. However, we again identified that the service had failed to ensure that staff training was appropriately updated. Our analysis of the training matrix found that some staff had not yet received appropriate training updates. A number of staff who, the provider, had identified as in need or training in specific topics in 2014 had not yet completed this training. In addition induction training for new staff was not provided in accordance with current best practice. Training complete during previous employment had been accepted, without any assessment of current skills, as evidence of the competence of new members of staff.

In January 2016 we found that risks were not effectively managed. First floor windows were unrestricted and individual risk assessments were inaccurate. At this inspection we found that window restrictors had now been installed on all first floor windows and in some ground floor rooms where specific risks had been identified. Risks assessments within people’s care plans had been reviewed and updated since our pervious inspection. Accidents and incidents had been appropriately investigated by the care manager and the service’s emergency procedures had worked effectively during a recent minor fire. This incident had been fully investigated and additional safety checks had been introduced as a result of learning identified during the investigation process. This meant people were now adequately protected from risks within the service.

Previously we found that the service was in breach of the requirements of the Mental Capacity Act as assessments of people’s capacity to make decision had not been completed and necessary applications under the Deprivation of Liberty Safeguards had not been completed. At this inspection we found the care manager had now completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Systems for assessing people’s capacity to make decision were now available and with support from professionals the care manager had made appropriate applications for people’s potentially restrictive care plans to be authorised by the local authority.

In January 2016 we found that people’s care plans did not accurately reflect their current care needs. Some care plans were of a generic nature and information about people’s likes, hobbies and interests was limited. At this inspection we found everyone’s care plans had been updated since our previous inspection. Each person’s care plan was now sufficiently detailed to enable staff to meet their individual needs. Staff told us, “They [care plans] are more up to date” and “They are all better than they were.” In addition, we found that all of the care plans we reviewed now included information about people’s life history and interest. The care manager told us “we are having fun with that” and staff said they had enjoyed gathering this information and gaining to know people better.

Recruitment practices were safe and three additional staff had been recruited since our January inspection. People told us, “The staff are very good, very kind and caring” and a relative said, “It is flooded with staff and they would all like to take [My relative] home.” Staff told us people were safe and that staffing levels had increased since our previous inspection. During this inspection we saw staff were able to spend time chatting with people and responded immediately to people’s requests for support.

The service employed an activities coordinator and people us, “[The activities coordinator] tries very hard, we made flags and things last week” and “We get so many different people in to do things with us I don’t know where they all come from.” During our inspection people enjoyed a variety of activities. The service had hosted a Summer Fair and Garden Party since our previous inspection.

In relation to the training and induction of staff we identified a continuing breach of The Health and Social care Act 2008 (Regulated Activity) Regulations 2014. You can see what action we told the provider to take to address these breaches at the back of the full version of the report.

The service is a detached rural building in its own gardens in the west of Cornwall. Accommodation is available on two floors and the building was clean, appropriately decorated and well maintained.

The service did not have a registered manager. The registered manager had accepted a new role as the provider’s training lead before our inspection. One of the service's existing deputy managers had been promoted to lead the home and had applied to the commission for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they felt safe and well cared for at Menwinnion Country House. People said; “I think we get incredibly well looked after”, “They really do look after us” and, “I feel safe here.” People’s relatives said, “The staff are charming and very attentive” while Health and Social care professionals who visited the service regularly said; “I do think people are safe here” and, “I don’t have any concerns at all.”

Risks were not effectively managed at Menwinion Country House. Specific risks in relation to unrestricted windows on the first floor had not been appropriately assessed. We raised concerns about people’s safety because of the absence of restriction of window openings, with both the provider’s nominated individual and the service’s management team during the inspection process. Shortly after the inspection we received a notification informing the commission of injuries one person had sustained falling from their ground floor bedroom window. This showed the service had failed to promptly address safety concerns raised during the inspection process.

In addition we found that risk assessment documentation had not been accurately completed and that accidents and incidents that had occurred within the service had not been consistently recorded. Where incidents were recorded they had not been appropriately investigated by managers to identify any trends or areas of increased risk within the service.

Recruitment practices at Menwinnion country house were safe and there were sufficient numbers of staff available to meet people care and support needs. However, staff had not received appropriate training or regular supervision from their managers. Staff told us the training they had received was, “Very hands on.” In the five staff training records we examined only two staff had received safeguarding and first aid training while only three staff had received manual handling training. Staff had not received regular supervision in accordance with the provider’s policies during their induction and none of the recently employed staff had completed the Care Certificate training.

Managers and staff did not fully understand the requirements of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. Managers had correctly identified that one person’s care plan was restrictive and had granted themselves an appropriate urgent authorisation. However, the service’s managers had then failed to make the necessary application to the local authority.

The kitchen at Menwinnion Country House had received a five star food hygiene rating and people told us, “The food is excellent we have a good dinner every day.” We observed that people were offered drinks and snacks throughout the day and that people were offered choices at all meal times.

People told us their care staff were, “Absolutely marvellous” and “The young girls are fun and the older ones are kind and lovely. The boys are wonderful.” Throughout our inspection we observed that staff responded promptly to peoples' requests for support. A number of people chose to spend time near the service office laughing and joking with staff, the provider’s nominated individual and managers. People told us their care staff respected their decisions and choices. One person said, “I am in charge, they do what I want them to do.”

Where staff identified concerns about individuals well-being they took prompt appropriate action to ensure the person’s care needs were met. People regularly received visits from external health and social care professionals and staff routinely sought guidance from professionals to ensure people’s needs were met.

People’s care plans did not accurately reflect their current care needs. One person did not have a detailed care plan while another person’s had not been updated to reflect significant changes in the person’s specific needs. None of the care plans we examined included information about the person’s life history, background or interests. This meant staff were unaware of how people’s background could affect their current care needs.

Before our inspection the service’s activities coordinator had been covering for a staff vacancy in the laundry team. This had led to a decline in the amount of activities provided by the staff team. However, this vacancy had recently been filled and this had enabled the activities coordinator to support more activities within the home. On the first day of or inspection some people enjoyed a trip to a local tourist attraction while on the second day of our inspection an externally provided exercise class was held in one of the lounges. People told us, “They have entertainers who come in regularly” and, “I enjoy the scrabble on Monday afternoons.”

At the time of our inspection there was no registered manager at Menwinnion Country House. The previous registered manager had recently taken on a new role for the provider and one of the service’s existing deputy managers had applied to become registered. However, the service's current management team had not received appropriate support since the registered manager’s departure. Managers were unaware of their responsibilities in relation to the supervision of new members of staff and had failed to make necessary deprivation of liberty applications as support requested form the provider’s nominated individual had not been received. In addition, the provider’s quality assurance processes were ineffective and had failed to identify the significant areas of concern identified in this report.

We identified breaches of The Health and Social care Act 2008 (Regulated Activity) Regulations 2014. You can see what action we told the provider to take to address these breaches at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service effective?

On the day of our inspection Menwinnion Country House was effective. All of the people we spoke were happy with the quality of care they received. People's comments included 'Brilliant, you would not get as good treatment in a first class hotel' and 'everything is good here'.

We reviewed the care documentation of three people who used the service and found these documents had been appropriately reviewed to ensure they reflected the individuals care needs. Staff training needs had been identified and appropriate update training provided.

Is the service caring?

The service was caring on the day of our inspection. We saw that people were supported by staff in a quiet, caring and courteous manner. People who used the service told us 'Brilliant, you would not get as good treatment in a first class hotel' and 'the staff are fabulous, very helpful. I can't fault them'. A relative who was visiting during our inspection told us told us 'X is in good hands'.

Care staff had received appropriate supervision and the nominated individual explained that additional management staff were being recruited to provide existing staff and management with additional support.

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service, relatives, staff and management of Menwinnion Country House.

Is the service safe? We found that Menwinnion Country House had good systems in place to ensure people were protected against the risk of abuse. Staff were aware of the signs and symptoms of abuse and how to report any allegations.

Is the service effective? All of the people we spoke and interacted with who received care from Menwinnion Country House were happy with the quality of care they received. People told us 'the staff are brilliant. I am very happy here'.

The care plans did not fully document changes in a person's condition in a timely manner. Therefore they did not reflect the current needs of people.

Is the service caring? People told us they were well cared for by staff. Their comments included 'they are all lovely here'. We heard staff talk with the people who lived at Menwinnion Country House in a kind, relaxed and caring manner.

We found staff morale was high and staff members told us 'I love the job and enjoy working with the people here' and 'It has a family atmosphere'.

We found people's likes and preferences in relation to their care had been recorded during the assessment process and we found that staff had complied with people's wishes while providing care.

Is the service responsive? The service was responsive, we found people were aware of the complaints procedure but had not raised a complaint as they were happy with service they received. People told us 'I've never needed to make a complaint. They are very good'.

The provider's complaints policy also included procedures for resolving and recording minor issues raised by people who used the service. We saw these issues had been effectively investigated and resolved.

Is the service well led? The service had appropriate quality assurance systems in place. We saw that audits of the environment and experiences of people who lived at the home had been completed.

Staff told us they felt supported by the mangement team. One person said the home was "Well run".

Each person had a care plan in place which stated their individual needs. People had access to a range of services including hairdresser, chiropodist and GP'S. People who lived at Menwinnion Country House were very complimentary of the staff and told us they were 'brilliant' and the care 'could not be better'.

The provider had a system in place to ensure training was completed relating to safeguarding people from abuse and protecting their rights. The majority of the staff we spoke with understood the role of the local authority and how to make a safeguarding alert. All of the staff were confident that if they raised any concerns to the manager these would be acted upon.

Staff were supported to provide care to the people who lived at Menwinnion Country House. The views and opinions of the people who lived at the home and/or their representatives were gained to ensure the home was providing a good quality service. Systems were in place to audit the home on a daily basis.

People said the home was clean and tidy and that the staff were kind, caring and helpful. One person told us 'The food is second to none here, they get you anything you want' and another person commented 'It is just like a hotel, I am looked after really well here'.

One visitor told us their relative viewed Menwinnion as their home and said 'when we arrive the staff always ask if we want a cup of tea. It is just like visiting X in their own home as they first thing they always did was put the kettle on when we visited'.

People told us they felt safe at Menwinnion and could approach the staff with any concerns or problems they had.

We found people were safeguarded from abuse from the systems and arrangements the registered provider had in place. For example, the recruitment procedures and the training and supervision of staff.