Kingsclear

People’s experience of using this service:

Potential risks to people had been assessed and measures put in place to mitigate any risks identified. For example, pressure-relieving equipment and repositioning regimes reduced the risk of people developing pressure ulcers. People were supported to eat and drink safely. People at risk of failing to maintain adequate nutrition were weighed regularly. The home was clean and hygienic and people were protected from the risk of infection. Medicines were managed safely.

Systems used to follow up accidents and incidents had improved, which helped managers identify any emerging themes and actions that could be taken to minimise risk. Staff were recruited safely and understood their role in safeguarding people from abuse. Any incidents involving unsafe care had been referred to the local authority and notified to CQC. The provider had investigated incidents and contributed to safeguarding enquiries when requested to do so.

People’s care was designed and planned to meet their individual needs. Relatives had opportunities to be involved in planning and reviewing their family members’ care. People had access to a range of activities and events. Staff encouraged people to engage with others to ensure they did not become socially isolated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood people’s individual communication needs and these were recorded in people’s care plans.

Input from the provider’s senior leadership team had improved the culture within the home and the support provided to staff and the home’s management team. Systems and processes used to monitor quality and safety had improved. Staff and managers had developed effective working relationships with other professionals involved in people’s care.

Whilst improvements had been made to address the concerns identified at the last inspection, these needed to be embedded and sustained over time to ensure people’s experience of care remained consistently good.

People had opportunities to give their views about the home and these were listened to. Relatives told us staff kept them up to date about their family members’ welfare and wellbeing. People knew how to complain and told us they would feel comfortable doing so if necessary. Any complaints received had been managed in line with the provider’s complaints procedure.

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 August 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 28 April 2022. Breaches of legal requirements 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 and good governance.

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, Responsive and Well-led which contain those requirements. The inspection was also prompted partly due to concerns we had received about some aspects of the management of the home.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Kingsclear 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.

Follow up:

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

Kingsclear is a registered care home providing personal and nursing care to up to 97 people. The service provides support to older people and ‘Windsor’ first floor provides care and support to people who are living with dementia. The accommodation is purpose built and arranged over three floors. At the time of our inspection there were 47 people using the service.

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

Risks in relation to the monitoring of people’s weight, broken equipment and health and safety had not been identified in order to keep people safe. Although communal areas and people’s rooms were clean we found other areas such as sluice rooms, storage and housekeeping room were dirty and cluttered. Medicines were not always monitored safely.

Quality assurance systems were not always effective in identifying shortfalls which meant areas of improvement were not always acted upon. Relatives and staff told us that although the management team were approachable, they did not always respond promptly to requests. They felt communication and organisation needed to be improved. The registered manager was in the process of implementing systems to ensure complaints were consistently acknowledged and people were aware of the outcomes.

In other areas we found improvements had been made to the way in which risks were managed. Systems to monitor people’s well-being, food and fluids and catheter care had been embedded into practice. People were protected from the risk of abuse as staff were aware of their responsibilities in reporting concerns. The management team ensured potential safeguarding issues were reported to the local authority in line with requirements. Accidents and incidents were reviewed and monitored to identify trends and action was taken to minimise the risk of them happening again. There were sufficient staff available to support people and a range of activities were planned which people enjoyed.

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. People told us staff treated them with kindness and respected their dignity and privacy. Staff knew people well and used this knowledge to support them in a personalised way. People told us they enjoyed the food and always had a choice. Where people had specific nutritional needs, these were known to staff and catered for.

People’s had access to a range of health care professionals and guidance provided was acted upon. The service had worked closely with a range of professionals to make improvements in the care people received such as the local authority safeguarding team, dieticians and pharmacy support.

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 29 December 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified continuing breaches in relation to risks to people’s safety, safe medicines practices, infection control and good governance at this inspection. We issued a warning notice in relation to the governance of the service.

Follow up

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

Kingsclear is a care home with nursing and accommodates up to 97 people in a new adapted building. The first floor provides care and support to people who are living with dementia. At the time of our inspection there were 54 people living at Kingsclear.

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

There was a lack of managerial oversight of the service. The provider’s quality assurance systems had failed to identify concerns found during the inspection. Safeguarding concerns had not always been identified and reported to the local authority and CQC in line with requirements. Risks to people’s safety and well-being such as fluid monitoring, mouth care and catheter care were not always effectively assessed and monitored. Records in relation to people’s care lacked detail. Information shared in handover between staff was not recorded in order to ensure any concerns could be tracked. Medicines administration records in one area of the service were disorganised and contained gaps in recording. Other aspects of medicines administration were managed well.

There was a lack of social interaction with some people who spent time in their rooms. We have made a recommendation regarding staff deployment in relation to this.

People and their relatives were involved in the care planning process. Care plans were detailed and contained personalised information for staff to refer to. Robust infection prevention and control measures were followed by staff. Staff told us they felt supported and valued by the management team. Safe recruitment processes were in place to ensure staff were suitable for their roles.

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 25 Oct 2019). Breaches of regulations were identified in relation to person centred care, safe care and treatment, staffing and the governance of the service. We completed a further targeted inspection on 17 September 2020 (published 3 November 2020). A continued breach of regulation regarding personalised care was identified. Improvements were found in all other areas. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. The provider completed an action plan following both of these inspections to show what they would do and by when to improve. At this inspection we found previous improvements had not been sustained and the provider was in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding processes and risks to people’s safety and welfare. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

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 risks to people’s safety and well-being, medicines recording and safeguarding processes. We identified a lack of management oversight in identifying these concerns.

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 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 with the 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.

Kingsclear is a care home with nursing and accommodates up to 97 people in a new adapted building. The first floor provides care and support to people who are living with dementia. At the time of our inspection there were 50 people living at Kingsclear.

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

We found the atmosphere and culture within the service had improved. However, further work was required to ensure the care people received was person-centred. Staff were not always aware of people’s life histories, hobbies and interests and care plans were not always completed in a personalised manner. People had not been supported to record how they wished to be cared for at the end of their life. Records of people’s needs were not always comprehensive and up to date. The registered manager was working closely with the staff team and provider to address these concerns.

Staff spent time with people and took opportunities to engage with people when appropriate. Risks to people’s safety and well-being were known to staff and systems implemented to mitigate these risks. People were supported by a consistent staff team which meant they were able to develop trusting relationships. Staffing levels and deployment had been reviewed and agency staff were now rarely used. This meant people did not have to wait for their care.

The changes implemented by the management team had had a positive impact on both the care people received and the morale of the staff team. Communication systems had improved and people and staff were able to contribute to the running of the service.

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

Rating at last inspection

The last rating for this service was requires improvement (25 October 2019). Four breaches of regulations were identified. 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 improvements had been made in the majority of areas. The provider was still in breach of one regulation.

Why we inspected

We undertook this targeted inspection to check if the provider had met the requirements of the breaches of regulations identified at our last inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we did not assess all areas of a key question.

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 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 monitor the service.

We have identified a breach in relation to the need for increased personalisation of people’s care. Please see the action we have told the provider to take at the end of this report.

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.

Kingsclear is a care home with nursing and accommodates up to 97 people in a new adapted building. The first floor provides care and support to people who are living with dementia, this area is called Windsor. At the time of our inspection there were 31 people living at Kingsclear.

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

At our inspections of Kingsclear in March and May 2018 we identified a number of breaches of regulations and two warning notices were issued in respect of Safe care and treatment and Good governance. At our inspection in August 2018 we found improvements had been made in all areas of the service and no breaches of regulations were identified. The service was rated as Requires Improvement overall as we wanted to ensure systems were fully embedded into practice over time. At this inspection we found the provider had failed to ensure that improvements were sustained in all areas of people’s care.

People, relatives and staff told us they did not feel sufficient staff were deployed in order to meet people’s needs consistently. Risks to people’s safety were not consistently managed and known to staff. Accidents and incidents were not always clearly recorded in order to ensure that appropriate referrals to the local authority safeguarding team had been made. We have made a recommendation regarding this. People’s needs and life histories were not always available for staff to refer to and staff told us they did not always get the opportunity to learn about people’s lives.

A new manager was in post and felt they had the support they required from the provider to ensure the action plan to address the above concerns was implemented. The provider informed us staff had been recruited and were awaiting recruitment checks to be finalised prior to their employment starting. Staff told us they felt supported by the new manager and additional resources had been made available to ensure staff received a smooth induction and their competence was monitored.

People lived in a well-maintained environment. Medicines were managed well and people received them in line with their prescriptions. People had access to healthcare professionals as required. 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.

Staff were caring in their approach to people and ensured people’s dignity was respected. There was a range of activities available and people told us they felt this area of the service was continuing to improve. Further improvements in this area were planned to ensure people living with dementia consistently received meaningful activities. Complaints were responded to and people told us they felt comfortable in sharing any concerns.

Previous Inspection

The last rating for this service was Requires Improvement (Report published 19 October 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of risks to people’s safety and well-being, staffing levels, person-centred care and the management oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

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

Kingsclear 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. Kingsclear provides facilities and services for up to 97 people who require personal or nursing care. The service is purpose-built and provides accommodation and facilities over three floors. An area on the first floor provides care and support to people who are living with dementia, this area is called Windsor. Since our last inspection there has been a reduction in the number of people living at Kingsclear. On the day of the inspection there were 15 people living at the service.

At our inspection on 7 March 2018 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following receiving concerns relating to people’s care people were receiving we completed a further focussed inspection of Kingsclear on 1 May 2018 looking at the areas of Safe and Well-Led. During this inspection five breaches of legal requirements were identified. Concerns identified during these inspections related to a lack of managerial oversight, risks to people’s safety not always being identified and acted upon, staff not being appropriately deployed and accidents and incidents not being adequately monitored. We found that people’s legal rights were not always protected as the principles of the Mental Capacity Act 2005 not being followed, training for nursing staff not being comprehensively updated, care not always being provided in a person centred manner and safeguarding concerns not always being reported to the local authority or to CQC.

Following our inspection on 1 May 2018 we issued warning notices in relation to safe care and treatment and good governance. As a result of our concerns Kingsclear was placed into Special Measures. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection we found improvements had been made in all areas of the service. However, continued work was required to ensure that Kingsclear was meeting all regulations. During our inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation.

Since our last inspection a new registered manager had been appointed who had registered with CQC. 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 registered manager had started their employment at Kingsclear seven weeks prior to our inspection.

During our inspection we found inconsistencies in the way the principles of the Mental Capacity Act 2005 were applied. Following the inspection, the registered manager forwarded evidence that these concerns had been fully addressed. We have made a recommendation that systems used to assess people’s capacity and ensure best interest decisions are recorded and embedded into practice.

There were sufficient staff who were appropriately deployed to meet people’s needs safely. People’s needs were responded to in a timely manner and staff had time to spend with people. Staff had received the training they required to meet people’s needs. Staff were provided with an induction, regular training and supervision to ensure they had the skills they required for their role. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. People lived in a safe and well-maintained environment. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

Safe medicines practices were followed and people received their medicines in accordance with their prescriptions. Medicines were safely stored securely; sufficient stocks were available and appropriate guidance was followed by staff. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required. Healthcare professionals confirmed that improvements in the management of people’s healthcare had been made.

People were supported by staff who knew their needs well and provided personalised care. However, records relating to people’s care needs were not consistently updated to ensure staff had the guidance they required when providing people’s care. We have made a recommendation in relation to this. People and their relatives told us that staff were caring and treated them with kindness. Staff supported people to maintain their independence and respected people’s privacy and dignity. People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met. People’s weight was monitored and appropriate action taken where significant changes were identified.

There was a range of activities available for people to take part in and people received the support they required to be involved. In addition to planned activities, staff spent time with people individually. Resident meetings were held regularly and people and their relatives were able to make suggestions regarding the running of the service and the food and activities provided.

The provider had a complaints policy and the registered manager maintained a complaints log which showed that concerns had been addressed and responses given. Quality assurance processes were in place and regular audits of the quality of the service completed. The registered manager had taken action to rectify shortfalls identified in the service. Staff told us they felt supported by the management team and were able to discuss any concerns openly. The registered manager had had a positive impact on the culture of the service. Both staff and people reported improvements since they had been in post and this was noted during our inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We completed a comprehensive inspection of Kingsclear on 7 March 2018 where we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Concerns including insufficient staff being deployed to meet people’s needs, risks to people’s safety not being identified and met, a lack of person centred care and the overall governance of the service. The ratings from the previous comprehensive inspection for the Key Questions of Effective, Caring and Responsive were included in calculating the overall rating in this inspection. Due to the short timescales between the inspections the provider has not had the opportunity to submit an action plan regarding how they intend to address the breaches identified during the inspection on 7 March 2018.

Kingsclear is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsclear accommodates up to 97 people in a new adapted building. Part of the service specialises in providing care to people living with dementia. At the time of our inspection there were 33 people living at Kingsclear.

There was no registered manager in post. Prior to the inspection we were informed by the provider and local authority safeguarding team that the registered manager had left the service without serving notice. A peripatetic manager had been allocated to the service and supported us during the inspection. They told us they intended to apply to register with the CQC as the manager of Kingsclear. 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.

Risks associated with people’s behaviours had not been comprehensively assessed and staff were not provided with guidance on how to keep people safe. Triggers to people’s behaviours had not always been identified and acted upon. People’s health needs were not always monitored effectively and there was a lack of understanding from staff regarding how pain and discomfort may affect people’s behaviour.

There was a lack of management oversight of the service which meant the provider was unable to assure themselves that people were safe and were receiving the care they required. The management team in place did not have a comprehensive overview of the risks within the service. Records regarding accidents, incidents and safeguarding were not accurately maintained so the provider could not take an overall view of the needs of the service. Although the provider had systems in place to enable them to monitor and action emerging risks, these were not been used effectively. There was a lack of leadership regarding how staff were deployed. This had led to people not always receiving their care in a timely manner and some staff feeling under pressure.

The peripatetic manager was unable to access records relating to people’s needs or the care they had received. Care staff employed by the provider did not have full access to risk assessments and care plans in order to ensure they were providing the care people required and were aware of any risks to their safety. Agency staff were unable to access any records relating to people’s care and were unable to record the care they had provided.

People were not protected against the risk of abuse. Safeguarding concerns had not always been reported to the local authority safeguarding team. Where altercations between people living at the service had occurred steps had not been taken to minimise the risk of this reoccurring. The provider was unable to give information regarding the number and type of safeguarding incidents which had occurred. The provider had failed to ensure that CQC were notified of safeguarding concerns in line with their regulatory responsibilities.

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

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

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

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

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

Kingsclear is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kingsclear accommodates up to 97 people in a new adapted building. Part of the service specialises in providing care to people living with dementia. At the time of our inspection there were 27 people living at Kingsclear.

There was a registered manager in post who supported us to access information during the inspection. 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.

Prior to the inspection we received concerns regarding the clinical competency of nursing staff and staffing levels within the service. We found sufficient staff were not consistently deployed to meet people’s needs. Staff told us they struggled with the workload and did not have time to spend with people socially. Following the inspection senior managers told us they had reviewed the allocation of duties to support staff in their roles. We found that clinical training had not always been provided in line with the needs of people living at Kingsclear. This meant that pressure was being put on community nursing services and that people were at risk of not receiving healthcare in a timely manner. The provider assured us that training was booked for clinical staff and this would be completed within six weeks. We have made a recommendation regarding this. In other areas we found that staff had received the training they required for their roles and that a full induction into the service and organisation had been provided.

Risks to people’s safety were not always managed consistently and there was a lack of guidance for staff on how to support people when they became anxious. Care records available to staff lacked detail and guidance regarding people’s individual needs and preferences. Staff were unable to tell us about people’s personal histories, their likes and dislikes in detail. There was a lack of person centred activities available to people. This meant staff were unable to provide person centred, responsive care to people. People told us they were regularly bored and staff told us they felt people needed more stimulation. People’s legal right were not always respected as the principles of the Mental Capacity Act 2005 were not consistently followed. Assessments to determine people’s capacity to make decisions were not decision specific and best interest decisions were not recorded.

Staff did always feel valued and listened to. There was a lack of consistency in approach and ethos within the service and staff did not work together as a team. Although quality assurance systems were in place these did not always identify shortfalls in the service provided. Where concerns were identified these were not always acted upon effectively.

Staff supported people in a kind and friendly manner. However, although interactions were pleasant they were not always focussed on the individual as staff did not know people as well as they could. On occasions staff did not use terminology which was respectful to the people they supported and were heard to discuss people’s care in communal areas. We have made a recommendation regarding this. With the above exceptions we observed staff respected people’s privacy and supported them in a dignified way. People were offered choices and supported to maintain their independence. People told us that they generally enjoyed the food and choices were available to them. Meal surveys were regularly distributed to monitor people’s satisfaction. People had the opportunity to comment on the quality of the overall service they received through surveys, residents meetings and a comments box placed in the communal entrance. The provider had a complaints policy in place and complaints were responded to in line with this policy.

People’s medicines were stored and administered safely and access to healthcare professionals was arranged as required. Staff were aware of their safeguarding responsibilities and received training in this area. All staff had undergone robust recruitment checks to ensure they were of suitable character to work in this type of service.

People lived in a safe, clean and well maintained environment which was designed to meet their needs. Regular health and safety checks were completed and equipment was checked to ensure it was safe for use. The provider had developed a contingency plan which gave guidance to staff on the action to take in the event of an emergency. Infection control procedures were in place and followed by staff. Accidents and incidents were recorded and monitored for any emerging trends to prevent them from happening again.

During the inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.