17 April 2019
During a routine inspection
People’s experience of using this service: At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to governance. The registered manager did not record the way they reviewed, assessed and monitored the quality of service provided. A formal, independent system was not in place to ask people and relatives for feedback about service provision.
Staff monitored people's health and wellbeing and took appropriate action when required to address concerns.
The service assessed risks to the health and well-being of people who use the service and staff. Where risks were identified action was taken to reduce the risk.
Staff understood how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. The registered manager knew how to identify safeguarding concerns and to act on these appropriately.
Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.
People had food and drink to meet their needs. Staff followed advice given by professionals to make sure people received the care they needed.
People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were treated with respect and their privacy and dignity were promoted. They said staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to improve and maintain their independence with personal care.
Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.
A complaints procedure was available. People told us they would feel confident to speak to the registered manager and staff if they needed to.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Good (October 2016).
Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.
Follow up: We identified concerns at this inspection and will ask the provider for an action plan with timescales of improvements to be made. We will therefore re-inspect this service within the published timeframe for services rated requires improvement with a requirement notice.