Lester Hall Apartments

Lester Hall Apartments is a residential care home providing accommodation and personal care for people living with mental health needs, including those living with dementia, physical disability and a learning disability or Autism. Accommodation is in 1 adapted building over 3 floors with a passenger lift. The service is registered for up to 33 people and there were 14 people living in the service at the time of inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Since the last inspection the provider had made improvements and the service was now able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support; People received individualised care and support. Guidance and support for staff of how to support people with their routines, preferences and health conditions had improved. People received consistency and continuity from staff who knew them well and were competent and skilled. The use of agency staff had significantly reduced. Safe staff recruitment procedures were in place.

Right Care; People were supported to lead active and fulfilling lives. Improvements had been made to support people with interests, hobbies and activities important to them. Staff were kind, caring and treated people with dignity and respect.

Right Culture; There was a shared commitment to the culture and values of the service. There was a positive team approach and improved oversight and leadership. Feedback from people and staff about the improvements made was consistently positive. There were new and improved effective systems and processes in place to continually review, monitor and improve quality and safety.

Risks were continually assessed, monitored and reviewed. Staff were aware of how to protect people from known risks and worked closely with external health and social care professionals in how risks were managed.

Safeguarding, incident management and opportunities of learning to mitigate risks had improved. People received their medicines safely and when required.

Infection prevention and control practice was in place to minimise the risk and spread of infection. Staff had received required training.

The provider had improved the referral and assessment process. This was robust with senior management oversight, ensuring new admissions were planned for.

People’s communication needs had been assessed and planned for, and easy read information was available. People had access to the providers complaint policy.

The provider enabled people, relatives, staff and external professionals to share their experience of the service. Feedback was used to further develop and improve the service.

The staff worked well with external agencies and health and social care professionals, in supporting people with their ongoing care and support needs.

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 (published 3 August 2022).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 5 July 2022. Breaches of legal requirements were found in safe care and treatment, safeguarding, staffing, person centred care and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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.

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.

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.

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

Follow up

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

Lester Hall Apartments is a residential care home providing accommodation and personal care for people living with mental health needs, including those living with dementia, physical disability and/or Autism. Accommodation is in one adapted building over three floors with a passenger lift. The service is registered for up to 33 people and there were 21 people living in the service at the time of inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support; care and support were not personalised, routines were not consistently followed and opportunities for social inclusion was limited.

Right Care; staff did not provide consistent care that was dignified and respectful.

Right Culture; not all staff had the required skills or competency to provide safe and effective care.

Risks associated with people’s care and support needs were not sufficiently assessed, monitored or mitigated. This placed people living at the service at increased risk of harm.

Safeguarding procedures had not always protected people from experiencing harm or abuse. People told us they did not always feel safe living at the service.

Staff deployment did not consider staff skill mix and competency. There was a high use of agency staff who were not sufficiently trained or experienced to meet all people’s care and support needs. Staff recruitment was ongoing. The management team took action to make some immediate improvements.

The providers policies and procedures reflected best practice guidance and recognised assessment tools were used. However, incident management policies and procedures were not consistently followed, and this impacted on learning and opportunities to mitigate further risks.

New and improved audits and checks had been implemented. Action plans were in place to support the service to improve. Further time was required however for improvements to be embedded and sustained.

People told us they were not happy with the quality and choice of meals. The provider had completed a recent mealtime experience review and agreed to complete this again.

Staff’s approach to care and support was inconsistent. Some staff showed dignity, respect, encouraged independence and opportunities to participate in activities, others did not.

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.

People had been supported with their health conditions and accessed external health care services. Recommendations made by external health care professionals were implemented.

People and visitors had access to the provider’s complaint procedure. An ongoing refurbishment plan was in place to improve the decoration and furnishings. A new sensory/quite room was being developed.

Medicines management followed expected best practice guidance. People received their prescribed medicines when required.

Improvements to infection prevention and control practice had been made. This included an increase in domestic staff and more robust cleaning.

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

Rating at last inspection and update

The last rating for the service was requires improvement (published 4 November 2021) and there was a continued breach in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. However, the current provider has managed the service since 2021. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulation and new breaches were identified.

Why we inspected

The inspection was prompted in part due to concerns received about the staff deployment and competency of staff to meet people’s individual needs. 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 all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider took some immediate actions to mitigate the most urgent risks and this has been effective.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, how people were protected from avoidable harm, how people received person centred care, staff deployment and support and the governance of the service. See the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Lester Hall Apartments is a residential care home, providing personal or nursing care to up to 33 people with mental health support needs. At the time of inspection, 23 people were living at the service.

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

The service was not always sufficiently cleaned. We found areas within the home that had not been cleaned for some time, including a person’s bedroom, and communal areas.

The service was dated and in need of repair and refurbishment. Areas of flooring were uneven and damaged, causing dirt to get trapped and a trip hazard.

Audits and checks were not in place to ensure cleaning was completed to an acceptable standard across the whole service.

A new provider and management team were in place, who had identified the areas within the service which required attention, however no timescales had been set to take action. Some improvements had been made since our last inspection.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Medicines were administered and stored safely.

People had risk assessments and care plans which reflected their current needs.

People and staff told us that the new provider and manager were doing a good job, and the service had improved in several areas.

Meetings were held for staff and people to feedback their thoughts to the management team.

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 (published 17 October 2020) and there was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Two targeted inspections took place afterwards in response to concerns received by CQC about infection prevention controls (IPC), and staffing at the service. We looked at the IPC measures the provider had in place and there was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Report published 5 February 2021). Targeted inspections do not change the ratings of services and the rating remained Requires Improvement.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

Why we inspected

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 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 remains Requires Improvement. This is based on the findings at this inspection.

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 of regulation in relation to cleanliness and lack of oversight within the service. 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.

Lester Hall Apartments is a residential care home providing accommodation and personal care for people

living with mental health needs, including those living with dementia. The service can support up to 33

people in one adapted building.

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

Staff were not always safely recruited into their roles. Some staff did not have risk assessments in place where there had been information of concern on their police Disclosure and Barring Service (DBS) check. The provider took immediate action to rectify this.

The culture of the service was not fully person-centred as some people had a perception that some staff were employed as ‘security staff’. This could cause some people to feel fearful or uncomfortable and could have a negative impact upon their mental well-being. We have made a recommendation about embedding a person-centred culture for everyone living in the service.

Not everyone who showed distressed behaviours had a positive behaviour support plan in place but care files were person centred and people had a range of care plans in place which were reviewed regularly. Staff had guidance on how to provide safe support to meet people’s needs.

Care staff and one to one workers received appropriate training for their roles to ensure they could fulfil their roles and responsibilities.

People who received one to one support spoke positively about the care they received. We observed positive relationships and interactions between people and staff.

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.

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

Rating at last inspection

An inspection to examine infection prevention and control took place in December 2020 which led to a rating of inspected but not rated. The previous rating was requires improvement (published 17 October 2020.)

The overall rating for this service remains requires improvement.

Why we inspected

We undertook this targeted inspection to check a specific concern about whether all staff were trained appropriately for their roles. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and responsive sections of this report.

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

Follow up

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

Lester Hall Apartments is a residential care home providing accommodation and personal care for people living with mental health needs, including those living with dementia. The service can support up to 33 people and there were 26 people living in the service at the time of inspection.

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

Poor infection prevention and control processes and practice placed people at risk of harm. During a recent outbreak of COVID-19 government guidance on how to work safely in care homes was not always followed. The service did not always follow their policy on how to safely manage an outbreak of COVID-19. This included safe use and disposal of personal protective equipment (PPE) and not effectively using cohorting and zoning of people and staff to reduce the risk of infection spread. It also included not adhering to their policy in areas such as laundry and uniform processes.

Management oversight of infection prevention and control processes required urgent improvements. Quality assurance processes had not identified the widespread concerns in this area found during the inspection. There were not always enough domestic staff on shift to do all necessary cleaning tasks to help reduce the spread of infection. Improvements were required to the environment to support good infection prevention and control.

Rating at last inspection

The last rating for this service was requires improvement (published 19 October 2020).

After the last inspection the provider completed an action plan which outlined their planned improvements and timescales to achieve these. A t this inspection not enough improvement had been made and the provider was still in breach of regulations.

You can read the report from our last inspection, by selecting the 'all reports' link for Lester Hall Apartments on our website at www.cqc.org.uk.

Why we inspected

As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.

This inspection took place on 14 December 2020 and was announced shortly before entering the building. A follow up unannounced visit took place on 21 December 2020.

We have found evidence the provider needs to make improvements. Please see further detail in the Safe section of this report.

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 a breach of regulations in relation to infection prevention and control which meant people's safety could not be assured.

Follow up

We will monitor information which the provider will send weekly to CQC updating us of the actions they are taking to make improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lester Hall Apartments is a residential care home providing accommodation and personal care for people living with mental health needs, including those living with dementia. The service can support up to 33 people in individual apartments within an adapted building.

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

Identified areas of risk in relation to people’s support needs did not always have supporting risk assessments in place to keep them safe. One person did not have detailed plans of care telling staff how to keep them safe from harm. People’s risk assessments had not always been reviewed and updated regularly. This was being addressed by the compliance manager.

Quality assurance systems were not always effective at identifying any areas of concern for example, they had not identified and addressed the missing risk assessments and person-centred care plan for one person using the service. People’s views about their care and the running of the service were sought through meetings and satisfaction questionnaires. This needed to be strengthened so the provider could demonstrate that changes had been taken to address concerns raised.

People and their relatives felt Lester Hall Apartments was a safe place to live. Staff we spoke with had completed training in safeguarding vulnerable people from abuse and understood how to recognise abuse.

Sufficient staff were available to provide a timely response to people and provide safe care. Staff had been employed following robust recruitment checks. The provider had followed their recruitment procedures to ensure staff were recruited safely.

The service had sufficient and safe infection prevention and control measures in place. Government guidance in relation to COVID 19 had been followed by staff. People’s medicines were safely managed, and they received their medication as prescribed. The provider ensured that lessons were learned when things went wrong, so that improvements could be made to the service and the care people received.

There were two registered managers in place, one of whom was also the registered provider. People and staff felt confident about the leadership of the service and described both registered managers as respectful, professional and responsive. Staff felt well supported and able to raise any concerns they may have. They were confident that any concerns raised would be dealt with appropriately.

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. (published 21/11/2019)

Why we inspected

We received concerns in relation to people’s care and support needs. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

We reviewed the information we held about the service. No immediate 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 remained Requires Improvement. 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 Lester Hall Apartments on our website at www.cqc.org.uk.

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.

Lester Hall Apartments is a residential care home providing accommodation and personal care to 24 people who were primarily living with mental health needs at the time of the inspection. The service can support up to 33 people in individual apartments within an adapted building.

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

People's care plans included detailed guidance and information about measures required to reduce risks. People’s safety was not always promoted by staff as some staff had not followed guidance or understood how they should reduce potential risk. People were supported to take their medicines. Medicine records were not always completed correctly or accurately.

Systems to monitor the quality of the service were in place but these were not always effective in identifying where improvements were required. The provider was in the process of implementing more robust systems and processes at the time of our inspection. These had yet to be embedded into working practices to demonstrate they could support sustainable improvements.

People were supported by sufficient numbers of staff who had undergone a robust recruitment process. Staff had knowledge and understanding of reporting potential safeguarding concerns and following infection control procedures.

People’s needs and expectations of care were assessed and used to develop a care and support plan. Staff were supported through ongoing training to enable them to meet people's needs. Staff promoted people’s health by supporting them to attend routine and specialist appointments and by liaising with health care professionals when required.

People were supported to have maximum choice and control of their life 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 were positive about the staff and care provided. They spoke of the caring and respectful nature of staff and how staff considered their privacy, dignity and independence.

Care plans were in the process of being revised and updated to support staff to provide personalised care. People were encouraged to take part in activities and interests of their choice, including going out into the local community. There was a complaints procedure in place and systems in place to deal with complaints effectively. The service provided appropriate end of life care to people.

The management team were aware of their role and responsibilities in meeting their legal obligations. The provider worked with key stakeholders to facilitate improvements, develop the service, and keep up to date with good practice.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 21 August 2018) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last comprehensive inspection in February 2017 the service was rated as Good.

Lester Hall Apartments 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. The service cares for people with mental health needs. At the time of our inspection there were 30 people using the service.

There were two registered managers in post who job shared. 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.

Systems and processes did not ensure the safe management of medicines and people could not be confident they were supported to take their medicines as prescribed.

There was a lack of systems to monitor the quality of the service and identify where improvements were needed to ensure people received safe, good care as a minimum.

Procedures for controlling the risk of infection were not embedded in staff working practices and were not effective in supporting the prevention of infection for people.

Where people were at risk of poor nutrition or dehydration, records were not completed accurately or correctly to show people had received nutrition and fluids in line with their assessed needs. People were positive about the quality and choice of meals provided.

Records did not reflect that all potential risks to people had been assessed appropriate, and did not include the detail and guidance regarding the measures staff needed to take to reduce risks. Staff demonstrated a good understanding of actions they needed to take to keep people safe.

Care plans were not always updated in a timely manner and records did not consistently provide the detail and information staff needed to meet people's needs. The registered manager was in the process of reviewing and updating care plans and records.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.

Staff had completed a range of training to provide them with the knowledge and skills they needed to meet people's needs. Training records were not maintained accurately or fully completed to support the effective analysis and monitoring of staff training.

People were supported to access a range of health professionals to maintain their health and well being. The service worked in partnership with other agencies to ensure people received the care and treatment they needed.

People's needs were assessed prior to them using the service. People were supported to make choices and decisions about their care. Staff understood the principles of the Mental Capacity Act 2005, sought consent before providing care and respected people's right to decline care and support.

People were treated with kindness, respect and compassion and were given emotional support when needed. Staff supported people to achieve as much independence as possible and protected people's right to privacy and dignity.

People and their relatives were involved in planning their care and were able to make changes to how their care was provided.

People had access to a range of varied activities and were supported to be involved in their local community. People maintained contact with their friends and family and were therefore not isolated from those people closest to them.

People understood how to raise concerns and complaints and were confident these would be listened to and acted on.

The registered manager and the registered provider promoted a culture that was focussed on personalised care. Staff supported the provider's values of enabling people to be as independent as possible and engaged in meaningful activities. People, relatives and staff were able to share their views about the service directly to the registered provider and these were used to develop the service.

We found 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 report.

We last inspected Lester Hall Apartments in July 2014 and found the service was meeting the requirements of the regulations.

Lester Hall Apartments provide care for up to 33 people with a range of needs which include mental health needs, physical disabilities, dementia and drug and alcohol dependency. The service is based in a large residential property that has been converted to provide apartments and spacious communal areas. It is situated close to the village of Wigston in Leicester. At the time of our inspection visit there were 28 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. Risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety, although some risk assessment records required further development to provide the detail staff needed to keep people safe.

There were enough staff to provide safe and effective care. Staff were skilled in meeting the needs of people using the service including how to respond when people became distressed or agitated.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

Staff told us they felt supported in their roles and the registered manager and provider gave clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

Staff were knowledgeable of and acted in line with the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing care and support and respected people's right to decline care. Care plans required further development to include the support people required to make specific decisions, for example in relation to their healthcare. This is important to ensure people have the support they need to make their own decisions.

People had their health and social needs assessed and care plans were put in place to meet their needs to guide staff on how best to meet these. People were supported to have sufficient to eat and drink and access a range of external health professionals. This meant that people were supported to remain as healthy as possible.

We saw positive relationships between people and staff who were caring and attentive in their approach in meeting people's needs. Staff demonstrated that they knew people well and took time to chat with them and provide reassurance. Staff promoted and upheld people's privacy and dignity and respected people as individuals.

Care plans included information about people's needs, preferences, life history and how they preferred their care to be provided. Staff used the information they had about people's interests and preferences to tailor their care and support. Care plans were regularly reviewed and updated to reflect changes in people's needs. This meant that people received personalised care that reflected their preferences and met their needs.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used information to plan the activities provided. This meant people were able to spend their time in the way they preferred.

People and relatives were provided with opportunities to be involved in decisions and develop their care. The provider ensured people had the information they needed to raise any concerns or complaints about the service or their care. People told us they knew how to complain and felt their concerns would be listened to an acted upon.

People, relatives and staff were confident in how the service was led and the abilities of the management team. The registered manager and the provider were committed to providing quality care for people. The registered manager oversaw all aspects of the service. The provider was involved in the day-to-day running of the service and got on well with people who happily approached her whenever they wanted to. Staff told us they had confidence in the registered manager and the provider and were supported to share their views about people's care.

The provider ensured all people using the service were involved in it's running. People were able to share their views through satisfaction surveys and through discussions with managers and staff. People felt listened to and able to comment on how well the service was running.

The registered manager undertook a range of checks to ensure people were receiving quality care. We saw that on-going improvements had been made as a result of checks and audits, for example health and safety compliance within the service was good. Further development of quality assurance would enable the provider to evidence how they consistently monitored the service to ensure people received good care.

People gave conflicting information as to their awareness of their care plan. People in some instances said they had a keyworker who was supportive whilst others said they didn't think a keyworker was necessary to them. Others said they would like to have a keyworker. People's understanding and awareness of advocacy services and raising concerns and complaints was mixed.

People in some instances told us they preferred their own company and chose to remain in their room, whilst others told us they enjoyed taking part in the activities at the service. On the day of our visit we saw a number of people taking part in a game of pool, dominoes, cards and bingo. We also saw people going out in the community either by themselves or accompanied by staff or friends and relatives. People in some instances told us that at times they felt isolated and would benefit from being encouraged to take part in activities.

We looked a range of records which included a number of people's care plans around consent to care and treatment and nutritional and hydration needs. Care plans were in place and had been regularly reviewed. Records recording staff training were up to date.

Records showed that the service supported people to access a range of health care professionals who work with the staff of the home to monitor and promote people's health. Monitoring of people's health included regular reviews with a range of health care professionals. People's diversity, values and human rights were respected. The service supported people to access advocacy services and had used legislation which included the Mental Capacity Act to promote people's safety and welfare where people were unable to make an informed decision for themselves.