South Park Residential Home

South Park Residential Home provides residential accommodation for up to 11 older people, some with a diagnosis of dementia. At the time of our inspection there were 11 people using the service.

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

Although feedback from people and relatives was positive and they told us they felt safe and were satisfied with the care they received, we found a number of areas of improvement that the provider needed to address.

Staff recruitment checks and medicines management procedures and medicines records were not safe. We also found the provider’s quality assurance checks were not robust enough to identify the issues we found at this inspection.

We have made a number of recommendations to the provider in relation to end of life care planning, activities provision and formal engagement methods with people and relatives.

People using the service, and their relatives told us the service was safe. Risks to people were assessed and included ways in which staff could support people to keep safe.

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.

The environment was clean and the provider worked with healthcare professionals to ensure people’s healthcare needs were being met. People were supported in relation to their nutrition and hydration. We received positive feedback about the food and where people needed additional support in relation to their diet this was being met.

People had individual care plans in place which met their needs and staff supported them in line with their wishes. People and their relatives told us they knew who to speak with if they were not happy about the service.

Relatives and staff told us there was an open culture in the service and the manager was approachable. They thought the service was well-managed.

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 good (published 9 June 2018), this was published under the previous provider.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 South Park Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, fit and proper persons and good governance at this inspection. Please 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.

South Park Residential Home is a ‘care home‘. People in care homes receive accommodation and personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home does not provide any nursing care and specialises in supporting older people living with dementia. The care home can accommodate up to 11 people on either a permanent or temporary 'respite' basis in one adapted building across two floors. At the time of our inspection there were ten people permanently residing at the home who were all living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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 the last comprehensive inspection of this care home in February 2017 we continued to rate them 'Requires Improvement' overall and for the three key questions 'Is the care home safe', 'effective' and 'well-led?'. This was because we found the provider had failed to appropriately check the suitability and ‘fitness’ of new staff, ensure staff were suitably trained and supported to carry out their duties and effectively manage and scrutinise the quality and safety of the service people living in the home received.

We undertook a focussed inspection in July 2017 and found the provider had followed their action plan to improve and met their legal requirements. However, we continued to rate the service 'Requires Improvement' overall because we wanted to be sure they could maintain what they had achieved over a more sustained period of time. In addition, we identified issues with their fire safety arrangements. Specifically, we found fire safety equipment used in the home was not always appropriately maintained, staff did not routinely participate in fire evacuation drills and fire safety risks were not always identified and mitigated.

At this comprehensive inspection we found the service continued to improve. We saw the provider had taken appropriate action to resolve the fire safety issues we identified at their last inspection. Specifically, we saw fire safety risk assessments were in place, staff had completed their fire safety training and they routinely participated in fire evacuation drills. In addition, we found the provider continued to appropriately check the suitability and ‘fitness’ of new staff, ensured staff were appropriately trained and supported and operated effective governance systems. We have therefore improved the service’s overall rating from ‘Requires Improvement’ to ‘Good’ and for most of the key questions, ‘Is the service safe, effective, caring and well-led?’

However, the service’s rating for one key question, ‘Is the service responsive’, has deteriorated from 'Good' to 'Requires Improvement'. This is because people did not have sufficient opportunities to follow their social interests and take part in meaningful recreational activities inside the home or in the wider community. We received mixed feedback from people living in the home, their relatives, professional representatives and staff about the availability of fulfilling social activities in the home. People were not engaged in particularly meaningful activities throughout our inspection. We recommend the service seek advice and guidance from a reputable source, about developing a more structured and dementia friendly programme of social activities which is based on the interests of people living in the home.

In addition, although people when they were nearing the end of their life received compassionate and supportive care at the home, people’s care plans did not contain a section that people could complete if they wanted to record their wishes during illness or death and staff had not received any end of their life/palliative care training. We discussed these issues with the registered manager who agreed to support people living in the home make decisions about their preferences for their end of life care and arrange for all staff to complete end of life care training. Progress made by the service to achieve these stated aims will be assessed at our next inspection.

Finally, although we saw the provider continued to improve the interior décor of the home, there remained considerable room for further improvement of the home’s physical environment. We recommend the provider seeks the relevant guidance and research on the design of the environment for people living with dementia.

Improvements described above the service still needed to achieve notwithstanding, people living in the home and their relatives told us they remained happy with the standard of care provided at South Park Residential Home. We saw staff continued to look after people in a way which was kind and caring. Staff had built up caring and friendly relationships with people and their relatives. Our discussions with people living in the home, their relatives and community health and social care professionals supported this.

There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse and neglect. The provider continued to identify and manage risks to people’s safety in a way that considered their individual needs. There remained enough staff to keep people safe. The environment continued to be kept hygienically clean for people and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene. Medicines continued to be managed safely and people received them as prescribed.

People continued to be supported to eat and drink sufficient amounts to meet their dietary needs. The registered manager was aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff continued to seek people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.

Staff continued to treat people with dignity and respect. They ensured people’s privacy was maintained, particularly when being supported with their personal care needs. Staff communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People continued to receive person centred care and support which was tailored to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. This meant people were supported by staff who knew them well and understood their needs, preferences and choices.

People felt comfortable raising any issues they might have about the home with registered manager and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider routinely gathered feedback from people living in the home, their relatives and staff. The provider also worked in close partnership with external health and social professionals and bodies.

The registered manager had a positive impact at the home and was highly regarded by people living there, relatives and staff. It was evident from the registered manager’s comments they understood their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.

At our last comprehensive inspection of this service, which we carried out on 23 and 24 February 2017, we continued to rate Southpark Residential Home ‘Requires Improvement’ overall and for the three key questions ‘Is the care home safe’, ‘effective’ and ‘well-led’. Although we found the service had taken appropriate action to resolve all the outstanding breaches from previous inspections, we identified three new breaches of the regulations that included a failure to check the suitability and fitness of new staff, ensure staff were suitably trained and supported to effectively carry out their duties and effectively monitor the quality and safety of the service people received.

After the February 2017 inspection the provider wrote to us to say what they would do to meet their legal requirements in relation to the three breaches of the regulations described above. We undertook this unannounced focused inspection to check the provider had followed their action plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Southpark Residential Home’ on our website at www.cqc.org.uk.

Southpark Residential Home provides accommodation and personal care for up to 11 people. The home specialises in supporting older people living with dementia. At the time of our inspection there were eleven people living at the home, which included one person receiving temporary respite care.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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.

During this focussed inspection we found all three outstanding breaches had been satisfactorily resolved. Specifically, the provider had improved their staff recruitment practices by ensuring appropriate employment and criminal record checks had been carried out for all new staff. Staff had either completed or were booked to attend refresher training on dementia awareness, moving and handling, food hygiene and fire safety. This ensured staff had the right knowledge and skills they needed to perform their roles effectively. And, measures had been put in place to ensure the provider operated more effective governance systems to routinely assess and monitor the quality and safety of the service people at the home received. The new quality assurance processes helped the registered manager and staff identify issues promptly and ensure appropriate action was taken to address shortfalls in staff recruitment checks, staff training and one-to-one supervision meetings.

In addition, as we had discussed with the registered manager at our previous inspection we saw the provider had purchased a range of new furniture for people’s bedrooms and the main communal area.

However, while we saw significant improvements had been made by the provider at this inspection, we did identify a new breach in respect of the service’s fire safety arrangements. Specifically, fire safety equipment they used in the home was not always appropriately maintained and safe for its intended use, staff did not routinely participate in fire evacuation drills of the building, and fire safety risk were not always identified, assessed and mitigated.

This meant fire safety risks people might face were not suitably managed and represents a breach of the Health and Social Care (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.

The service has had a registered manager in post since February 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last comprehensive inspection of this service in January 2016 we rated the service ‘Requires Improvement’ overall and for the four key questions ‘Is the service safe’, ‘effective’, ‘responsive’ and ‘well-led?’ This was because the provider had failed to develop detailed risk management plans to help staff prevent or manage risks people might face, comply with the principles of the Mental Capacity Act 2005 (MCA), enable people to engage in meaningful activities that reflected their social interests and to notify the Care Quality Commission (CQC) without delay about incidents involving the people living at the home that had adversely affected their health and/or wellbeing.

During our last focused inspection of this service in August 2016 we found the provider had taken appropriate action to improve their arrangements for managing identified risks, complying with the Mental Capacity Act 2005 (MCA), providing people with sufficient opportunities to participate in fulfilling social activities and submitting statutory notifications to us. At the time of the focused inspection we continued to rate the service as 'Requires Improvement' overall because we needed to see the provider could consistently maintain these improvements over a more sustained period of time.

At this comprehensive inspection we found the provider had maintained improvements in the way they mitigated risk, complied with the Mental Capacity Act 2005 (MCA), offered people opportunities to engage in meaningful activities and dealt with statutory notifications. However, we have continued to rate the service as 'Requires Improvement’ because they still cannot demonstrate they met all the regulations and fundamental standards.

Specifically, the provider failed to operate safe recruitment procedures. Recorded evidence was not always available in staff’s files to show the provider had checked their eligibility to work in the UK and criminal record checks were not being renewed at regular intervals. This meant the provider had not done enough to satisfy themselves about the suitability of new and existing staff to work at the home.

Furthermore, while there was a full training programme in place to enable staff to update their knowledge and skills; we found that half the staff team were not up to date with this programme and had not completed all the necessary training for their role. A system was also in place to support, supervise and appraise staffs working practices. However, this was not being followed and staff were not receiving the formal support they required from their line manager to undertake their duties.

Finally, although there were systems in place to monitor and review the quality of service delivery, which had identified some of the concerns we found during this inspection; these clinical governance systems had nonetheless failed to identify all the issues we found during this inspection. Specifically in relation to staff records, recruitment, training, supervision and appraisal.

These failings represent three breaches of the Health and Social Care (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.

Although we saw the provider had developed some good fire safety systems, we have also made a recommendation about involving staff in fire evacuation drills at the home.

The breaches and issues described above notwithstanding, people told us they were happy living at South Park Residential Home. We saw staff looked after people in a way which was kind and caring. Staff had built caring and friendly relationships with people. Our discussions with people using the service and their relatives supported this.

There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. There were enough staff to keep people safe. The premises and equipment were safe for people to use because staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

People were supported to eat and drink sufficient amounts of nutritious food that met their dietary needs. They also received the support they needed to stay healthy and to access healthcare services.

Staff continued to care and treat people with dignity and respect. They also ensured people’s privacy was maintained particularly when being supported with their personal care needs.

People received personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. People were supported to maintain relationships with people that mattered to them.

People and staff spoke positively about the management style of the newly registered manager. They provided good leadership and led by example. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

The provider sent us an action plan to say what they would do to meet their legal requirements in relation to the four outstanding breaches described above. We undertook this unannounced focused inspection on 02 August 2016 to check the provider had implemented their action plan and were now meeting legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘South Park Residential Home’ on our website at www.cqc.org.uk.

South Park Residential Home is a care home which provides personal care and support for up to 11 adults. The service specialises in supporting older people living with dementia. There were 11 people living with dementia in the home at the time of our inspection.

The service has not had a registered manager in post since August 2015, although they are required to have one. An interim manager has been in day-to-day charge of South Park Residential Home since April 2016 and they have applied to the Care Quality Commission (CQC) to become the service’s registered manager. A registered manager is a person who has registered with the (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our focused inspection, we found the provider had followed their action plan and were meeting their legal requirements. However, while improvements had been made we have not revised the services overall rating which remains 'Requires Improvement'. To improve the homes overall rating would require the provider to demonstrate consistent good practice in all aspects of the care they provide over a longer and more sustained period of time.

Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. Specifically, risk management plans were now in place to help staff prevent or manage behaviours that challenged the service. Staff we spoke with were familiar with these risk management plans and clearly knew how to prevent or deescalate behaviours that challenged.

Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and professional representatives to ensure they were involved in discussions about people’s care needs.

The provider now notified the CQC in a timely way about the occurrence of any incidents and events that affected the health, safety and welfare of people using the service.

There were effective systems in place to assess and monitor the safety and quality of the service people received. The manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken promptly.

The views and suggestions of people living in the home, their relatives, professional representatives and staff were routinely sought by the provider and were also used to improve the service they provided.

The positive comments made above notwithstanding about all the improvements we saw had been made; we found staff had not received any formal training on managing behaviours that challenge the service or ensuring older people living with dementia had sufficient opportunities to engage in meaningful activities that reflected their social interests and age. These are key aspects of staff’s role and responsibilities. This meant people’s needs and wishes may not always be fully met by staff who were not suitably trained to carry out all the duties they were expected to perform.

We have therefore made two recommendations about staff training in relation to managing behaviours that may challenge the service and arranging meaningful and age appropriate social activities for older people living with dementia.

South Park Residential Home is a small care home which provides personal care, support and accommodation for a maximum of 11 adults. The service specialises in caring for older people, some of whom are living with dementia. At the time of our inspection there were 11 people living at the home.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager on our records left the service in August 2015. An interim manager has been appointed whilst the provider recruits a new permanent manager for the home.

During this inspection we found the provider had not ensured that risk management systems in place were always used appropriately to ensure people were protected from the risks of injury or harm. They had not ensured risks were appropriately assessed to ensure the safety of two people that were sharing a room and had behaviours that could challenge the service and others.

We also found the provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and associated code of practice to ensure, where people lacked capacity to make decisions about specific aspects of their care, these were taken in people’s best interest.

The provider also did not operate an effective system to assess, monitor and improve the quality and safety of the service.

Providers are required to inform CQC when there are significant events in a service, including any incidents where people sustained significant injuries or when the police are called. These are called notifications. We found the provider had not submitted notifications about events that happened, to CQC, as required by law.

People’s feedback about the level of activities and engagement within the home was not positive. During our inspection we saw only few activities take place in the home. For long periods of time we observed people had little stimulation or engagement. The interim manager told us they were already in conversations with the provider about improving this aspect of the service for people. We have made a recommendation to the provider to improve the opportunities people have to participate in meaningful leisure and recreational activities in the home.

Despite these issues people and relatives said people were safe at South Park Residential Home. Staff had been trained to identify signs that could indicate people may be at risk of abuse. They knew what action to take to ensure people at risk were protected. They had also been trained to ensure people were not harmed by discriminatory behaviour or practices.

Where risks to people's health, safety and welfare had been identified, staff had access to guidance on the actions to take to ensure people were protected from injury or harm. The provider made arrangements for regular checks of the environment and the equipment in the home to ensure these did not pose unnecessary risks to people. However checks of water systems had not been undertaken recently to ensure these were hygienic. The interim manager was aware of this and taking appropriate action to ensure these were tested. Staff kept the home free from obstacles and trip hazards so people could move around safely.

There were enough staff on duty at the time of our inspection to support people in the home to meet their needs. However the provider did not routinely review staffing in the home as the level of people’s dependency changed to ensure people’s needs could always be met. The provider had carried out checks to ensure staff were suitable and fit to support people. But in some cases employment references had not been received for some staff. The interim manager was taking action to ensure appropriate references for these staff were obtained.

Staff received training that was appropriate to their role. They were supported in their work by senior staff. Staff demonstrated good awareness of people's needs and how these should be met. People and relatives said staff looked after people in a way which was patient, respectful and kind.

Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff were welcoming to visitors and relatives and encouraged people to maintain relationships that were important to them.

People were supported to stay healthy and well. They received their medicines as prescribed and these were stored safely in the home. Staff regularly monitored people's general health and wellbeing. Staff ensured people ate and drank sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff sought appropriate support from healthcare professionals such as the GP if any concerns about a person’s health and wellbeing were identified.

People and their relatives were satisfied with the care and support people experienced. In most cases care and support had been planned for people which reflected their needs and their individual choices and preferences for how they received care. People's care and support needs were reviewed with them regularly. Appropriate arrangements were in place to deal with people’s complaints if these should arise.

People and relatives spoke positively about the management of the home. The provider sought people's views about how the care and support people received could be improved through satisfaction surveys. However the provider was not following their own policy for ensuring these were undertaken quarterly. The interim manager acknowledged this and told us a survey would be undertaken with people shortly.

The provider had procedures in place in relation to the MCA and Deprivation of Liberty Safeguards (DoLS). Staff had received training to understand when an application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Applications made to deprive people of their liberty had been properly made and authorised by the appropriate body. The provider was complying with the condition applied to the authorisation.

We found a number of breaches of regulations in relation to good governance, safe care and treatment, the need for consent and notifications. You can see what action we told the provider to take with regards to these breaches at the back of the full version of the report.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan on 18July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer one of our five questions: Is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the registered manager. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had taken appropriate action to ensure people received prompt and appropriate standards of care. We saw from records and from our own observations there were now enough staff on duty, particularly during busy periods, to meet the needs of people using the service.

We saw the provider had made appropriate arrangements to ensure care support workers were free from unnecessary administrative duties and able to spend their time providing the care and support people needed.

We saw from records and from speaking with the registered manager, the service was improving the availability of activities to promote the overall welfare and wellbeing of people using the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with five people using the service and their friends and family members. We also spoke with the provider, who was the acting manager for the service at the time of our inspection, and two support workers.

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

Is the service safe?

We asked people using the service and their friends and family, if they felt people were safe at the home. One person using the service said, 'You feel really well looked after and no one can come in and do anything to you.' A visitor to the home said, 'I think people here are safe.' They told us they were very alert to any changes or bruises to people and felt confident that their friend was happy in the home. They said, 'I can see it in their face that they are happy.' A relative told us, 'I feel mum is safe and they are keeping her safe.'

Any potential risks to people's health, safety and welfare within the home and in the community were regularly assessed by the registered manager. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury in the home and in the community.

People were cared for in an environment that was kept clean and hygienic. Staff knew how to maintain good standards of cleanliness and personal hygiene to reduce the risk of cross infection. The home was free from clutter and obstacles which meant people were able to move freely around the home.

People received the medicines prescribed for them by healthcare professionals, in a timely manner, to help them manage their health related conditions or illnesses.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. This means that people will be safeguarded as required.

However we were concerned there were not enough suitably trained and experienced staff on duty, particularly during the busy morning period, to meet the care and support needs of all of the people using the service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing.

Is the service effective?

People using the service and their relatives were involved in planning and developing their care and support. Their views and experiences were used to develop their individual care and support plan. People's specific needs had been taken into account and staff demonstrated a good understanding and awareness of these.

People's care plans were reviewed monthly by staff to ensure these were up to date and people had received the care and support planned for them. Any changes to people's individual needs were updated on their individual care plans so that staff had the most up to date information about how to care for and support people.

Is the service caring?

People were cared for by friendly and attentive staff. One of the people using the service said, 'The staff are all so nice. They don't make you feel a nuisance.' A relative told us, 'I definitely think the staff are very caring. They have the attitude that they will support people to do what they want to do.' Another relative said, 'I think the staff are friendly.'

During our inspection we observed friendly and kind interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rushed or hurried by staff and could do so at their own pace.

Is the service responsive?

There were appropriate mechanisms in place to monitor people's general health and wellbeing. Regular checks of people's weights, urine and blood pressure were undertaken by staff. These were documented and reviewed by senior staff to identify any potential underlying issues or concerns.

Staff was responsive to any changes and deterioration in people's general health and well-being. They took appropriate action so that people got prompt medical care and attention they needed.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

The registered manager understood the importance of robust quality assurance and carried out regular checks to assess and monitor the quality of service provided.

We observed from people's records their individual care and support needs had been assessed and support plans were in place to meet these needs. Where people lacked capacity to make decisions about their care and support, their representatives had been involved in planning and developing their plan of care. Risks to their health and wellbeing had been identified and plans were in place to manage these. From the records we looked at, information was reviewed and updated regularly so that staff had up to date information about people's current care and support needs.

People received appropriate support to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of food and drink.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about staff's suitability to work for the service.

The provider had systems in place to assess and monitor the quality of service that people received.