Cherry Tree House

Cherry Tree House is a residential care home providing personal care for up to 34 people who may be living with a physical disability or dementia. At the time of our inspection there were 20 people using the service. Cherry Tree House accommodates people in 1 building over 2 floors.

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

Quality monitoring systems were in place which helped to check various areas of the home. Any actions identified were carried out to make sure the service was continually improving. However, some improvements in relation to monitoring records were identified.

Areas of the service were in need of refurbishment to support effective cleaning.

Medicine were safely ordered, stored and administered.

Care plans included risk assessments for known risks and staff followed support plans to help keep people safe. Care plans were up to date, risk assessments were in place and regularly reviewed. People were regularly asked their views on the service provided and action had been taken when suggestions were made.

People had support from safely recruited staff. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. Staff continued to receive guidance and support from management when required.

People were supported to have access to healthcare services to monitor and maintain their health and wellbeing. People were encouraged to maintain a healthy diet, where people had specific dietary requirements, these were catered for.

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.

We found the registered manager to be open and responsive to feedback. Visiting healthcare professionals told us that the management team and staff worked well with them.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 December 2022). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last 5 consecutive inspections.

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 focused inspection of this service on 6 and 9 September 2022. Breaches of legal requirements were found. Following the inspection, the provider told us they had made improvements in relation to safe care and treatment and good governance.

We undertook this focused inspection to check on the reported improvements, and to confirm whether they were now meeting the legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 remained requires improvement. 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 Cherry Tree House on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation in relation to the environment, systems and processes for assessing people’s needs to help inform decisions about safe staffing levels and good governance.

Follow up

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

Cherry Tree House is a residential care home providing personal care for up to 34 older people who may be living with a physical disability or dementia. At the time of our inspection there were 24 people using the service.

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

The manager had made some improvements since our last inspection, but concerns remained in some areas. Further improvements were needed to ensure people’s medicines were managed safely. People remained at increased risk of receiving ineffective or unsafe care, because robust systems were not always in place to make sure their needs were consistently met. Care plans and risk assessments lacked detailed guidance for staff on how to meet some people’s needs. Monitoring charts around food and flood intake and the support provided for people to regularly reposition were not used effectively.

Whilst the manager was responsive to feedback, the concerns identified showed further improvements were needed to ensure issues and concerns would be consistently identified and addressed in future.

People felt safe and gave positive feedback about the care and support they received. Staffing levels had improved, and sufficient numbers of suitably qualified staff were deployed. Risks associated with the environment including in relation to fire safety, window opening restrictors and unrestricted access to the stairs had been assessed and managed.

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. There was a positive atmosphere within the service and people enjoyed the companionship and comradery they shared with other people using the service and the staff who worked there.

Professionals gave positive feedback about improvements made and how staff worked with them to meet people’s needs. Staff had completed a wider range of training and supervisions and spot checks were being used to monitor performance and address any practice issues.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 23 May 2022) and there were multiple breaches of regulation. At this inspection, some improvements had been made, but the provider remained in breach of two regulations.

This service has been in Special Measures since 21 October 2021. During this inspection the provider demonstrated some improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

We carried out an unannounced focussed inspection of this service on 21 and 25 January 2022, 10 February 2022 and 3 March 2022. Multiple breaches of legal requirements were found. Following the inspection, the provider told us they had made improvements. We undertook this focused inspection to check on the reported improvements, and to confirm whether they were now meeting the legal requirements.

We also 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.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to 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 Cherry Tree House on our website at www.cqc.org.uk.

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 breaches in relation to the safety of the care and support and the provider’s governance arrangements at this inspection. Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Cherry Tree House is a residential care home providing personal care for up to 34 older people who may be living with a physical disability or dementia. On the first day of our inspection 21 people were using the service; by the last day of our inspection 15 people were using the service.

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

People were at risk of harm because the provider had failed to adequately assess and manage risks. Concerns identified at our last inspection had not been addressed, putting people at continued risk of receiving ineffective or unsafe care.

The provider had not ensured people’s medicines were managed and administered safely. Infection prevention and control risks were not effectively identified and managed. Concerns relating to the environment and fire safety risks had not been properly assessed. People’s care plans and risk assessments did not always provide enough information about their needs, risks to their safety or provide guidance to staff on how to safely support them. Robust systems were not in place to monitor and make sure people’s needs were met.

Sufficient numbers of suitably qualified and competent staff were not deployed to safely meet people’s needs. We observed numerous practice issues in relation to staff’s use of personal protective equipment, moving and handling practices and the support provided with people’s medicines. The provider did not have a robust system in place to ensure staff were suitably trained and to identify and address practice issues. Good practice guidance was not always followed.

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.

The provider had not acted to prevent people being unlawfully deprived of their liberty.

Whilst the new manager began addressing our concerns and made some improvements during the course of our inspection, this was reactive rather than proactive management. Overall, the service was not well-led. The provider did not have a robust system of audits to oversee and ensure the service was safe. They had not taken sufficient and timely action to address known issues and risks. They had not met the requirements of CQC’s warning notices and put people in their care at ongoing risk of harm by their failure to act.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 23 December 2021) and there were multiple breaches of regulation.

At this inspection we found the provider remained in breach of regulations and rated inadequate overall. This service has been rated inadequate or requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced focussed inspection of this service on 18 and 19 August 2021. Breaches of legal requirements were found, and we issued two Warning Notices in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This focussed inspection was carried out to follow up on action we told the provider to take and to check whether the provider had met the requirements of these Warning Notices.

We also 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. This included checking the provider was meeting COVID-19 vaccination requirements.

This report only covers our findings in relation to the Key Questions Safe, Effective 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 remained the same. 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 Cherry Tree House 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 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 identified breaches in relation to providing safe care, safeguarding people from abuse and improper treatment, staffing and the provider’s governance and oversight of the service.

Since the last inspection we recognised the provider had also failed to adequately display their rating on their public website in line with relevant legislation. This was a breach of regulation.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Cherry Tree House is a residential care home providing accommodation and personal care for up to 34 older people aged 65 and over. The home is arranged over two floors. At the time of our inspection 25 people lived at the service.

People’s experience of using this service

People at Cherry Tree House did not receive a safe, effective or well-led service.

At the last inspection, we found concerns relating to infection prevention and control, staffing and quality assurance systems were not effective. At this inspection we identified the same areas required improvement.

Risks to people were not always identified and safely managed. Medicines had not been managed safely. People had not always received their medicines as prescribed.

There were concerns relating to people’s safety; a lack of guidance and training for staff on how to support people in the event of a fire put people at risk of harm.

Safe recruitment processes had not been followed. Systems had not been maintained to calculate safe staffing levels and there were not always sufficient numbers of staff on duty. People described delays in care support, and we observed staff were overstretched in meeting people’s needs. There was a lack of meaningful activities for people.

The service did not have sufficient infection prevention and control measures in place; government guidelines for working safely in care homes during the COVID-19 pandemic were not fully implemented or adhered to.

The service was not well-led. The provider had not taken adequate steps to monitor the service and to make sustained improvements. Audits had not been used effectively to monitor quality and safety issues.

Improvements had been made to many areas of the environment through reorganisation, renewal and redecoration. This had supported the maintenance of improved standards of hygiene.

Staff had access to training, supervision and support. Some staff with responsibilities for administering medicines had not had their competency assessed regularly and we made a recommendation about this.

Menus provided choices and alternatives, we received mixed feedback about the meals. Any concerns regarding nutrition or other health needs were referred to health care professionals.

Staff knew how to protect people from the risk of abuse and harm. The registered manager had used safeguarding reporting systems when 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.

The provider had begun responding to concerns and had acted to make sure enough staff were deployed. Whilst some feedback recognised recent changes, further sustained improvements were needed.

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 8 December 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, shortfalls in care support and staff not wearing appropriate personal protective equipment. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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 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 safe care, staffing, fit and proper persons employed and good governance. You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Tree House 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.

Special Measures:

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Cherry Tree House is a residential care home providing accommodation and personal care for up to 34 older people aged 65 and over. The home is arranged over two floors. At the time of our inspection 14 people lived at the service.

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

The service was not always clean and at times staff were expected to undertake cleaning duties within their caring role. Some furniture and fittings were damaged which meant these areas could not be effectively cleaned. Areas of the service needed redecoration and maintenance. The registered manager was not adequately monitoring the standards of cleaning.

Staffing levels needed to be reviewed as care staff were also responsible for additional duties including laundry and cleaning, which took them away from their caring role. Accidents and incidents were monitored and investigated, though records did not always evidence what was learnt.

Quality assurance systems were not effective and failed to identify shortfalls which placed people at risk or receiving a poor-quality service.

Processes were in place for reporting safeguarding concerns and people told us they liked the staff, felt safe and were happy in the service. People's medicines were administered safely. The provider's recruitment processes helped ensure only suitable staff were employed.

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 had worked at the home for a long time and morale was good as they felt valued and supported by the registered manager. Staff worked closely with relevant professionals.

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

Rating at last inspection

The last rating for this service was good (published 21 June 2018).

Why we inspected

We inspected to look 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.

We found there was a concern with infection control so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-led. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cherry Tree House Care 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.

We have identified breaches in relation to infection control and addressing quality shortfalls 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Is the service safe?, Is the service responsive? and Is the service well-led?, to at least good. They sent us an action plan stating when and how they would achieve the improvements needed.

At this inspection the provider’s deployment of staff was sufficient to meet people’s needs, activities were taking place and we had been told about all events that required a notification being sent to us. However, there was some improvement needed with regard to medicines management, to ensure the store room remained below the recommended temperature for storing medicines and those to be returned were safely accounted for. The registered manager assured us these would be addressed. The service was rated as Good.

Cherry Tree House is situated in the Ashby area of Scunthorpe close to local shops and amenities. The home is registered to provide accommodation and personal care for up to 34 people, some of whom may be living with dementia. Communal rooms: lounge, dining and bathroom, are located on two floors along with people’s bedrooms, so that the premises are sectioned into four wings. Staff, catering and laundry facilities are all on the ground floor. An enclosed garden provides a safe outdoor space where sheltered seating is available. At the time of this inspection there were 12 people permanently living at Cherry Tree House and three people staying there on respite.

Cherry Tree House 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.

The service had a registered manager who had been in post for the last 25 years. 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 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 protected from the risk of harm. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of safeguarding concerns. The premises were safely maintained. Accidents and incidents were appropriately managed and equipment was safely used. Recruitment policies, procedures and practices ensured staff were suitable to care for and support vulnerable people. People were protected from the risks of infection and disease by good infection control management. Lessons were learnt when things went wrong.

People made choices and decisions wherever possible in order to exercise control over their lives. They were supported by qualified and competent staff that were regularly supervised and received annual appraisals of their personal performance. Staff respected people's diversity and met their individual needs. People’s nutrition and hydration needs were met. The provider worked well with other health and social care professionals. People were supported with their health care.

The premises were suitable for providing care to people with dementia but needed improved signage to aid people's orientation around the building. People’s mental capacity was appropriately assessed and their rights were protected. 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. Consent from people was appropriately obtained before they were supported.

People received compassionate care from kind staff who knew about people’s needs and preferences. People were involved in their care and the right to express their views was respected. People’s wellbeing, privacy, dignity and independence were monitored and respected.

People were supported according to individual person-centred care plans, which reflected their needs well. These were regularly reviewed. People maintained family connections and support networks and their communication needs were assessed and met. There was an effective complaints procedure in place and people’s complaints were addressed. Staff sensitively managed people’s needs with regard to end of life preferences, wishes and care.

Quality assurance systems were effective. Audits, satisfaction surveys, meetings and handovers ensured there was effective monitoring of service delivery. The culture was person-centred, open and inclusive and ensured good outcomes for people. The registered manager understood their responsibilities with regard to good governance and practiced a management style, which was open and approachable. Engagement and involvement of people, public and staff was evident.

The registered manager looked for new ideas around best practice, updated their learning and practice whenever possible and improved the service delivery. They fostered good relationships with other agencies and organisations.

Further information is in the detailed findings below.

Cherry Tree House is situated in the Ashby area of Scunthorpe close to local shops and amenities. The home is registered to provide accommodation and personal care for up to 34 people some of whom may be living with dementia. At the time of our inspection there were 23 people using the service.

We undertook this unannounced inspection on the 8 and 13 February 2017. The service was last inspected in November 2014, when it was found to be compliant with the regulations inspected and was rated as good.

There was a registered manager in place. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were not enough staff available to meet people’s needs, which meant their health, safety and welfare was potentially placed at risk. This was a breach of the staffing regulation and meant the registered provider was not meeting the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.

Safeguarding training had been provided to enable care staff to recognise and report potential signs of abuse. Recruitment checks were carried out to ensure care staff were safe to work with people who used the service. Risks to people were monitored and assessed, although accidents had not always been appropriately reported which meant people’s health and wellbeing was potentially compromised at times. This was discussed with the registered manager who acknowledged this was an oversight on their behalf. People’s medicines were administered in a safe way, by care staff who had received training on this aspect of their role.

Care staff were provided with a range of training opportunities to help them develop their careers and carry out their roles. People received a choice of nourishing home cooked meals and were consulted about their care and support. Community based health care professionals confirmed the service had good working relationships with the service.

Care staff were familiar with people’s needs and we found they had developed strong relationships with people. Care staff involved people in decisions about their support, to ensure their wishes and feelings were respected.

Opportunities for people to meaningfully interact with staff in activities was sometimes limited, which meant their health and wellbeing was not always fully promoted. People were able to raise concerns and complaints and have these investigated and resolved wherever possible.

People who used the service, their relatives and staff had confidence in the registered manager. Management checks were carried out to enable the quality of the service to be assured, although accidents and incidents had not always been reported to the CQC as required. Action was not always taken address shortfalls when noted to enable improvements when required.

People were provided with a choice of suitable and nutritious food and drink. We visited the kitchen and looked at the weekly menu. The cook told us the menus were changed every four weeks. We saw there were choices of different foods and options for people who had special dietary needs.

We looked at the laundry facilities. There was a process for segregating clean and dirty laundry. This ensured the risk of cross contamination was minimised. We also found there were suitable arrangements in place for the handling and disposal of clinical waste. The manager told us that regular checks were carried out of the environment and we saw cleaning rotas were in place and checks regarding cleanliness of facilities were completed.

The manager told us that they were always willing to listen to complaints and deal with them in the appropriate manner. Staff we spoke to said they would not hesitate in contacting the manager if they had a problem. One member of staff said, "If I passed on a complaint to my manager I know it would be listened to and acted on effectively."

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We looked around various parts of the service. We found it was clean and free from odours.

We saw that staff demonstrated a caring and professional manner that was open and friendly. We observed that staff interacted with people in a positive and encouraging way and involved people in decisions about their support. One person said that staff were 'Like Angels'.

People told us they were 'Very comfortable' and that staff treated them well. People that used the service said they had 'No concerns' about the home.

We found that appropriate recruitment checks were carried out, before staff had begun working in the home to ensure they were safe to work with people that used the service.

We saw evidence of regular meetings and surveys of people's views to enable them to be consulted and contribute ideas and suggestions for the home. We saw that systems were in place to enable the health, welfare and safety of people that used the service to be monitored effectively by the provider.