Prospect House Care Home

Prospect 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. Prospect House is registered to provide accommodation and personal care for up to 24 people. There were 22 people living at the service at the time of the inspection.

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

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 or their representative were not always actively involved in their care planning. Care plans lacked person-centred details and did not contain enough information to guide staff on how to support people safely.

Not all health and safety checks were routinely carried out, we identified the lift was being operated without a valid Loler certificate. This had not been identified by the registered manager.

Medicines were not always safely stored and monitored, we found medication that required storing in the fridge left on the side. Protocols in place for as and when required medication lacked person centred detail to enable staff to recognise when to utilise this medication, how much was required and its effectiveness.

Not all staff had received mandatory training to enable them to support people safely, this was discussed with the registered manager and refresher courses were being provided.

Safe recruitment policies were in place however they were not always followed, gaps in employment were not always accounted for.

We observed limited activities taking place throughout the inspection. People were not actively encouraged to participate and were observed to be sitting in the same place for long periods of time.

People’s fluid and nutrition was not always accurately recorded as it was not documented at the time, records were often updated sometime after support had been provided and on the reliance of the carer being aware of what each person had drank and eaten.

Not all people’s dietary requirements were catered for, there was no alternative meal option for people with diabetes.

We observed positive and caring interactions between staff and people who lived in the home. Staff knew the people they supported well. Management was visible in the home and knew people well however governance systems were in effective and did not drive improvements.

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 inspection was carried out (published 02 May 2018) with a rating of good.

Why we inspected

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Prospect House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to support not being carried out in the least restrictive way and consent not being sought in line with the Mental Capacity Act 20025. Risk assessments and care plans were not updated frequently and lacked person centred details. Staff did not all have the mandatory training to support people safely. Governance systems that were in place were ineffective and did not identify concerns found during this inspection. Concerns were raised regarding the deployment and number of staff working within the home.

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

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.

Residents were able to see and speak to their loved ones whilst maintaining social distancing. Window visits, telephone and video communications took place via a booking system and visitors to the home were limited to professionals. At the time of the inspection arrangements were being set up for a nominated visitor to enter the home and a suitable station had been set up with infection control measures in place.

Good practices of infection prevention and control were being maintained and staff were seen to be wearing appropriate PPE throughout. We were told that visiting professionals generally arrived wearing their own PPE and did not put it on or remove it inside the home. However, a specific room with full PPE had been created at the time of inspection and the home planned for all visitors, including professionals to use this area for entry and exit.

There was a policy in place should people need to isolate and risk assessments and plans had been implemented where isolation was challenging.

COVID-19 testing was undertaken weekly for all staff and monthly for residents who were able and willing. Care staff and residents were part of a vaccination programme and arrangements had been made for anyone who had missed the first dose.

The home itself was going through some refurbishment to improve infection prevention and control throughout.

Further information is in the detailed findings below.

The last inspection of the service was carried out in January 2017 and during that inspection we found breaches of regulations in respect of the management of medication and assessing and monitoring the quality and safety of the service. 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, effective, caring, responsive and well-led, to at least good.”

During this inspection we found that the required improvements had been made.

Prospect 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. Prospect House is registered to provide accommodation, personal and nursing care for up to 24 people. There were 21 people living at the service at the time of the inspection.

The person registered with CQC as the manager of the service no longer works there. A new manager has been appointed and they are in the process of applying to CQC to become the registered manager. 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.

Improvements had been made to the management of medication. Safe procedures were followed for storing, administering and recording medication. Medication was ordered and obtained in good time to ensure that people received all their prescribed medication when they needed it.

Improvements had been made to the systems for checking on the quality and safety of the service. There were effective systems in operation for checking on aspects of the service and making improvements.

The environment had undergone some improvements since the last inspection making it more comfortable and suitable for people living with dementia. Improvements included the redecoration and refurbishment of some areas. The management team and staff were constantly looking at ways to further improve the environment for people living there.

People told us they felt safe living at the service. They were protected from abuse and harm because staff understood how to recognise and report safeguarding concerns. Risks to people and others were assessed and managed safely. This included risks associated with aspects of people’s care and the environment.

The environment was clean and hygienic and smelt pleasant throughout. Staff followed good infection prevention and control practices such as the use of personal protective equipment (PPE) to help minimise the spread of infection.

Safe recruitment processes were followed. The suitability of staff was assessed prior to them being offered a position. This included checks carried out with previous employers and a check on their criminal background. There were sufficient numbers of suitably skilled and experienced staff to meet the needs of people and keep them safe.

Staff received training and support for their role. New staff completed induction training to learn their role and they were provided with ongoing training in areas of health and safety and topics relevant to people’s needs. Staff received an appropriate level of support through one to one supervisions, appraisals and staff meetings.

People’s nutritional and hydration needs were understood and met. People were given a choice of food and drink which was prepared in accordance with their likes, dislikes and dietary requirements. People received the support they needed to eat and drink in a pleasant and relaxed and environment.

People were supported to access appropriate healthcare services as and when they needed to. Staff recognised when there was a decline in a person’s health and wellbeing and took the appropriate action. This included prompt contact with GPs and referrals to other health and social care professionals.

The registered manager and staff had good knowledge and understanding of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. The registered manager worked alongside family members and relevant health and social care professionals to ensure decisions were made in people’s best interests when this was required.

People were treated with kindness and compassion and their privacy, dignity and independence was respected. Staff knew people well and had formed positive relationships with them and their families. People and where appropriate their family members were encouraged to express their views and be involved in making decisions.

People were involved along with relevant others in assessing and planning of their care. People’s wishes and preferences were obtained and captured in their care plans. Care plans were kept under review and updated with any changes as they occurred so that staff had the information they needed to meet people’s needs in the right way. People’s end of life wishes were respected.

People were given the opportunity to able to take part in a range of group and individual activities. Profiles detailing people’s backgrounds, life history, things of importance and personal preferences were developed. These provided staff with a good insight into people’s past lives and lifestyle choices enabling them to engage people in conversations and activities of interest.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff all described the manager as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service.

Prospect House is a care home registered to provide accommodation and personal care for up to 24 adults, there were 24 people using the service at the time of our inspection.

The service did not have a manager who was registered with the Care Quality Commission. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager who was in post at the time of our last inspection in July 2016 resigned from their post shortly after the inspection. A new manager has been appointed and was due to commence work on 24 January 2017. At the time of this inspection the deputy manager and business manager were responsible for the day to day running the service.

The last comprehensive inspection of the service was carried out in July 2016 and we found that the service was not meeting all the regulations. We asked the registered provider to take action to make improvements to the management of people’s medication, safeguarding people, prevention of infection, protection of people’s rights, staff training, meeting people’s needs, and record keeping. The registered provider sent us an action plan following the inspection detailing how and when they intended to make the improvements. During this inspection we found improvements had been made. However we found further improvements were required in relation to the management of people’s medication.

Improvements had been made to the management of medication; however we found further improvements were needed. Controlled Drugs (CDs) (medicines controlled under the Misuse of Drugs legislation and subsequent amendments) were not regularly checked. Medications prescribed by a doctor were not available for some people at the service because stocks for some people had run out. Care plans to instruct staff on the application of topical creams where not always in place.

Improvements had been made to the systems for checking on the quality of the service and making improvements. More robust audits had taken place to check on aspects of the service such as people’s care records, medication, and the safety of the environment. Action plans were developed to address any identified areas for improvement and they were made promptly to mitigate risks to people and others. However checks failed to identify and drive improvements to the management of people’s medication and associated records.

We have made a recommendation about making the environment more dementia friendly. The environment had been improved since the last inspection, which included some redecoration and deep cleaning of some areas which were unhygienic. However there was a lack of stimulus and signage to help orientate and stimulate people living with dementia.

Improvements were made in relation to maintaining people’s safety. Following an incident or accident follow up action had been taken to identify why incidents had occurred and how they could be prevented from happening again in the future. Falls were closely monitored and appropriate referrals were made to the falls team for assessment.

People’s rights and liberties were protected in line with the Mental Capacity Act 2005. The use of CCTV inside the service had been disconnected in the best interest of people’s rights, privacy and dignity. Staff had completed training in the Mental Capacity Act 2005, and they had an understanding of the basic principles of the act.

The right amount of suitably skilled and qualified staff were on duty to meet people’s needs and keep them safe. People told us that they thought there was enough staff on duty to keep them safe and this was echoed by family members. Improvements had been made in relation to staff training. Staff had undertaken training relevant to their roles and the needs of the people who used the service.

A full review of people’s care had taken place and their records were updated to reflect their current and changing needs. Care records were written in a more personalised way to reflect people’s wishes and preferences about the care and support they received. Monthly reviews of each person’s care had been planned to ensure people’s needs were being met. A consistent approach is needed to ensure care records are kept under review and up to date so that they accurately reflect people’s needs.

The registered provider had notified us as required by law, of events that occurred within the service.

Improvements had been made in the way that staff communicated with people who were unable to verbalise and with those who had difficulty reading. Options available on the day’s menus were presented using photographs of the actual meals and staff communicated with people using flash cards and by exchanging written information.

People’s privacy, dignity and independence was promoted and respected. Staff comforted and reassured people who were upset and anxious. People were engaged in activities of their choice and staff respected the wishes of those who chose not to participate. People had the choice of spending time amongst others in the main lounge or in one of two other quiet lounges.

People told us they felt safe at the service and that staff treated them well. Staff knew the different types and potential signs of abuse and what their responsibilities were for reporting any incidents which impacted on people’s safety. Risks to people where identified and measures were put in place to keep people safe.

People’s nutritional and hydration needs were assessed, planned for and appropriately monitored. Staff had access to guidance to help them recognise when a person required input from an external professional such as a dietician and/or speech and language therapist and referrals were made promptly when a concern was identified.

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

Prospect House provides accommodation for people who require personal care, and supports older people living with dementia. The service is registered to accommodate up to 24 people, and at the time of the inspection there were 17 people using the service.

The service had not had a registered manager in post since January 2016. At the time of the inspection there was a manager in post who was in the process of applying to CQC to become the registered manager. However following this inspection we were informed that the manager had left the service before their application to become registered manager had been processed. A deputy manager and business manager were in post to support with the running of the service whilst the registered provider was recruiting for a replacement manager. 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.

During our inspection we identified multiple breaches of the Health and Social care Act 2008 (regulated activities) 2014. We will publish the actions we have taken at a later date. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. As a result of serious concerns found during the inspection we raised two safeguarding referrals to the local authority for investigation.

We identified a number of issues around the safe storage and administration of people’s medicines. These issues had also been identified by staff working for St Helens Contracts and Commissioning Group (CCG), during a medicines management audit in April 2016. At our inspection we found that limited action had been taken to complete the action plan outlined by the CCG. This placed people at risk of harm due to medication errors. There were no quality monitoring processes in place by either the manager or the registered provider. This meant that areas of improvement could not be identified and acted upon.

People’s safety was not always maintained, and follow up action had not been taken to identify why incidents had occurred, or how they could be prevented from happening again in the future. For example one person had sustained serious bruising, however no action had been taken to identify what had caused this, or to report this to the local authority. The registered provider had failed to carry out checks on the water supply to ensure they were free of dangerous bacteria, and there were parts of the environment which were unclean and dirty, which placed people at risk of infection. This meant that people were at risk of harm and ill health.

People’s rights and liberties were not always protected in line with the Mental Capacity Act 2005. Mental capacity assessments had not been completed for people requiring covert medication, and the correct procedure had not been followed with regards to the use of CCTV that was in place. Staff had not completed training in the Mental Capacity Act 2005, and were not aware of their roles and responsibilities in relation to this. For example, one person was having covert medication administered without due regard being given to whether this was in their best interests. This placed people at risk of having their right and liberties undermined.

Staff had not undertaken the training necessary for them to carry out their role effectively. For example a majority of staff had not recently completed training in Dementia awareness, infection control or moving and handling. There was an induction process in place for new members of staff, however this did not work to the current standards required by the Care Certificate.

The registered provider is required to give due regard to the protected characteristics outlined in the Equality Act 2010. We found examples where adequate consideration had not been given to ensuring that people’s needs were met with regards to their disabilities, or religious and spiritual needs. This meant that people’s rights and dignity were not always maintained.

Care records did not always contain accurate, up-to-date or personalised information. There was a review process in place, however there were multiple examples which showed that this process was not robust where information had not been updated to reflect changes. This meant that adequate information was not always available to ensure that people who used the service received safe care.

The registered provider is required by law to notify us of certain events that occur within the service. We found multiple examples where this had not been done, or had not been done in a timely manner. This meant that the registered provider was not acting in accordance with the law.

The registered provider is required to demonstrate that they have an appropriate understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and understand the consequences of failing to take action on set requirements. However the number of breaches of the Regulations identified showed that the registered provider did not have a sufficient understanding of their roles and responsibilities in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us that they enjoyed the food that was on offer. People were given a choice of second helpings and staff provided people with the support and assistance they needed at meal time. Menu options were presented in written and photographic format to support those people who had difficulty reading. However the photographic menu was not updated to reflect the choices available during the two days of the inspection. This undermined the dignity of those people who were unable to read the written menu.

People told us that staff were respectful, and we saw examples where staff treated people with kindness. Care records containing people’s personal information were stored securely which ensured that their confidentiality was being maintained.

There were activities available for people and they told us that they enjoyed these, and felt that there was “plenty to do”. A local volunteer group were visiting people at the time of this inspection, and another volunteer group had previously visited the service, and spent time gardening with people. This ensured that people had the social interaction they needed, and that they remained involved with the community.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection of Prospect House, speaking with people who used the service, the staff supporting people and from looking at various records.

Is the service safe?

We carried out a tour of the premises and saw that it was safe in the areas that people occupied and lived. We observed that up to date fire extinguishers and portable appliance checks had been carried out and were found to be suitable and safe to use.

Some of the people living Prospect House during our inspection had complex needs which meant they were not able to tell us their experiences.

We saw members of staff positively interacting with the seven people who lived in the home. On the day of our inspection it was quite warm and we observed members of staff providing cold drinks to people throughout the day.

In discussion and in observation, we saw that people were relaxed and at ease. One person told us they were content and treated with respect and dignity.

We found satisfactory safeguarding procedures in place, with staff having had up to date safeguarding training in order to recognise any potential issues and take appropriate action.

Is the service effective?

We spoke with the members of staff who were on duty throughout the day and they all demonstrated that they had a clear understanding of people's needs and how to meet them.

We found that people's health and care needs had been appropriately assessed, with peoples care plans being detailed and the newly reviewed care plans being more person centred and individualised.

Is the service caring?

During our inspection we observed that members of staff were attentive, caring and enthusiastic about meeting the needs of people who lived in Prospect House. We saw people positively responding to members of staff, which showed that a good rapport existed between them.

Throughout our inspection we saw that people were treated with dignity and respect by the staff. Some of the staff comments were, 'It's much better now, improving all the time', 'It's a lovely place to work now' and 'It's a lot better and I mean a lot better . We have much more time with the residents'.

Is the service responsive?

During our inspection we saw written evidence that highlighted when any issues had been identified; the service had responded and addressed them.

In reviewing people's care plans we saw that assessment reviews had taken place, with appropriate changes made to help ensure that people's needs were met.

We saw members of staff responding to people's requests in a prompt, skilled and knowledgeable way.

Is the service well-led?

The service had a manager registered with CQC in post. Prospect House Care Home had quality assurance monitoring processes in place. We saw that the service sought the opinions and views of people who lived in the home and also when possible sought the views of their relatives.

The registered manager at Prospect House had been in post since February 2014 and it was clear that improvements regarding the daily running of the home had taken place. Some of the staff comments were, 'I don't know where this manager has been all of our lives' and 'The home has improved so much since the new manager came'.

We saw documented evidence that staff team meetings had been taking place.

We saw that audits to monitor the quality of service delivery were in place including, medication audits, accident audits and records of completed accident forms, with appropriate and relevant action recorded. We were informed that no complaints had been made since our last inspection.

We were informed by the local authority's contract monitoring unit that they had seen some positive changes with the new manager and the provision of care had also improved.

Prospect House has been non-compliant in a number of the regulations, since February 2013. Since then we (Care Quality Commission CQC) have carried out six inspections, including this one. The providers were issued with Warning Notice's in July 2013 and in November 2013, further enforcement action was taken. We carried out this inspection to assess if any of the areas of non-compliance had been addressed. At the time of our inspection we spoke with the seven people who were living there.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Is the service safe?

We carried out a tour of the premises and saw that it was unsafe in some areas. We saw a number of fire doors wedged open with both door wedges and chairs. A number of vacant bedrooms on the ground floor had bad odours including urine and a smell of fire damage. The outside balcony areas to some of these rooms were crumbling, which created a high risk of trips and falls. The window frames in some of these rooms were rotting.

We saw an electricity meter cupboard with a sign stating 'danger of death' to be kept locked was open and accessible to all.

We observed that up to date fire extinguishers and portable appliance checks had been carried out and were found to be suitable and safe to use.

Some of the people living in Prospect House during our inspection had complex needs which meant they were not able to tell us their experiences. Two people, when asked if they felt safe? They replied yes. We saw members of staff positively interacting with people who lived in the home. People were treated with dignity and respect. In discussion and in observation, we saw that people were relaxed and at ease with the care staff.

We found satisfactory safeguarding procedures in place, with all staff having had up to date safeguarding training. We also saw that the majority of staff had received Fire Safety and Health and Safety training.

Staff recruitment records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work for the service were suitable and had the skills and experience needed to support people living in Prospect House.

Is the service effective?

We spoke with the members of staff who were on duty throughout the day and they all demonstrated that they had a clear understanding of people's needs and how to meet them.

We saw that staff training and staff supervision was consistent and up to date. This helped to demonstrate that the staff employed to work for the service had received the correct training and support to meet people's needs.

We found that people's health and care needs had been reassessed, with people's care plans being reviewed and updated to reflect their changing needs.

Is the service caring?

During our inspection we observed that staff were attentive, caring and enthusiastic about meeting the needs of people who lived in Prospect House. We saw people positively responding to members of staff, which showed that a good rapport existed between them. We saw that people were treated with dignity and respect by the staff.

Some of the staff comments were, 'I love working here, and it's a much better atmosphere for us (staff) and the residents' and 'We now have more staff, which means we can spend more time with the residents'.

Is the service responsive?

Prospect House had some quality assurance monitoring processes in place. We saw questionnaire surveys that had been returned by relatives of people who lived in the home. The comments were positive; however there were no dates on the survey forms. The manager informed us that there is a garden party planned for June and they will hand out quality monitoring surveys to families and any other visitors to the home and will try and get comments from people on the day.

We saw that audits to monitor the quality of service delivery were in place including, medication audits, accident audits and records of completed accident forms, with appropriate and relevant action recorded. We saw that other audits had taken including, care plan audits, staff file audits and infection control audits. There was a new 'Comments and Suggestions' box prominently situated in the entrance to the home.

Is the service well-led?

The manager at Prospect House has been in post for three months and it was clear that some improvement regarding the daily running of the home had taken place. Some of the staff comments were, 'It's much more organised here now, you know what you are supposed to be doing' and 'The manager is really approachable. All of the staff get on better. I am not thinking of leaving anymore'.

We were informed by the manager that they were in the process of developing the policies and procedures for the home. For example, dementia care diversity in care; safe and positive touch; safeguarding; nutrition and dignity; equality and moving and handling.

At this inspection we saw that improvements had not been made.

We saw that care and welfare remained in need of improvement. At this inspection we found risks to people's care and welfare had not been identified or plans put into place to protect the people living in the service.

Records within the service were not sufficient to make sure staff consistently delivered and monitored the care of people living in the service.

We also saw that not all staff had received training to meet people's assessed needs to enable them to provide the care and support they needed.

People living in the service were at risk of poor nutrition. Diets and fluids were not monitored in order to make sure that instructions from dieticians were carried out.

There have been 11 safeguarding concerns raised since the last inspection. Three of these have been upheld as neglect by social services at meetings that the manager attended and the rest remain as ongoing investigations both by social services and the police.

At this inspection we saw that improvements had been made to the environment. This had included replacing furniture, improving lighting and repairing fire doors.

We saw that care and welfare remained in need of improvement. At our inspection there had not been sufficient staff to meet the needs of people living in the service. This had resulted in staff being unable to deliver care and support to at least two people. Following our inspection we referred both people to social services safeguarding for investigation of potential abuse.

Records within the service were not sufficient to make sure staff could consistently deliver and monitor the care of people living in the service.

Observations during our inspection showed that equipment that had been agreed as unsuitable by relevant professionals was not in use. We also saw that not all staff were skilled in communicating effectively with people with assessed dementia care needs. We saw staff giving people food with no interaction and no explanation as to what the food was.

There were no effective arrangements in place to check the quality of the service and plan how improvements were made.

We spoke with some of the people living in the home and found their feedback was positive. Some of the comments were, 'It's a nice place and nice food' 'The homes okay, the girls are really good' and 'I love the place, I'm fine thank you'.

During our inspection we observed positive interactions between members of staff and people living in the home. We saw members of staff speaking to people in a calm and sensitive manner and encouraging people to get involved in different activities. It was a sunny day and some people were sitting outside, enjoying the nice weather. People wore hats and sat under sun umbrellas to protect them from the sun.

We carried out a tour of the premises and found a number of areas that were in need of attention, which would help ensure that people living and working in the home are safely protected.

We looked at the homes records including care records, medication, maintenance records, staff training and supervision records. We found the care records to be lacking in sufficient detail, with which to appropriately inform staff of peoples care needs. The medication, training and supervision records were satisfactory. The training and supervision records for staff showed they had received relevant and appropriate training and supervisions.

We observed that some people who lived at the home were not receiving the appropriate level of nutrition or the support to eat their meals, which they had been assessed as needing.

We looked at the level of staffing, the qualifications, skills and experience of the care workers. We found that two of the staff on duty during our inspection had not undertaken any training in the delivery of personal care and one member of staff said they felt uncomfortable providing personal care on their own.

We looked at the recruitment process within the home and we saw there were some shortfalls in the recruitment procedures. This potentially placed people who lived in the home at risk.

We found there was a strong smell of urine in some areas of the home; this was both human urine and a smell of urine from the cats, which lived in the home.

These issues were relayed to the Registered Manager at the end of our inspection.

During our inspection we identified some areas for improvements with the record keeping. There was a risk peoples needs would not be met and the quality of care compromised if the records are not detailed and person centred. The systems in place to monitor the quality of the service did not always identify the shortfalls. We found there was a commitment to staff training but some staff had not received training relevant to their role. Other concerns were in relation to omissions in reporting notifications to Care Quality Commission (CQC) and a shortfall in the management of a person's prescribed medication. The provider told us action would be taken to address shortfalls identified during this inspection.