Maidstone Care Centre

Maidstone Care Centre is a residential care home providing personal and nursing care to up to 58 people. At the time of our inspection there were 52 people using the service. The service provides support to people who may be living with dementia who require support and nursing care. The service is arranged over 3 floors with lift access.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

There were not enough staff employed to meet people’s needs. The service employed large numbers of agency staff, these were not always regular agency staff. People were not consistently supported by staff who knew their needs. Potential risks to people’s health and welfare had been assessed but there was not always guidance in place for staff to mitigate all the risks.

Medicines were not always managed safely. Accidents and incidents had been recorded and some analysis had been completed but more detail was needed to reduce the risk of them happening again. The provider had organised bespoke dementia training for staff, however, very few staff had attended, and the recommendations had not been consistently deployed.

There had not been a consistent management team in place to drive improvement and the service continued to be in breach of regulations. Audits had been completed but action had not always been taken to rectify the shortfalls identified. A new manager had started the week of the inspection, they had already identified most of the shortfalls found at this inspection. Following the inspection, they supplied evidence of the improvements they had put in place.

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.

People were supported to remain as independent as possible, and their privacy was respected. People and relatives were invited to meeting to express their concerns and suggestions, the provider had responded to suggestions, including the employment of a receptionist at the weekend. Complaints had been investigated and apologies given when the complaint had been upheld.

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 27 July 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to risk management, staffing levels and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

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.

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 based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 Maidstone Care Centre on our website at www.cqc.org.uk.

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.

Maidstone Care Centre is a residential care home providing accommodation and personal and nursing care to up to 58 people. The service is arranged over three floors with lift access. At the time of our inspection there were 57 people using the service. Peoples’ needs varied and included people with diabetes, complex nursing needs and people living with dementia.

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

Peoples’ risks were not always managed safely and care plans were not always accurate or person centred. People were not engaged in activities as much as they would like. Medicines were not managed safely and lessons had not always been learned after incidents.

Quality monitoring processes, such as audits, were in place but were not effective in identifying concerns. Action plans had not been implemented or monitored to drive improvements.

The service was clean and well decorated and infection control was safely managed.

People and their relatives told us they felt safe living in the service and staff were kind and caring. One person said, “I feel safe here; it is the people around me that make me feel safe.” Another person said, “I definitely feel safe, everyone is very caring.” One relative said, “[Relative] is completely safe there. The staff are very caring.”

People received care which promoted their dignity and encouraged independence. Relatives told us they were involved in their relative’s care plans and were kept up to date with any changes. Staff training was up to date.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

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

At the last inspection (published 8 October 2021) the service was rated requires improvement and had continued breaches of regulations 12 (safe care and treatment), 13 (protecting people from abuse and improper treatment) and 17 (governance). At this inspection we found some improvements and the provider was no longer in breach of regulation 13, but there were continued breaches of regulations 12 and 17.

Why we inspected

The inspection was prompted in part due to concerns received about risk assessments and care monitoring, lack of activities and quality assurance processes. A decision was made for us to inspect and examine those risks. We also followed up on actions we told the provider to take at the last 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.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

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 repeated breaches in relation to safe care and treatment and good governance and a new breach in relation to person centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maidstone Care Centre is a care home providing personal and nursing care for up to 58 people. At the time of inspection, 54 people were using the service. The service supports people who are living with dementia and people who are cared for in bed. The building consists of three floors, the ground and first floor support people needing nursing care. Residential care is provided on the second floor.

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

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with 2 people to tell us their experience.

People told us they liked living at the service. One person said, “I like living here, people are honest”. Relatives also told us they were happy with the service, one relative told us, “She [relative] is getting everything she needs”. However, we identified shortfalls in the care that was being provided by the service.

Aspects of people’s care plans had not always provided enough guidance for staff to support people in the best way possible. Clear guidance was not always in place for staff to support people who could exhibit episodes of distressed and anxious behaviour.

The registered manager had systems in place to check the quality of the service. This was effective in some areas, for example, infection control and medication. However, quality checks of training and peoples risk plans were not always effective.

Medicines were being managed safely and staff understood their roles regarding administering medicines safely.

Infection control practices followed the current government guidance for the use of Personal Protective Equipment (PPE) in care homes. The registered manager ensured staff complied with the current guidance to keep people and staff 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.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 02 December 2020). There were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 August 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when. This included how they would improve the quality of care and keeping people safe.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The inspection was also prompted in part by notification of a specific incident where a person using the service sustained a serious injury. This incident was later closed by the police and not subject to any criminal investigation.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maidstone Care Centre 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 have identified breaches in relation to safe care and treatment, safeguarding and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People spoke positively about the home and were complimentary about the staff and new manager. Comments included, “It’s a warm and welcoming home, all of the staff are kind” and, “I have no concerns or worries about living here, everything I need is taken care of.” However, we identified shortfalls in the service provided to people.

Aspects of people’s care plans were detailed and provided clear guidance to staff. However, care had not always been planned to mitigate all risks to people. Where some people had specific health conditions, or experienced behaviour which could be challenging, guidance about how to best support them was not in place.

Although staff had received training about safeguarding, people were not safeguarded from abuse. We found instances where safeguarding matters had not been brought to the attention of the manager and had not been referred to the local authority safeguarding team for investigation.

A system was in operation to check the quality of the service. This had not been fully effective and shortfalls we found had not been identified. Other checks had identified shortfalls, and these had been addressed. Accidents and incidents were analysed, and action was taken to make sure they did not happen again.

The manager was relatively new in post. People and staff told us they felt supported by them and they had acted quickly to make improvements. People and staff had been asked for their views of the service and these had been used to improve the service. The manager was working to an action plan to improve the quality of the service.

Medicines were managed safely and staff worked with other professionals to ensure people’s needs were met and processes were up to date.

Infection control practice in relation to the latest COVID-19 government guidance for the use of PPE in care homes was followed to keep people and staff safe.

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 Good. (Published 25 January 2018).

Why we inspected

We undertook this focused inspection in response to concerns received about the safe care and treatment of people using the service and the governance of the service. This report only covers our findings in relation to the Key Questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated 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 Maidstone Care Centre 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 have identified three breaches in relation to risk management, safeguarding and checks and audits 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 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.

Maidstone Care Centre provides residential and nursing care and accommodation for up to 57 older people, some of whom may be living with dementia. The accommodation is arranged over three floors with a unit on each floor. Units are called Medway, Rochester and Pembury. People who required nursing care live on the ground and first floor units and residential care is provided on the second floor. A passenger lift is available to take people between floors. There were 48 people living at the service at the time of our inspection.

At our last inspection, in July 2016, we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk to individuals' safety, people’s care plans were not person-centred, activities were not available to meet people’s needs, notifications and safeguarding concerns had not been raised with the local authority or with the CQC, people were being unlawfully deprived of their liberty, people’s nutrition and hydration needs had not been met, staff had not been trained to meet people’s needs, recruitment practices were not safe and governance systems. This inspection took place to check that the registered provider had made improvements in these areas. We found that improvements had been made, and the breaches were now met.

There was a registered manager based at the service who was supported by a deputy 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.

People told us they felt safe living in the service with the staff that were supporting them. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Potential risks to people in their everyday lives had been assessed and recorded. The premises and equipment were maintained and checked to ensure the safety of people, staff and visitors. Accidents and incidents involving people had not been consistently recorded. Records showed staff had not always completed the required documentation or had the persons’ care records been updated as a result of an accident. Following our inspection the registered manager implemented a guide to inform all staff of the correct procedure.

People’s care plans were personalised and gave staff the information and guidance to meet people’s needs. Care plans contained information about people’s preferences and life histories. People were supported to participate in a range of activities to meet their needs. Independence for people was encouraged and promoted. People were supported to make choices and decisions and staff followed the principles of the Mental Capacity Act 2005.

People had access to the food that they enjoyed and were able to access drinks and snacks throughout the day. People’s nutrition and hydration needs had been assessed and recorded. People were supported to maintain their health with the support of health care professionals. Medicines were stored and administered safely.

Care and nursing staff regularly received training to ensure they had the skills and competencies to provide safe care. Staff received an induction when they joined the service. Staff completed training courses to meet people’s needs. The provider’s pre-admission assessment had not identified when people required any specialist support from staff. Following our inspection the registered manager updated the pre-admission assessment to include any specialist training that staff required.

People were treated in a kind and caring manner by staff who understood the importance of maintaining people’s privacy and dignity. Staff were aware of their role and responsibility in meeting people’s needs. Staff were supported in their role through supervisions with their line manager. There were sufficient staff on duty to meet people’s assessed needs. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

Systems were in place to monitor the quality of the service being provided to people. A system was in place to monitor and record complaints that had been raised. The provider had a range of policies and procedures to guide and inform staff about their role.

The service provides accommodation, nursing and personal care for 57 older people some of whom may be living with dementia. The accommodation is arranged over three floors with a unit on each floor. Units are called Medway, Rochester and Pembury. People who required nursing care live on the ground and first floor units and residential care is provided on the second floor. A passenger lift is available to take people between floors. There were 54 people living at the service at the time of our inspection.

The service had a 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.

People told us that they felt safe. However, people’s risk assessments were not always comprehensive to mitigate the risks and in some cases there were no risk assessments in place. Risk assessments had not always been updated after people’s needs had changed. The service did not always respond to accidents and incidents appropriately and ensure proper records were maintained.

There were environmental risk assessments in place. People had Personal Emergency Evacuation Plans in place, however, these were not detailed to enable staff to support people safely from the building.

Recruitment practices were not always robust, with gaps in employment history not always being explored. Our observations identified issues with the way staff were deployed around the service and staff interactions with people. The registered manager used a dependency level tool that was completed for each person. We have made a recommendation about this.

People’s medicines were well managed. Staff were knowledgeable and knew how to administer medicines appropriately.

Staff had received additional training in managing and preventing pressure ulcers but it appeared that this training had not been embedded in practice. People were not receiving care and treatment in line with health care professional advice.

Staff had received mandatory training but had not completed some mandatory face to face training, placing people at risk of harm from unqualified staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded. One person did not have a DoLS in place when they needed to have one, however, the registered manager did action this following our inspection. The service did not notify the Commission when DoLS were authorised by the local authority.

People were supported to access routine health care which included GP, chiropodist and optician’s appointments. Appropriate referrals were being made to specialist healthcare professionals when needed.

The staff were caring although for some people there was a lack of engagement with staff which we observed on the first day of our inspection. Engagement with people was better on the second day of inspection but it was not clear this was because of being prompted from feedback by inspectors.

Staff knew how to be respectful and treated people with dignity. They knew about the importance of confidentiality and keeping records secure. However, not all records were maintained in a secure place.

People were not involved in the drawing up of their care plans. Care plans did not include people’s likes and dislikes and were not person centred. End of life care plans were not up to date and did not reflect people’s wishes.

Although there were activities taking place we were told by some people that they were bored and did not like what was on offer. The activities did not take into account peoples likes and preferences. The gardens were well maintained and offered a place for people to enjoy them, however, they were not easily accessible for people to use as and when they wanted. The registered manager took action to ensure people could access the garden and take part in activities in good weather.

There was a complaints policy in place and many people said they would be supported by care or nursing staff if they had a problem. Verbal complaints were not recorded, but the registered manager made alternative arrangements for people who wished to express any concerns in a personal way.

The registered manager and staff were making some improvements however they had not been well supported in their role to make the desired improvements to the service that were needed to keep people and staff safe. Quality assurance, auditing and monitoring in the service had failed to identify areas of required improvement and were not effective.

Staff told us they felt supported by the registered manager and that there was an open and transparent culture. Communication in the service was good, with regular staff meetings being held.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked to the provider to take at the end of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home. Each shift was led by a nurse and senior carer who could access records and respond to emergency situations. There was a plan in place to enable people's care to continue should a foreseeable emergency occur, for example a power failure.

Care and treatment records did not contain all of the information required to ensure peoples safety. This was because we found that for some people their records were not being completed in such a way as to enable health issues to be followed up. Staff were not always kept informed of a person's most up to date care needs. Compliance actions have been set for this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Policies and procedures were in place. However, we found that people's human rights were not protected. This was because the manager of the service was not taking steps to ensure that staff were consistently following guidance. For example within the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We saw that where appropriate people's capacity was not always assessed. For example where a person's liberty had been restricted the Deprivation of Liberty Safeguards process had not always been followed. This meant that it was not always possible for the manager to demonstrate that decisions were in people's best interest. Compliance actions have been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We found that the records kept about people's needs were not always kept up to date. We observed saw that staff were not always deployed in such a way as to meet people's needs flexibly. People we talked with who used the service were generally happy with living there. One person said, 'I do not have any problems, I like to get up early and the staff are friendly'. Others said 'The staff are fantastic, they are polite and friendly'. One person told us that they were able to access the garden as they wished. Another person told us that they 'loved to see people bringing in their dogs for people to see'.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We saw that staff interacted positively with people who used the service. People we talked with about the service told us that staff were caring and friendly. We observed staff offering people choices. We talked with five people who used the service including their relatives. All of the people we talked with who used the service were happy with the care they had received. They told us that the staff were caring, one person said 'The staff are fantastic'. Another person said 'I've never needed to complain; staff are always respectful and give me choices'.

Is the service responsive?

People's needs had been assessed before they moved into the home. We saw that each person had a named key worker and that systems were in place that enabled care plans to be reviewed and updated. We observed that staff asked people for their views and permission before providing any care or treatment. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded. However it was not always demonstrated that care and support had been provided in such a way as to ensure that it met their wishes. This was because people were not always being asked to sign and agree their care plans and assessments before the service was delivered. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

We asked the manager how their quality audits were analysed and how they had responded to people. The manager could not provide any information about how people's comments on the quality of the service were collated and responded to.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw that people who used the service were asked for their feedback about the service they received. People had opportunities to participate in residents and relatives meetings. People told us that they were confident that they would be listened to if they complained. Two people we talked with who used the service told us that if they wanted to raise any issues they could tell any member of staff, they said that 'The manager of the service was nice and friendly'.

However, we had received information of concern about the number of managers that had left the service. The service commissioners told us that there had been five managers at the service in the last 12 months. We found that the service had not employed a registered manager since April 2013. It was a condition of the provider's registration that they employed a registered manager at the location. We noted that the managers of the service had not been able to sustain compliance following previous enforcement action within the last year. Relatives of people who used the service had also raised concerns about why managers were not staying at the service. This meant that the provider could not demonstrate that the service was well led, at service level or at higher levels within the organisation.

The inspection was carried out by two Inspectors over eight hours. We commenced the inspection at 07.00 so that we could meet and speak with night staff as well as with day staff.

During the visit we talked with people living in the home and with four relatives. We talked with 13 staff including the newly appointed manager and deputy manager. The regional operations manager was available in the home for much of the inspection and informed us about recent changes in the home prior to the appointment of the new manager.

People spoke positively about the home. Their comments included, 'I am very happy and hope to spend the rest of my days here.' 'It's usually very good here.' 'They look after us very well on the whole, I have no complaints.' A relative said 'This is a good home. They are looking after my relative very well. The care is fine.'

We found that the home had a calm and relaxed atmosphere, and people living in the home spoke positively about their care and treatment. We saw that increased numbers of staff during 'twilight' hours had made a significant improvement to meeting people's needs at those busy times of day.

We found that the home had carried out reliable recruitment procedures for new staff, and they were being supported in their new posts.

We saw that new staff training programmes had been implemented. Newly recruited staff had received mandatory training, and most existing staff had completed updates in mandatory training. Staff were receiving training in other relevant subjects such as dementia care.

We found that reliable systems had been put in place to monitor the quality of care that people received.

In accordance with information sharing policies we contacted Kent County Council Social Services and discussed the concerns raised. The visit was carried out by one Inspector and a Kent County Council Safeguarding Vulnerable Adults Coordinator.

On arrival we discussed the concerns with the Regional Manager who was in the building. We visited each unit and talked with people living in the home, and with staff. We viewed some records, including staffing rotas, staff recruitment files and staff training programmes.

A Care Quality Commission inspection had been carried out on 25th June 2013, and we had already found shortfalls in staffing numbers and staff training. We sent warning notices with a deadline for completion by 31st August 2013. Because of the nature of the concerns raised, we found it necessary to visit the home again before the deadline was due.

We did not make any changes to our judgements as a result of this visit, but will review the home again after the date of compliance has been reached.

We obtained a variety of responses from people living in the home and relatives about their view of the home. Some people said they were happy living in the home and did not have any concerns. Other people said that the staff were so busy and short of time that they did not have time to care for people properly.

We found that care planning was generally up to date on computer systems but not on paper versions.This meant that care staff were not aware of people's specific needs. Care plans tended to be generic and non-specific.

People said that the food was good and they were provided with a suitable variety.

We inspected medication procedures and found them to be well managed.

Staffing levels were inadequate on all units for day and night staff. This was having a major impact on the quality of the care being given.

Staff training was not up to date. This impacted on people's care, as staff lacked the knowledge they needed to provide effective care.

We found that a new manager was providing strong leadership in the home. The staff were growing in confidence in sharing their views.

Complaints management had improved and we saw that complaints were responded to appropriately and were properly addressed.

The manager sent us an action plan to state that the company had decided to employ a second activities co-ordinator for the mornings in Pembury unit.

At this visit we looked at staffing rotas and discussed them with the deputy manager; and we talked with four staff on duty in Pembury unit, and two other staff. We observed care and activities for a short time in this unit.

The staff told us that the employment of an additional staff member in the mornings had made 'a big difference', as this was the busiest time of day. They said that the activities co-ordinator was able to provide ongoing activities during the morning while care staff were assisting people to get up.

We talked briefly with some of the people living in the home, and they responded cheerfully. We saw that they were enjoying taking part in different activities, or were watching others.

At the last visit the Inspector had found shortfalls in the care planning system, in that the care plans reviewed did not show people's preferences for how their personal care should be provided. This omission compromised the dignity of people who used the service.

At this visit, we looked at eight care plans, and talked with five people and three relatives and visitors. We also talked with seven members of staff, as well as with the manager.

During the visit, we noticed that there was only one activities co-ordinator to provide activities for 57 people accommodated on three floors. We asked further questions about care staff numbers and found further concerns about the numbers of care staff employed for duties in the residential dementia unit (Pembury).