Archived: Holwell Villa Residential Home

Holwell Villa is registered to provide accommodation and personal care for up to 17 older people. At the time of our inspection, 13 people were living at the service.

People’s experience of using this service

People told us they were happy and felt safe living at Holwell Villa; One person said, I’m happy living here.” We found the service was not operating in accordance with the regulations and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

Although the registered manager demonstrated a strong commitment to the people living in the service and spoke passionately about providing good quality care. They did not have sufficient oversight of the service to ensure people received the care and support they needed.

Systems and processes to monitor the service were not effective and did not drive improvement. These included concerns with care records, risk management, medicines, The Mental Capacity Act 2005 (MCA), recruitment, training as well as the overall leadership and management of the service.

People were not protected by safe recruitment procedures. We looked at the recruitment files for four staff members. Whilst some recruitment checks had been carried out, others had not.

Staff told us they felt supported and appreciated by the service’s management team. However, we found staff had not been provided with the appropriate training necessary for them to undertake their role.

People were not supported to have maximum choice and control of their lives. Staff did not always act in accordance with the Mental Capacity Act 2005 (MCA). Where people's capacity was in question MCA assessments were not always taking place and best interests decision processes had not always been followed.

People’s medicines were not managed safely. We looked at the Medication Administration Records (MARs) for 13 people. We found people’s MARs were not accurate and therefore staff were unable to assure themselves that people had received their medicines as prescribed by their doctor.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe.

Other risks were well managed, for example, risks had been identified in relation to people’s care needs such as mobility, falls and skin care. Records demonstrated that action had been taken to minimise these.

Regular checks were undertaken in relation to the environment and the maintenance and safety of equipment, and fire safety systems were serviced and audited regularly.

Holwell Villa was clean, and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

People's privacy and dignity was respected, and their independence promoted. People had access to healthcare professionals when required and were supported to maintain a balanced healthy diet.

People and staff were positive about the leadership of the service and told us the home was well managed. Relatives did not raise any concerns about people’s safety and told us people were well cared for. One relative said, “The home is very well run, the registered manager has always gone above and beyond, we have always been very happy with the care they provide.”

People, along with family members were encouraged to share their views through regular reviews and felt comfortable raising complaints and were confident these would be acted on.

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 on 25 August 2018) and there were multiple 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 not enough improvement had been made and the provider was still in breach of regulations.

Following this inspection, we issued a ‘notice of decision’ to impose a condition on the providers registration. This required the provider to undertake a review of the quality assurance systems in place and carry out monthly audits in respect of pressure area care, risk assessment, care planning and recruitment. The provider was required to send to the Care Quality Commission a monthly report confirming the dates on which these audits had taken place, and include the actions taken or to be taken as a result of these audits to demonstrate any areas of risk were being properly identified, assessed and mitigated.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the need for consent, recruitment, training, notifications, governance and requirements relating to the registered manager at this inspection. We have also made recommendations in relation to the environment, staffing levels, care planning and meeting the Accessible Information Standard (AIS).

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

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.

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 and continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.

Holwell Villa is registered to provide personal care and support for up to 17 older people some of whom may be living with dementia, physical frailty or have needs relating to their mental health. The home does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were 16 people living at the home.

Holwell Villa was previously inspected in May 2017, when the home was rated as ‘requires improvement’ overall. Following that inspection, the registered manager sent us a plan describing the actions they had taken to improve. At this inspection, May 2018, we found improvements had been made in relation to the environment, fire management and care planning. However, we found other improvements were still needed.

The home 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 home is run.

The home’s quality assurance and governance systems were not effective. Although some systems were working well and some improvements had been made since the last inspection, other systems had not identified the concerns we found during this inspection.

Some improvements were needed to the homes recruitment procedures to ensure people were kept safe. We looked at the recruitment files for four staff. We found some recruitment checks had been carried out, but others had not. For example, two members of staff did not have a valid DBS certificate in place. Following the inspection, the manager assured the Commission the required DBS checks were now in place.

Some people’s care and support was not always appropriate, did not meet their assessed needs, or reflect their personal preferences. We visited the home at 7.45am on the 3rd May and found 11 people were up, washed and dressed. We asked what time staff had started to assist people. One member of staff said, they had started at 5.30am. We asked why they had started so early. A staff member said this was the normal routine, records we saw confirmed this. We discussed what we found with the manager who told us people were free to choose when they wanted to get up and go to bed and assured us that she would address what we had found with all staff.

Risks to people’s health and wellbeing were not always managed safely and the systems in place to reduce risks to people were not always understood by staff. Where risks had been identified, action had not always been taken to minimise these risks. For example, where people had been identified as needing specialist equipment this had not always been provided. This placed people at increased risk of developing pressure ulcers.

People received their medicines when they needed them and in a safe way. People were cared for and supported by staff who knew them well. Staff were kind, caring, treated people with respect and maintained their dignity. The manager and staff understood their roles and responsibilities to keep people safe from harm; protect people from discrimination and ensure people's rights were protected.

People were encouraged to make choices and were involved in the care and support they received. Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS) in ensuring people’s rights to make choices where they had the capacity to do so were respected.

People were aware of how to make a complaint and felt able to raise concerns if something was not right. The provider and manager welcomed comments and complaints and we saw where concerns had been received these had been investigated in line with the homes policy and procedures.

People, relatives and staff told us they were encouraged to share their views and spoke positively about the leadership of the home and consistently told us the home was well managed. The manager was aware of their responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people who used the service.

The home was clean and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At the time of the inspection there were 15 people living at the home. The not provide nursing care. Where needed this is provided by the community home offers both long stay and short stay respite care. Holwell Villa does nursing team.

This inspection took place on the 10, 16, and 17 May 2017; the first day of the inspection was unannounced.

The home 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.

The home was previously inspected in April 2016, when the home was rated as ‘requires improvement’ overall. Following that inspection, the registered manager sent us a plan describing the actions they had taken to improve. At this inspection, in May 2017, we found improvements had been made to the management of people’s medicines, the homes recruitment processes, as well as the way the home recorded people’s mental capacity and best interest decisions. However, we found other improvements were still needed.

Records showed that whilst some premises checks had been completed, risks to people's health, safety, and wellbeing had not always been identified, assessed, or mitigated. We checked the homes emergency fire exits and found they were both locked and did not automatically release when the fire alarm sounded. We found risks in relation to storage of flammable oxygen cylinders and fire doors, which had been propped open. We raised our concerns with the registered manager and shared them with Devon and Somerset Fire Service, who visited the home during the inspection and advised the registered manager on the immediate action they needed take to ensure people were safe in the event of a fire. Following the inspection the registered manager confirmed that both emergency exit doors had been replaced.

Records were not always well maintained. We looked at the care records for five people in detail and found one person’s individual needs had not been assessed or planned. This person did not have a plan for their care and the home had not assessed any of the risks associated with providing care and support for this person during their stay. Whilst some people's care plans were personalised and provided staff with detailed guidance about each person’s specific needs others did not contained the same level of detail. We have made a recommendation in relation to care planning.

We looked at home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality of the services provided at Holwell Villa. We saw the provider and registered manager used a variety of systems to monitor the home. These included a range of audits and spot checks, for instance, checks of the environment, medicines, care records, accidents and incidents, finances and people’s wellbeing. Although some systems were working well, others were not as they had not identified a number of concerns we found at this inspection.

We raised our concerns about quality assurance systems and governance with the registered manager. The registered manager accepted the quality assurance system had not identified our concerns and said they would take action to address this. Following the inspection the registered manager confirmed they had contacted Torbay Quality and Improvement Team to seek further advice and support. They confirmed action had been taken to address concerns surrounding fire safety and evacuations procedures and assured us that all care plans had been reviewed and updated.

People said they felt safe and well cared for at Holwell Villa; their comments included "I do feel safe,” and "I’m very happy here”. Relatives told us they did not have any concerns about people's safety. People were protected from the risks of abuse and harm. There was a comprehensive staff-training programme in place, this included safeguarding, first aid, pressure area care, infection control, moving and handling, and food hygiene. Staff demonstrated a good understanding of how to keep people safe and how and who they would report concerns to.

People were encouraged to make choices and were involved in the care and support they received. Staff had a good understanding of the MCA and DoLS and how to support people within their best interests. People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home and staff spoke about people with kindness and compassion.

People received their prescribed medicines when they needed them and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. Staff had received training in the safe administration of medicines. However, systems did not always allow for a full audit trail. We have made a recommendation in relation this.

People told us they enjoyed the meals provided by the home, describing them as "very good.” They said they could have drinks and snacks whenever they wished. One person said, "there's always a choice and there's plenty, you'd never go hungry here."

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. We saw a range of activities were available including music therapy, arts and crafts, arm chair exercises, pet therapy, card games and quizzes. Activities were designed to encourage social interaction, provide mental stimulation, and promote people’s well-being

During the inspection, we observed that the home maintained a high standard of cleanliness and steps had been taken to minimise the spread of infection. We saw the premises and equipment were clean and staff had been provided with aprons and gloves Records showed that equipment used within the home was regularly serviced to help ensure it remained safe to use.

People their relatives and staff told us the home was well managed and described the registered manager as open, honest and approachable. All of the people, relatives, staff and health care professional we spoke with told us they confidence in the registered manager and felt the home was continuing to improve under their leadership.

People and relatives were aware of how to make a complaint and all felt they would have no problem raising any concerns. The complaints procedure and policy were accessible for people in the main entrance and complaints made were recorded and addressed in line with the policy.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Holwell Villa Residential Home is a long established care home providing care and accommodation for up to 17 people. 16 people were living at the home at the time of the inspection. People living at the home were older people, some of whom were living with a significant dementia, mental health needs or physically frailty.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had been registered with the Care Quality Commission (CQC) in March 2016.

We saw much good practice in relation to people’s care. However we also identified concerns over the safety and management of the home including people’s medicines, maintenance of records and assessments of risks. Immediately following the inspection the registered manager sent us information about changes they had already made in response to the inspection. The registered manager was working with the local authority’s quality team and had a service improvement plan in place.

People were not protected from the risks of unsafe medicines management. Some records had not been properly completed to show that people had received their medicines and some prescriptions were not clearly written. Guidance for staff on the administration of ‘as required’ medicines was not clear, and this meant that a full audit trail of medicines could not be carried out. The registered manager took immediate action on this.

People were not being protected because the home had not operated a fully safe staff recruitment process. The registered manager took immediate action to address this.

There were enough staff to support people and meet their needs, but not all staff were aware of information needed to keep people safe, such as the numbers of people staying at the home in the case of a fire. Although staff understood how to safeguard people from abuse, the registered manager had not always followed local procedures initially when concerns had been raised with them, which could have compromised further investigations.

Some risks from the environment had not been assessed or plans put into place to reduce risks. For example we saw that some fire doors were being held open inappropriately. The registered manager took immediate action to address this. Risks to people’s care, such as from swallowing difficulties, poor nutrition or pressure areas were being assessed. Plans showed that staff had taken action to help reduce the risks to people, through providing appropriate equipment to relieve pressure or supplementing their diet.

The service was not always supporting people in line with the Mental Capacity Act 2005 (MCA), and protecting their rights. Assessments of people’s capacity and decisions made in their best interests were not always being carried out or recorded in accordance with the MCA. However we did not identify any decisions made by the home or staff had been inappropriate or unduly restrictive. We have made a recommendation about the implementation of the MCA with regard to best interest decisions.

People’s care files and plans did not always reflect in detail people’s needs or wishes about their care and how this was to be delivered. We have made a recommendation in relation to the need to increase the detail in people’s care plans. Relatives told us they had been involved in giving information about their relations care need, wishes and social and personal history. However, activities people were supported to follow at the home were not always being recorded, which meant it was not possible to see how people’s wishes or interests were being supported. People who were able told us they were happy with the activities provided, and that they were enabled to be as active as they wished to be. One person went out for a long walk with a community care worker which they enjoyed.

People told us they respected the registered manager, and staff said the home was a relaxing and comfortable environment to work in. However we identified concerns over failures in management systems and a lack of robustness in auditing practices. Records were not all well maintained.

The registered manager told us they were keen to learn and develop their skills and were accessing support and training to help them develop professionally, including support in developing leadership skills.

People were involved in having a say about the service they received. Quality assurance and quality management systems were in place to ensure people had a chance to share their views and experiences. However feedback had not been analysed from the last quality assurance processes, and no action plans had been put into place to address any issues. The home had complaints policies and procedures but these were not always being followed or a record kept of minor issues that had been quickly resolved. This meant it was not possible to monitor if issues kept re-occurring or what actions had been taken in response.

Areas of cleanliness were being addressed and rooms were being upgraded to provide a more comfortable environment for people. This included making adaptations to the environment to help people with dementia orientate themselves and remain more independent. A small extension was being built to the rear of the home to provide new dining space and en-suite rooms. This would give an additional area for people to spend time away from a busy communal area if they wished.

Staff told us they received the training they needed for their job role and were knowledgeable about people’s care needs. Staff were supported by the home’s management and received regular supervision and appraisal, including spot checks on their performance. However management systems for recording training needed development.

People were supported by community healthcare services as they needed this, including for both physical and mental health needs. Staff were aware of people’s healthcare needs and of signs that a person’s physical or mental health was deteriorating. They understood how to escalate these concerns to support the person, and where to intervene to de-escalate issues.

People were supported to make choices about meals and they told us they ate well. People who needed additional support to prompt or support them to eat well received this from staff.

We saw evidence of good relationships having been built up between people being supported and the staff supporting them. People told us they liked the staff and were happy with the service they received. Staff took time to understand people’s wishes and spoke with them discreetly about their care. They demonstrated respect for people’s dignity and individuality.

We identified a number of breaches of regulations during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The manager indicated on the front of this report is no longer the Registered Manager at the home and had no current involvement with the service or the improvements that had been made. They had informed us they left the service in March 2014. We are awaiting their de-registration from the service. A new manager was in post and will be making an application to register.

This inspection was carried out by an adult social care inspector. During the inspection we looked at the evidence to answer the key questions:

Is the service responsive?

Is the service safe?

Is the service well led?

Holwell Villa is a care home without nursing providing care and support for up to 17 older people. Many of the people who live there are living with dementia.

On this inspection we looked at records including the new care plans for three people. We spoke with the manager, the representative of the provider and two members of staff. We spent time with some of the people who lived at the home, observing the ways in which they were supported. We also looked at areas of the home where we had previous concerns. We found that improvements had been made.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. For full details of the previous non-compliance please see the full inspection report of 7 May 2014.

Is the service responsive?

We found that the provider had responded appropriately to the concerns that had been identified at the last inspection. Many of the issues had also been identified by the provider and new manager prior to the inspection and action had been already under way to address the issues.

We found that the provider had taken appropriate professional advice and acted upon it to improve the service. Where concerns had been raised by either people who lived at the home or relatives the provider had taken appropriate action to investigate and address the issues. This told us the provider and manager were responsive to people's concerns and keen to implement best practice at the home.

Is the service safe?

On our last inspection on 7 May 2014 we had identified concerns over the ways in which the laundry at the home was managed. This could have led to poor control of infection. We saw that on this inspection the home had improved their laundry systems and taken appropriate professional advice about the cleanliness and infection control risks at the home. We found that the potential risks from poor control of infection had been managed

We had also identified concerns over medication systems on the inspection of 7 May 2014. On this inspection we saw that improvements had been made and people's medication was being stored and managed safely. People's medication had been reviewed and storage, administration and recording systems had been updated.

Is the service effective?

We saw that people's records had also improved, and were fit for purpose. We saw new care plans had been put into place and staff were using these appropriately to help improve people's health and wellbeing.

We saw effective policies and procedures were in place and assessments had been undertaken of risks. This helped to ensure people were cared for safely and in accordance with their wishes.

Is the service well led?

We saw that the provider, the provider's representative and the new manager had worked together to ensure that the improvements needed were implemented and sustained. We saw that the required improvements had been made.

We saw that there was a clear understanding of how the concerns had arisen and action was being taken to ensure that new standards of care were being maintained. Concerns had been reported appropriately to external bodies where needed for investigation.

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?

This is a summary of what we found '

Is the service safe?

We found there were enough staff on duty with the right skills. A training programme had been implemented to update staff practice and additional new staff had been employed to meet higher staffing levels.

We found people's care needs were being assessed and met, but that this was not always reflected in the record keeping or care planning systems. New systems were due to be introduced the week after our inspection.

We found that the premises had been updated to meet fire regulations and systems for updating risk assessments were being introduced. However we found that there were some risks of cross infection from the laundry area, laundry management systems and a lack of auditing for infection control risks. This could put people at risk of cross infection.

Improvements had been made to the medication systems but we found that the systems in use were still not always safe or clear enough for staff to ensure medication was administered safely or in accordance with the prescribing instructions. A new medication system was due to be implemented in the month after our inspection.

We saw the home did not have effective quality monitoring systems in place. For example although questionnaires had been sent out in the past to relatives, staff and people living at the home to gather their views the results had not been analysed or action plans completed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We did not see that proper policies and procedures were in place to ensure people's rights were protected.

Is the service effective?

We saw people's care needs and healthcare needs were being met. We saw staff effectively working with a person who presented significant challenges. We saw them de-escalate the person's level of distress. This told us staff understood what strategies to use with this person. We spoke with a member of staff about this. They told us 'We are here to help them. It's our job to understand and work out what they need and want.'

Staff told us that following recent changes there was a good staff team in place. One staff member told us 'Things seem to be settling down since the changes.'

We spoke with a member of staff about a person they had supported to get up that morning. They had a clear understanding of how that person liked their care delivered. This told us staff understood the people they were caring for and had the information they needed to carry out their job effectively.

Is the service caring?

We saw staff working respectfully and showing affection towards people at the home. We saw appropriate use of touch to comfort, support and direct people. We saw staff sharing humour and laughing together with people who lived at the home over a cup of tea and during a quiz.

We saw staff took time to give people choices and to respect their wishes. Staff spoke respectfully about people they were supporting.

A relative we spoke with told us that the home had 'worked tirelessly' to support their relation. They told us that the staff had gone 'above and beyond what they needed to do to support us both. The care (my relative) had was second to none. The staff and management were excellent'

Is the service responsive?

We saw the staff at the home responded well to people's changing needs. As an example we saw one person was offered their pain relief medication at lunchtime but did not want it then. We saw they asked later in the afternoon if they could have it and it was given to them straight away.

We saw another situation where staff supporting one person to eat were struggling to encourage them. Another staff member took over and the person responded differently and ate their meal. This told us the home were flexible in the support they offered.

Is the service well-led?

We had inspected the home in part because concerns had been identified. We found that the concerns had been substantiated. However we identified that plans had been put in place to improve the home and that these were actively in progress. We found the management team at the home had changed and there was substantial commitment to making the improvements needed.

The provider and manager were taking and acting upon professional advice.

The previous manager was registered at the time of the inspection but has made an application to remove themselves from the registration of the home as they are no longer involved in the home's operation. The current manager, referred to in the report as the new manager, is not yet registered.

Following the inspection the manager wrote to us and told us about the action she had taken. We visited the service and found that the actions had been completed. We saw that the home now ensured records were available to record the identities of care workers.

We spoke with a relative who was visiting the service. They told us 'it wasn't a bad place to be' and that they were welcome to visit at any time. In fact they said they were 'part of the furniture'. We saw another relative visiting and supporting a person at the home with their care. When we arrived the home had a busy and positive atmosphere, with people singing along to music. The home smelled fresh and clean.

We did not identify any other concerns on our visit.

We spoke with four people who lived at Holwell Villa on the day of our inspection. We also spoke to a visiting relative, three care workers, two ancillary staff and the Manager. People we spoke with were pleased with the service. One person told us 'I'm happy here, I like being here'.

During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life. People told us that they enjoyed activities within the home and regular trips and outings.

Strategies were in place to meet people's care needs. People's care plans had been reviewed on a monthly basis or more regularly when required.

We found that the provider had measures in place to ensure people received adequate nutrition and hydration.

We saw that a safeguarding policy was in place. Care workers had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

We saw that the provider had improved the surroundings since the previous inspection to provide a pleasant environment and promote people's well being.

We looked at staff recruitment files and found some missing information. This included photographic proof of identity for staff. Other records were up to date, accurate and securely stored.

We also had received some concerns about a person who had moved to another home with a pressure sore that had apparently not been identified by Holwell Villa's staff. We were not able to substantiate this information, as the records at the home did not give us sufficient information.

On our visit to Holwell Villa we looked at the records for the people being cared for, spoke with staff, relatives visiting the home and a visiting mental health professional. We spoke with three people living at the home, all of whom had dementia.

The relatives we spoke with told us that they were very happy with the care provided. One person told us their relative was very happy at the home, and another person told us they visited the home very regularly and thought the support given by the staff was "first-class".

However the care plans we saw were not always written in appropriate or respectful language. They did not reflect people's needs in a professional way, demonstrate respect for the individual or show an understanding of the needs of people with dementia.

People we saw looked well cared for. We were told the home was like a small family environment. However the accommodation was not significantly adapted to meet the needs of people with dementia.