Archived: Abbey Care Home

Abbey Care Home is a residential care home providing personal care to people aged from 18 to 65 years and over who may have mental health, learning disability, physical disability or dementia. The service can support up to 20 people in one adapted building, over three floors. The service is centrally located providing easy access to local community facilities and transport. At the time of the inspection there were 12 people accommodated.

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

The service was not well-led. There continued to be a failure to recognise and identify significant failings impacting on the quality and safety of service provision and a continued lack of consistency in how well the service was managed and led. Lessons had not been learned to minimise risk and drive improvement. Management and staff roles and responsibilities were not clear or understood. Concerns continued to be raised by whistleblowers, professional visitors and others.

People were not protected from abuse or avoidable harm. Management did not recognise or appropriately respond to abuse; they failed to properly apply safeguarding policies and procedures when circumstances needed it. People were not valued and treated with dignity and respect, especially people living with dementia or mental health needs. The provider failed to ensure there were enough suitably competent and skilled staff deployed to meet people’s needs safely and effectively.

There continued to be significant shortfalls with how the provider and registered manager were responding to the COVID-19 pandemic. They were failing to do all that was possible to keep people safe from the transmission of COVID-19 infection. Management and staff were not following Government guidance and best practice infection prevention and control (IPC) guidance. Measures to limit the risk of cross infection continued to be neglected, compromising people’s safety and welfare. Areas of the home were still not clean, and the provider was failing to have effective and additional cleaning schedules in place for frequently touched areas and deep cleaning.

Immediately following this inspection, we made safeguarding alerts to the local authority. The local authority safeguarding, and quality improvement teams continue to monitor the service through management support and regular visits to ensure the safety of people living at the service.

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 inadequate (published 11 November 2021) and there were multiple breaches of regulation. We took immediate enforcement action to force improvement. We shared our concerns with the local authority and fire safety authority. In response, the local authority monitored people’s care experience and offered to support the provider through the improvement process. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected: We received information of concern about infection prevention and control measures at this service during an outbreak of COVID-19 and the way people were being treated by some staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. As part of CQC’s response to care homes with outbreaks of COVID-19, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice is safe and that services are compliant with IPC measures.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This report only covers our findings in relation to the key questions Safe and Well Led. Ratings from previous 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 remains inadequate. This is based on the findings of this inspection.

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 Abbey Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to 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 continued breaches in relation to infection prevention and control practices, safeguarding, staffing, managerial oversight and leadership at this inspection. 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. We will monitor and review information received about this service and inspect sooner if we need to.

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

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

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

Abbey Care Home is a residential care home providing personal care to people aged from 18 to 65 years and over who may have mental health, learning disability, physical disability or dementia. The service can support up to 20 people in one adapted building, over three floors. The service is centrally located providing easy access to local community facilities and transport. At the time of the inspection there were 16 people accommodated.

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

Leadership, management and governance arrangements were poor and did not demonstrate the service was well led, people were safe, or their care and support needs were being consistently met. Quality assurance systems were ineffective and unreliable in identifying shortfalls, and where improvement was needed. People’s safety and welfare was compromised and there was a lack of understanding of the risks and issues and the impact on people using the service.

We identified significant shortfalls with how the provider and management team were responding to the COVID-19 pandemic. Although policies reflected government guidance, safe processes were not being followed. Areas of the home were not clean and measures to limit the risk of cross infection were being neglected.

Risks were not identified or managed effectively to keep people safe. The physical environment, including fire safety, maintenance work and health and safety precautions had not been monitored effectively to protect people from the risk of harm. This included a Velux window on the second floor without an opening restrictor and concerns about the integrity of existing restrictors and frames.

There were elements of a closed culture in the home. There were institutionalised routines and limits on how people spent their lives due to poor staff training and oversight. There was a lack of personalised care that ensured people’s physical, mental and emotional needs were being met. 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. Staff did not have the opportunity to develop more skills to ensure their understanding and there were no systems to demonstrate competency.

People were not valued and treated with dignity and respect, especially those people living with dementia or mental health needs. We found concerns raised prior to our inspection about poor practice were correct. This included decisions made by the provider and management team, which increased risks without adequately exploring alternatives, for example with other professionals.

Care plans did not reflect person centred care. An effective system was not in place to ensure there were enough staff on duty to support people to follow interests, take part in social activity and access the community.

People were not provided with regular access to meaningful activities and stimulation appropriate to their needs, to protect them from social isolation and promote their wellbeing.

Recruitment practices did not fully explore new employees experience and suitability for the role.

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

Rating at last inspection

The last rating for this service was Good (published 8 March 2018).

Why we inspected

This was a planned inspection based on the previous rating and prompted in part due to concerns received from whistle blowers. The concerns were about poor care, staffing, lack of training and skilled staff, poor cleanliness and hygiene, lack of dignity, respect and quality of life for people living at Abbey Care Home. A decision was made for us to inspect and examine those risks. We carried out an unannounced comprehensive 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

The overall rating for the service has changed from Good to Inadequate. 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 Abbey Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to 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 fire safety, infection control, risk, environment, staffing, staff training, dignity and respect, personalisation, leadership, management and governance.

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 continue to monitor information we receive about the service. 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.

Special Measures:

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

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

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

Abbey Care Home is registered to provide accommodation and personal care for up to 20 people. The service does not provide nursing care. At the time of our inspection there were 14 people using the service.

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

Staff did not demonstrate a good understanding of the proper channels for reporting safeguarding concerns, if they had any, and their responsibilities to protect people.

We have made a recommendation about staff training on the subject of safeguarding.

Measures were in place to control and prevent the spread of infection.

Rating at last inspection

The last rating for this service was good (published 8 March 2018)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This unannounced inspection took place on 9 and 25 January 2018.

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.

At the last inspection on 25 January 2017, we asked the provider to take action to make improvements in relation to the assistance provided to assist a person to transfer safely. We saw this action has been completed.

Staff at the service managed risk well. Care plans provided detailed advice and guidance of the support needed to minimise risk. People were supported from the risk of abuse. Where appropriate people were enabled to take informed risks which supported their independence.

There were enough staff to meet people’s needs. Care and domestic staff worked well as a team to provide seamless support to people. Staff were recruited safely and the registered manager had ensured new staff joined the service with the skills to meet people’s needs.

People were supported to take their medicines safely by skilled staff. Measures to minimise the risk of infection had been enhanced.

Staff were skilled at meeting people’s needs and had increased access to a wider variety of training. They were well supported and supervision was used positively to develop skills. The managers and staff worked well with outside professionals to maintain their health and wellbeing. People were able to make choices about what they ate and drank and there were measures in place where people were at risk of malnutrition and dehydration.

People’s rights were respected in line with the Mental Capacity Act 2005 (MCA). They were enabled to make choices in line with their preferences. Where they did not have capacity to make decisions, the registered manager followed robust processes and families and professionals were consulted to ensure decisions were made in the person’s best interest. The registered manager had invested substantially in updating and improving the property and the improvements were on-going.

The staff team all knew people well and treated them with kindness. People were supported to communicate their wishes and have a say about the service they received. They were treated with dignity and respect.

People received person-centred and flexible support. We have made a recommendation about increasing people’s independence. There was a new activity coordinator who provided non-institutionalised interaction which focused on individuals interests and pastimes. Care plans were informative and personalised and provided detailed guidance to staff. People felt able to make complaints and raise concerns.

The deputy manager and registered manager worked well as a team and were committed to driving improvements. The deputy manager was increasingly taking on the day-to-day running of the service and was a visible and enthusiastic presence. Audits and checks on the service continued to improve.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 13 January 2016. At the inspection in January 2016 we had found four breaches of legal requirements in relation to Regulation 12, 17, 18 and 20. We issued a warning notice for regulation 12 which was to be met by 30 May 2016. A focused inspection in June 2016 to follow up on the warning notice confirmed that it had not yet been met in full. We therefore imposed conditions on the provider’s registration. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. The overall rating from the inspection in January 2016 was Requires Improvement. One domain of ‘Safe’ was rated as Inadequate at that time.

At this inspection we found improvements had been made, however we found some areas which still required attention. We found a further breach in relation to regulation 12 with regard to care and treatment being provided in a safe way for service users. We also have made some recommendations in relation to staff training provision, activity provision and frequency and effective monitoring of the service.

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

At this inspection we found people were supported by staff who understood how to recognise and report abuse. The risks connected with people's care and support needs had been assessed and plans introduced to manage these. The provider assessed and organised their staffing requirements based upon people's care and social needs.

Safe recruitment practices were in place which ensured that staff who provided care were suitable to work at the service.

People were supported to take their medicines safely and when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent were able to support people with their medicines.

Staff had received training to equip them with the skills and knowledge to understand and support people's individual needs, however this was not always done safely. These skills were kept up to date through regular training and staff were also supported in their roles by managers and their colleagues. The provider did not provide specific enough training in areas such as understanding dementia and a variety of training course forums were not explored. This is an area for improvement.

People's right to make their own decisions and give their consent to their day to day care and treatment was sought and respected by staff. Staff asked people's permission before they helped them with any care or support. When people could not make their own decisions regarding their care and treatment the provider made sure decisions were made in their best interests to ensure their rights were upheld lawfully.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals and appropriate referrals had been made by the service. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

People were supported to have enough to eat and drink and risks associated with this were assessed and monitored by staff and other healthcare professionals. Staff followed the guidance of healthcare professionals where appropriate and helped people to access healthcare services. People's routine health needs were monitored and they had health care plans in place to make sure they received on-going healthcare support.

There was a friendly atmosphere within the service. People were treated with kindness and respect and were involved in making decisions about their day to day care and the support they needed. Staff were attentive to people's needs and knew them well. Staff supported people in a way that was caring and promoted their right to privacy and dignity. Where people were not always able to express their needs verbally we saw that staff responded to people’s non-verbal requests and had a good understanding of people’s individual care and support needs.

People received care and support that was tailored to their individual needs and preferences. They were supported to spend their time how they wanted to but a structured programme of activities provided or outings was not available. This is an area for improvement.

The planning and delivery of care for most people did ensure the welfare and safety of people using the service. Care plans and records reflected people’s current needs including condition specific guidance in relation to conditions such as dementia and how they affected the person.

People and their relatives were given opportunities to provide feedback on the care they received including raising concerns or complaints. Systems were in place to gain the views of people, their relatives and health or social care professionals.

The service assessed and monitored the quality of service provision, however this required further time to show processes and procedures in place were sustainable and the service could maintain compliance. Risks to people were being managed but staff had not all been proactive in assessing the risk and providing care safely. Evidence we were shown did not highlight fully that systems were in place to identify, assess and manage all risks related to the service. Documentation was brief and non specific and whilst we note a number of audits were taking place we still need to be assured sufficient actions have been taken to mitigate any risks identified and ensure people’s needs are met safely.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 13 January 2016. At the inspection in January we had found four breaches of legal requirements in relation to Regulation 12, 17, 18 and 20. We issued a warning notice for regulation 12 which was to be met by 30 May 2016. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. This inspection primarily was to follow up on the progress the provider had made in meeting the warning notice. The overall rating from the inspection in January was Requires Improvement. One domain of ‘Safe’ was rated as Inadequate at that time. At this inspection we found some, but not enough improvements had been made to meet the relevant requirements. We also found a continued breach in relation to regulation 18 with regard to sufficient staffing, and regulation 17 with regard to maintaining an accurate and complete record in respect of each service user, including a record of the care and support provided to the service user and decisions taken in relation to the care and support provided. An additional breach was also identified in relation to regulation10 which related to ensuring people were treated with dignity and respect.

This report only covers our findings in relation to the previous breaches and if the provider had met the warning notice. Any additional breaches found will be noted in this report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Abbey care Home’ on our website at www.cqc.org.uk

The service had a registered manager in post who was also the provider. Since the last inspection the previous manager had left and returned as the deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The service had a registered manager in post who was also the provider. Since the last inspection the previous manager had left and returned as the deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the service had increased their staffing during the weekdays, but at weekends had still not taken proper steps to ensure that each person was protected against the risks of receiving unsafe or inappropriate care when staffing was very low. There were insufficient members of staff available to meet people’s care needs and staff were not appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to people safely.

The service also did not assess and monitor the quality of service provision adequately this was with particular reference to areas relating to infection control and the environment. Risks to people were being managed but the service was not always proactive in assessing the risk. This raised concerns with us that people may experience unsafe care because insufficient actions had been taken to mitigate the risks to ensure their needs were being met safely.

People were protected from the unsafe administration of medicines. Staff responsible for administering medicines had received training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

The service was now meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals and appropriate referrals had been made by the service. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

Whilst in the main we noted that staff interacted with people in a caring, warm and friendly manner, we observed occasions where people were not referred to respectfully either verbally or in written documentation such as care plans. staff did not always respect people’s dignity as they were not self aware around their actions and the terminology they used when referring to people.

Where people were not always able to express their needs verbally we saw that staff responded to people’s non-verbal requests and had a good understanding of people’s individual care and support needs.

Our inspection of January 2016 found that the planning and delivery of care did not always ensure the welfare and safety of people using the service, as care plans and records did not always reflect people’s current needs. At this inspection we found that some improvements had been made, however not all the areas identified had been appropriately addressed. Care plans did not all contain suitable guidance to allow staff to care for people in a safe and effective way including ensuring they reflected current specialist care needs such as catheter care and different types of dementia, in line with people’s changing needs.

Training had been delivered to staff, however not all staff had received sufficient training in dealing with people’s behaviour which could place others at risk, supporting people’s mental health needs or needs related to specialist healthcare needs such as dementia. This lack of training and guidance available to staff placed people at potential risk.

Whilst we note that some formal audits had been undertaken since the last inspection, we noted these were still not effectively monitoring the safety and suitability of the premises. Evidence we were shown did not highlight effectively that systems were in place to identify, assess and manage any risks related to the service. This with particular reference to systems in place to ensure an effective infection control programme was in place, which was risk assessed and monitored to mitigate the risk of cross infection. Audits, completed by the provider and registered manager and subsequent actions had not all resulted in improvements and the proactive development of the service.

Effective quality assurance systems were not fully in place to identify areas for improvement and appropriate action to address any identified concerns. Systems were not fully in place to gain the views of people, their relatives and health or social care professionals. The provider had quality assurance systems in place to identify areas for improvement, however appropriate action to address any identified concerns had not always been taken. Audits, when completed by the registered manager and senior staff and subsequent actions had only resulted in improvements in the service when highlighted at recent inspections. These were of a reactive nature rather than proactively being noted by the service as an on going process through their own monitoring systems.

You can see what action we told the provider to take at the back of the full version of the report summary.

We have also made an additional recommendation in this report with regard to dignity and respect.

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?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that since our last inspection in January 2014 the provider had made improvements in ensuring that the service's infection prevention and control arrangements were appropriate. Systems had been implemented to ensure that the cleanliness of the service was monitored and standards achieved. The service was safe. We saw records which showed that the health and safety in the service was regularly checked.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "They look after me well here I think they do a good job.'

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect. One person said: 'It is difficult to talk to some of the other people here as they don't understand you but the staff do and if I have a problem I know who to talk to.'

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People using the service were generally provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People can therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system which was to be further developed, and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place which required further development to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We saw that staff were attentive to people's needs and responded to requests for assistance promptly. Staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of three people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. We found that there were arrangements in place for the safe storage and administration of medication. People were provided with their medication at the prescribed times.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service. The provider had systems in place to monitor the service that people were provided with.

We looked around the service and found that there were shortfalls in the hygiene and cleanliness in the service. This included in the kitchen and where food was stored.

The provider was compliant in the outcomes that were inspected. We saw the care records of three people who used the service and found that they experienced care, treatment and support that met their needs.