Archived: Ashley Manor Nursing Home - Southampton

We carried out an unannounced inspection of Ashley Manor Nursing Home on 2 and 3 April 2017. This was a comprehensive inspection that was carried out to check on the provider's progress in meeting the requirements required as a result of our inspection on 22, 23 and 25 November 2016. At the previous inspection continuing breaches of legal requirements were found in relation to staffing and clinical governance and a new breach was found in relation to recruitment. Following the inspection the provider sent us an action plan detailing how and by when they would meet the regulatory requirements.

At this inspection we found improvements had been made to the support provided to staff. Following our previous inspection staff had received training, supervision and appraisal to enable them to effectively undertake their roles and responsibilities. The provider had reviewed the induction for new staff and clinical supervisions were to commence for nurses in April 2017. Some time was needed for this to become part of the home’s routine staffing practices.

Following our previous inspection improvements had been made to staff recruitment. The provider had implemented safe recruitment practices and we found all the required staff pre-employment checks had been completed to ensure staff would be suitable to work in the home.

Requirements relating to clinical governance had still not fully been met. This is the process whereby a provider assesses the standards, safety and effectiveness of care delivered to people. We found some clinical audits, for example in relation to falls and infections in the home, had taken place but these had not always been accurate or effective in identifying potential risks to people’s health and welfare.

The home is required by a condition of its registration to have a registered manager. The home did not have a registered manager in place. However, the home manager had submitted their application to be registered with the CQC to ensure the provider would meet their registration requirements. 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.

Staff told us improvements had been made in the general running of the home. However, we found the provider did not have an effective system in place to ensure that clinical audits completed by nurses were always checked and the inaccuracies we found for example in relation to the falls audit had not been identified. Clinical governance systems were not operated effectively to ensure the home manager would routinely scrutinise all nursing and care decisions to ensure people received care in accordance with national best practice.

People received their prescribed medicines safely and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. Care plans were based around the individual risks and preferences of people as well as their medical needs. They informed staff what support people required and we saw people were supported in accordance with their care plans.

Staff sought people's consent before they provided their care and support. Where people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

Staff knew people well and supported people living with dementia to manage their anxiety and agitation.

People were treated with kindness, compassion and respect and staff promoted people's independence and right to privacy. The staff were committed to enhancing people's lives and provided people with positive care experiences.

People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain.

We identified a continuing breach of regulations 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.

The inspection took place on 22, 23 and 25 of November 2016 and was unannounced. This was a comprehensive inspection that was carried out to check on the provider's progress in meeting the requirements required as a result of our inspection on 28 and 29 June 2016, when continuing breaches of legal requirements were found in relation to consent, staffing and clinical governance. The provider was served with a warning notice in relation to clinical governance that they were required to meet by 21 November 2016. Following the inspection the provider sent us an action plan detailing how and by when they would meet the regulatory requirements.

At this inspection we found requirements in relation to consent had been met, requirements relating to clinical governance had been met in relation to record keeping but not fully in relation to clinical governance. This is the process whereby a provider assesses the standards, safety and effectiveness of care delivered to people. Requirements in relation to care staffs induction, nurse’s supervision, appraisal and training had not been met. We found a new breach in relation to staff recruitment.

Ashley Manor Nursing Home did not have a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited a home manager who had submitted an application to the Care Quality Commission to become the registered manager for the service.

The review of accidents and incidents process was not sufficiently developed to drive service improvement for people. Audits of the service were completed; however, overall they lacked action plans to drive improvement for people. Actions required had not always been addressed for people to ensure their safety. For example, the lack of colour coded knives placed people at potential risk from cross-contamination. Where actions had been completed there was not always written evidence to demonstrate this. The processes for identifying potential risks to people and auditing were not always in place or sufficiently developed to consistently drive service improvement for people.

The provider had completed some recruitment checks in relation to staff. However, they had not always ensured that applicants had provided a full employment history. They had not always assured themselves of applicants conduct in their previous role or the reasons for leaving their previous employment. There was the potential that people might have been placed at risk from the recruitment of staff as the provider had not fully assured themselves of their suitability for their role.

The provider had introduced an induction booklet for staff; however there was not a process for ensuring staff completed this to enable them to demonstrate their competence in caring for people. Care staff had received supervision of their work. There was not a robust process in place to ensure the nurses received clinical supervision of their practice with people as required. Staff had not had an annual appraisal of their work, to ensure they were supported in their work with people. Records showed not all staff had completed the providers training; this created a risk staff might not have the required skills to provide people’s care. There was a lack of a structured training plan for the year to ensure staff would be able to book onto training as needed, to ensure their skills in providing peoples’ care remained up to date.

Staff were able to demonstrate their understanding of the risks to people and understood the importance of maintaining complete records in relation to people’s care. Risks to people's safety had been assessed using screening tools. Processes were in place to identify what records needed to be maintained in relation to the provision of peoples’ daily care. Records reviewed showed care staff were completing peoples’ records as required, relevant actions were being taken for people where needed.

The provider has been required to undertake work to ensure peoples’ safety in relation to the risks from fire. Time is required to ensure the required works are completed.

There was sufficient staffing in the service for the people accommodated. The provider used a staff calculation tool based on people’s needs to assess the staffing level required for the service. This will need to be reviewed as new people are accommodated.

Staff we spoke with were able to describe the types and signs of abuse and who they would report any concerns to. Arrangements were in hand to ensure all staff had the opportunity to complete or update their safeguarding knowledge. The provider told us they were working with a local service, to update their safeguarding policy to ensure staff had access to up to date safeguarding information for people. Staff were not all aware of their right to speak in confidence about any concerns they wished to report and how to do this. Therefore there was a potential risk they might not be aware of how to whistleblow for people in the event they needed to. Incidents were recorded, reported and reviewed by the manager to identify if any action needed to be taken for people.

People were protected against the risks associated with medicines. The provider had appropriate arrangements in place to manage people's medicines safely. Medicines were stored securely within their recommended temperatures by staff. Records of medicines administration including creams were kept at the service. Information to support the safe administration of people’s medicines was available.

Infection control processes were in place to keep people safe. The majority of staff had undergone or were due to undertake infection control training. Arrangements still needed to be made for a small number of staff to complete this training to ensure they had the knowledge to protect people from acquiring an infection.

Staff had either completed training on the Mental Capacity Act 2005 or arrangements had been made for them to attend this training; to ensure they had the required knowledge to support people appropriately. People’s records demonstrated their consent had been sought for the provision of their care. Staff met legal requirements where people lacked the capacity to consent to their care.

People provided positive feedback about the meals they received. People’s care plans and charts provided staff with information about the type of diet the person required. People’s preferences about their meals were taken into account. There had been no negative feedback about the meals. However, the provider was in the process of exploring the options for the future provision of people’s meals with an external provider of chilled meals. They have assured us any changes to meal provision will only be made with people’s agreement.

Records showed people were able to see health care professionals as required.

People and visitors told us they liked the service and found staff to be caring. Staff were kind and supportive to people. Staff were observed to show concern for peoples’ welfare.

People’s care plans provided staff with guidance about how people communicated. Staff understood what people liked. People’s care records demonstrated staff had listened to people and respected their wishes. Staff spoke with people politely and treated them respectfully.

The manager had completed regular checks upon the night staff following feedback received at the last inspection in order to observe what they were doing and whether they treated people with dignity and respect at night; they had not identified any further issues. We did not receive any negative feedback about the conduct of the night staff.

The information gathered through people’s pre-admission assessments had been used to determine what actions the service needed to take to meet their needs.

Reviews of peoples’ care were taking place; however, there was a lack of evidence to demonstrate that people and their relatives had been invited. Following the inspection the manager sent us written evidence that they had written to peoples’ relatives to invite them to attend a review. The care plans for people living with dementia would benefit from greater detail to ensure staff had access to individualised information about people’s care needs in this area. The service needed to ensure nursing staff were able to respond to changes in peoples’ care needs, where this resulted in the need to use a syringe driver. Staff did not feel confident in their ability to meet this need for people if required. People were provided with social stimulation but there was scope for increasing the opportunities available for people to ensure their social care needs were fully met.

There was a process in place for people to make a complaint and these were responded to appropriately. The provider had missed the opportunity to collate the results of the June 2016 survey. People were asked for their views through the resident’s meetings and one to one contact with the provider. In order to make the providers contact with people more meaningful, there needed to be a more structured record of the contact and evidence of any actions taken for people.

Regular management and staff changes had been a cause for concern for people and visitors. Staff perceived the new manager as available, approachable and willing to help them. The provider is still

The inspection took place on 28 and 29 June 2016 and was unannounced. This was a comprehensive inspection that was carried out to check on the provider's progress in meeting the requirements made as a result of our inspection on 7, 8 and 11 January 2016 which resulted in the service being rated Inadequate. As a consequence of this judgement the service was placed in special measures and we took enforcement action in response to this failure to meet the required standards. We have placed a condition on the provider's registration that they must not admit any new people to Ashley Manor Nursing Home without the prior written consent of the Care Quality Commission.

The previous inspection report in January 2016 identified 12 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found action had been taken to address the concerns we identified. Sufficient improvement had been made for the provider to meet the requirements of nine of the twelve previously breached regulations. We found the provider still needed to make further improvements in three regulations in relation to good governance, consent to care and treatment and staff supervision before these requirements could be met. You can see what action we asked the provider to take at the back of the full version of the report.

At the time of the inspection the service was not running at full capacity and provided care to a low number of people. More time would be required for the service to complete their action plan and test out the robustness of the improvements and systems in place to ensure it would be able to continue to provide an improved service when new people were admitted. The service would need to sustain the improvements made before people could always be confident that they would receive a high standard of quality individualised care that always met their needs and ensured their safety. Following this inspection the service had not been rated as inadequate for any of the five key questions and has therefore been taken out of special measures.

Ashley Manor Nursing Home did not have a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited an acting home manager in January 2016. The acting home manager planned to register with CQC to ensure the provider would meet their regulatory responsibilities in relation to their registration.

Staff were complimentary about the acting home manager and people and relatives felt the service was well led. We found however, that the acting home manager did not have a good overview of the service’s audits and action plan that would have been reasonable for them to have known. They did not always show strong leadership and a good understanding of their responsibility for ensuring progress against the action plan was monitored and evaluated; there was a risk that progress with the plan might be delayed or fragmented.

The audits and checks the provider had in place to monitor the medicines management, catering and infection control arrangements had been effective in driving improvements in these three areas. However, other monitoring systems such as the daily record checks, staffing deployment and staff performance monitoring to identify and monitor risks to people, had not always been operated effectively so that action could be taken to reduce the likelihood of harm to people. We found additional processes and assessment tools had been introduced to ensure judgements of risk and service quality would be evidence based. More time was needed for the culture of the service to develop further. So that people could be assured when the provider was made aware of shortfalls and took action taken to address these; they would make their judgements based on thorough root cause investigations and the consideration of current best practice.

Action was being taken to address the shortfalls in staff training and staff supervision was starting to take place. Further improvement was needed to ensure all staff would receive regular opportunities to discuss their development needs and evidence they had the competence to undertake their roles effectively. All staff had not received regular supervision to enable them to discuss their performance and identify areas where their practice needed to improve. If the provider was to employ new staff there was a risk they would not receive a structured induction to adequately prepare them for their role in accordance with national good practice guidance.

We found improvements were still needed to ensure people’s consent to their care and treatment was gained lawfully. Nurses had received additional training to support them to assess people’s capacity and undertake decisions in people’s best interest when needed. However, where people had lacked the capacity to make decisions independently, the decisions made in their best interest, had not been reviewed to ensure they met the requirements of Mental Capacity Act 2005 (MCA). There was a risk that people’s rights would not be upheld if they lacked the mental capacity to make decisions about their care.

At our previous inspection in January 2016 we found people did not always receive the appropriate care and support they required to keep them safe. At this inspection we found people’s risks to their health and safety had been identified and arrangements had been put in place to keep people safe. Staff understood people’s risks and how to keep them safe. However, people’s care plans and daily records were not always up to date and completed when people received their care. These records did not include all the information staff required in order to keep people safe or to judge whether people had received the care they required. If new people were to be admitted to the service that staff did not know well or new staff unfamiliar with people’s needs were to refer to people’s records, they might not have all the information they required to keep people safe.

People had received their medicines as prescribed. The medicine audits had improved the safety of the service’s medicine management and we found the number of medicine errors had significantly decreased. The service’s medicine checks had effectively identified these errors and action had been taken promptly to reduce the risk of harm to people from not receiving their medicine as prescribed. The provider had sourced a new community pharmacist to support the service from 18 July 2016 to further improve their medicine practices.

We found the environment and equipment clean throughout. New housekeeping staff had been appointed and one of the nurses had taken on the role of infection control lead to ensure good infection prevention arrangements were put in place. The service had effectively implemented an infection control improvement plan with the support of the West Hampshire Clinical Commissioning Group (WHCCG) and continued to monitor the improvements to ensure they were sustained and all areas of concern addressed.

The required notifications of significant events had been made appropriately. The service had reported concerns that could indicate abuse or neglect to the local safeguarding team and CQC so that these concerns could be investigated to ensure people were safe. Plans were in place for all staff to complete their safeguarding training by 15 July 2016. Staff had a good knowledge of their responsibilities to keep people safe from abuse.

The provider had improved their recruitment practices and we found all the required staff pre-employment checks had been completed to ensure staff would be suitable to work at the service.

Improvements had been made to ensure people received the support they needed to eat and drink sufficiently to remain hydrated and well nourished. People told us they did not always like the food. The provider was working with people to improve the menu and time was needed for this to be completed.

People told us there had been an improvement in their relationship with staff. They experienced day staff as kind and caring but their experience of the night staff were still not always positive. Time was required to ensure these improvements had become sustained in the service so that people would always be treated with dignity and respect by all staff.

There were sufficient staff to meet people’s needs and staff attended to people’s request for assistance promptly. However, the current staffing level was not clearly determined by people’s individual support needs or risks, or the skills and knowledge of staff. If people’s needs changed, staff had to attend training or new people were admitted that staff did not know well, the current staffing levels and staff skill mix may not be sufficient to meet their increased needs.

People told us they were generally satisfied with the care they received and that it met their needs. We saw that although people’s care plans had been reviewed and provided more details about their preferences, there was little written evidence that people and their relatives had been involved in care planning. The provider was taking action to involve people and their relatives in the monthly care reviews.

The provider had investigated people’s co

Ashley Manor Nursing Home provides accommodation and nursing care for up to 45 older people. The home is in a rural location near Shedfield, and provides accommodation on three floors. At the time of our inspection 20 people were using the service.

Ashley Manor Nursing Home did not have a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Following our inspection in August 2015, we served a legal notice to deregister the registered manager. The provider had recruited a new manager who had started in post on 4 January 2016. The new manager had not yet registered with CQC.

At the last inspection on 10, 11 and 12 August 2015, we judged the home to be ‘Inadequate’ and as a consequence placed the home into ‘Special measures’. This means that CQC keep the service under review and re-inspect within six months. There is an expectation that there will be significant improvements during this time. The provider was asked to provide a detailed action plan as a result of the August inspection and supply weekly updates of the action plan to CQC. The provider complied with this request.

The administration of medicines in the home was unsafe. The provider had introduced a new medicines administration system which started on 4 January 2016. Between 4 January 2016 and 10 January 2016 we identified 73 gaps in MAR charts. None of the errors had been detected by nursing staff who had signed to state they had checked the MAR charts. None of the errors had been reported to CQC or the local authority as a safeguarding concern. These errors included medicine for pain relief and chronic illnesses and would have had an impact on people's health and wellbeing.

All nurses had received up to date medicines administration training since our last inspection in August 2015 and had their medicines administration competency checked. However we found that nurses were not competent in the administration of medicines due to the numerous errors, which had been made, not identified, not rectified and not reported.

Nurses competence to administer medicines had been assessed, but records did not demonstrate competent actions to safely administer people's medicines. Oxygen cylinders were not stored safely, placing people and others at risk of harm.

Some areas of medicine storage and disposal had improved since our last inspection. For example, medicine storage temperatures were recorded and monitored.

Care plans included risk assessment tools to assess people’s individual risks such as the risk of malnutrition. However it was not clear that all identified risks were being addressed and that assessments were regularly reviewed and updated in relation to people’s changing needs. For example people being nursed in bed were at high risk of acquiring pressure ulcers. There were no plans in place to ensure people at risk were repositioned regularly to reduce this risk.

Staff rosters were planned to meet the inflexible working hours of nurses and to ensure staff worked their contracted hours. This resulted in a high ratio of staff to people. However effective care was not delivered as staff did not work efficiently or as a team.

Recruitment and induction practices for permanent staff were not safe. The records of three recently recruited staff showed gaps which demonstrated that the provider could not be sure that staff recruited were suitable for the role. For example full employment histories had not been obtained. This placed people at risk of care being provided by unsuitable staff.

During the inspection we identified safeguarding concerns which should have been identified by the provider, appropriately investigated and reported to CQC and the local safeguarding authority. These included missed doses of required medicines, over doses of medicines and development of pressure ulcers. This was unsafe for people. The provider could not be assured that people were protected from abuse.

There were improved infection control procedures since our last inspection in August 2015, however people remained at risk in relation to infection control. For example, we found one person’s room to be dirty, their mattress and clothes were stained. Topical medicines did not have the opened date recorded. NHS guidance stipualtes that topical medicines should be disposed of three months after opening due to the risk of contamination.

Food and fluid charts had improved, however adequate monitoring of food and fluid intake was not taking place. Fluid charts were not totalled and although signed by nurses, there were no actions or explanations recorded when people drank significantly less than their target. People at high risk nutritionally did not have their intake monitored and care planning did not address the risks. For example one person was consistently losing weight but there was no care plan in place to address the weight loss. The provider could not be assured people were eating and drinking sufficient amounts to meet their needs.

The provider did not comply with the requirements of the Mental Capacity Act 2005 (MCA) to obtain valid consent for care and treatment. Mental capacity assessments did not include best interest decisions and one person had been given bed rails without their consent.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the deputy manager had made appropriate applications for eight people living in the home.

Staff had not received sufficient training to meet people’s needs. Training since our last inspection in August 2015 had focussed mainly around infection control and food hygiene. There were significant gaps in training in respect of mental capacity, fire safety and health and safety.

Not all staff received regular supervision meetings and appraisals to ensure they were adequately supported in their role. Records showed that 13 staff members out of 37 had had a supervision meeting and no one had received an appraisal. We were told by the deputy manager that these had been planned for January 2016.

Healthcare professionals visited the home regularly. A local GP visited the home twice weekly in order to treat anyone who was unwell and made extra visits if there was an emergency.

We observed that some staff behaved in a caring way towards people. However, not all staff behaved in a kind and caring way and it was evident that the overall culture of the home had not changed, in that care staff did not put people's individual needs first. One person who was distressed and in pain was made to wait because nursing staff were waiting for care staff to provide care and support rather than provide the care themselves. It was reported that staff dismissed one person who said they were in pain. Staff walked into people’s rooms without permission and removed items which belonged to people. There was no respect for people, their belongings or their wellbeing.

A welfare and activities co-ordinator had been recruited since our last inspection in August 2015. This had been positive for people as they had someone they could talk to directly about their concerns. Positive comments had been left in the comments book by relatives and friends of people living in the home. These included compliments about the revised lounge lay out and the relaxed atmosphere in the home.

Care planning was not responsive to people’s needs. We continued to identify gaps in care planning and a lack of understanding and knowledge of care planning. Care plans were brief, lacked detail and didn’t address the known risks. We identified gaps in care planning around the management of wounds and pressure ulcers, a lack of planning around diabetes, end of life care, dementia and mouth care. One person was put at risk due to the failure of staff to treat their pressure ulcers appropriately.

The provider had introduced a new handover system, however this had not been implemented by staff. A handover system is how information about people's current care needs is passed between staff on different shifts so that care continues seamlessly for the person. There continued to be concerns about staff knowledge of people’s individual needs and how they ensured they responded to updated information passed to them during handover.

The activities co-ordinator had scheduled an activity for every day, however these were all scheduled for the afternoons. Although activities had been introduced since our last inspection there was very little variety or external input.

A number of complaints had been received since our last inspection. Responses although apologetic did not always reflect that an investigation had been carried out and appropriate actions taken as a result.

Whilst some improvements in care had been noted during the inspection, there was unhappiness and unrest amongst staff which impacted on people’s care. We noticed that care staff and nurses did not work as a team providing seamless care for people. Nurses did not lead and direct care ‘on the floor.’ Nursing staff did not show respect for management or the provider. For example they failed to implement the provider's systems. Some staff told us they were being bullied, others were upset and it w

Due to their physical and/or mental frailty we were unable to speak with many people who lived at the home and consequently we used other methods to help us understand their experiences. These included observations of daily life in the home and looking at records and other documents. We were however able to speak with seven people who lived in the home which included one of the five people in the home we pathway tracked.

We were able to speak with three visiting relatives, including a relative of one of five people we pathway tracked. This was to hear what they thought about the help and support their relatives received.

We spoke with nine members of the home's staff as well as the home's manager. This was in order to hear what they had to say about how the home functioned.

We also contacted a local surgery whose staff had regular and frequent contact with the home in order to obtain their views about the abilities of the home's staff teams and standard of care the home provided.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

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

Is the service caring?

The service is caring.

All the people we spoke with who lived at the home and visiting relatives expressed positive views about the staff including their competence and abilities, as well as their attitude and demeanour. One person said, 'The staff are great'. Two people described the staff as 'fantastic'. A fourth person said, 'They are incredibly helpful and very friendly'. Another person said, 'They are all very kind'.

A local GP surgery that had regular contact with the home told us they thought the home's staff seemed, 'passionate and caring'.

Is the service responsive?

The service is responsive.

People's needs and risks to their welfare were usually reassessed at least monthly or sooner if required. This ensured that support plans were amended and updated when people's needs changed.

A local GP surgery told us the home's manager was quick to contact them if people living at Ashley Manor nursing home became unwell.

Visits from, or to healthcare professionals were arranged by the home's staff to ensure people's feet, dental or eye care needs were met. We saw that a range of healthcare professionals had visited people at the home to ensure people's specific needs were met. The specialists included community psychiatric nurses, speech and language therapists and a physiotherapist.

The homes records of complaints showed the home responded to people's concerns and attempted to resolve complaints satisfactorily.

Is the service safe?

The service is not as safe as it could be.

People were protected from risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were protected by recruitment procedures that ensured they were supported and cared for by suitable staff.

There were not always enough qualified, skilled and experienced staff available to meet people's needs.

People were not always protected from the risks of unsafe or inappropriate care and treatment because information about them was not always complete and accurate.

Is the service effective?

The service is effective.

People's support and help was planned and delivered in a way that promoted their safety and welfare and ensured their rights were upheld.

Is the service well led?

The home is not as well led as it could be.

The provider had systems in place for obtaining people's views about the quality of their service. However checks of working practice and procedures in the home were not sufficiently comprehensive or robust to ensure people were properly protected from risks to their safety and welfare.

People living at the nursing home told us that they were satisfied with the care and assistance provided and told us that the staff were extremely kind and listened to their needs. A relative told us that they were very happy with the care given to their relative. The food, accommodation, activities were good.

We saw that there were policies in place in relation to the control of infection in the home, including the minimising of the spread of infection. Policies included procedures for the reporting of infectious diseases when required. All areas of the home seen during the visit were clean and free from any unpleasant odours. A relative of a person using the service said: 'There are no bad smells; it has always been like that'.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw evidence that people's comments and complaints were listened to and acted on.

We saw that electrical work had commenced in order to rectify the listed faults and the manager was operating effective recruitment procedures.