Archived: Clarence Lodge

Clarence Lodge is a residential home registered to provide accommodation and personal care to a maximum of 28 people. At the time of our inspection, 11 older people were living there, some of whom were living with dementia. The home accommodates people across a ground, first and second floor.

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

Most of the people we spoke with were accepting of the service provided to them. Some told us the approach of staff could be improved, and that sometimes they had to wait for a response from staff when they needed support.

This is the fifth consecutive inspection that this service will be rated inadequate overall.

Risks to people were not always assessed and managed in a way which ensured people's safety. Actions had not always been taken to minimise risks. This put people at risk of injury or their health deteriorating.

There were not always sufficient staff with suitable skills, knowledge and experience deployed to meet the needs of people. The provider had not ensured that staff received the training they needed to be able to support people effectively, based on people's needs. Staff recruitment checks were still not sufficiently robust to ensure staff were suitable to work with vulnerable older people.

Each person had a care plan in place although there was not always sufficient detail to guide staff. Some care plans contained inaccuracies and contradictory information. Some areas of people’s care hadn’t been planned to reduce risk, such as risks associated with urinary tract infections and environmental risks.

The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and some risks had not been mitigated. This placed people at continued risk of harm.

There was a poor understanding of what constituted a safeguarding concern. Three incidents had not been reported to the local authority or CQC, which placed people at on-going risk of harm. This also meant there was no independent oversight to ensure people were fully protected.

Further improvements were still needed to ensure the views of relevant people were sought where people lacked capacity to consent. Though best interest decisions were in place for some people, not all aspects of their care were considered fully. For example, environmental risks.

There had been improvements in medicines management, but it was unclear whether the service could sustain these improvements, given only four staff were trained to administer medicines.

There was improved recording of people’s participation in activities. However, we were still not assured that the provision of activity was meeting individual and specialist needs.

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 7 October 2019) and there were multiple breaches of regulation. At this inspection we found that sufficient improvements had not been made, and the provider remained in breach of six regulations. We also found two new breaches in relation to reporting procedures and safeguarding people from the risk of abuse.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 August 2019. Breaches of legal requirements were found in relation to safe care and treatment, governance, nutrition and hydration, person centred care, recruitment, and staffing.

We undertook this focused inspection to check they had now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective, responsive, and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is 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 Clarence Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, reporting procedures, governance, staffing, nutrition and hydration, safeguarding people from the risk of abuse, and person-centred care.

CQC used its powers to keep people safe, and a Notice of Proposal to cancel the Registered Providers registration was sent to the Registered Provider on 11 December 2018. On 19 February 2019 the Notice of Decision was sent to the provider advising that we had decided to adopt the proposal to cancel registration.

The provider appealed against this decision to the First Tier Tribunal (Care Standards) under section 32 (1) (b) of the Health and Social Care Act 2008. The appeal hearing was held on 29, 30 and 31 October 2019, and the decision was made that CQC’s action “was (and remains) lawful, fair, reasonable and proportionate.” The appeal was dismissed by the tribunal judge. This means that the provider can no longer provide any regulated activities and the service is closed.

Just prior to the tribunal hearing the local authority took action to ensure that all people living in the service were supported to move to alternative accommodation.

This service is therefore no longer in operation.

Clarence Lodge is a residential care home registered to provide accommodation and personal care to a maximum of 28 people. At the time of our inspection, 12 older people were living there, some of whom were living with dementia. The home accommodates people across a ground, first and second floor.

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

Systems and processes designed to identify shortfalls, and to improve the quality of care were not always effective. While some improvements were noted since the last inspection in April 2019, on-going concerns were raised on this inspection. This is the fourth time that this service will be rated inadequate overall, we are therefore concerned about the overall governance at the service and people's experience of their care.

People told us that staffing levels impacted on the quality of care. They told us that this was worse at night but sometimes during the day, it impacted on their dignity.

Care plans contained more person-centred detail. However, they did not always contain accurate or informative information to ensure people’s care needs were met fully. People’s end of life preferences were still unclear.

We continued to find that people’s medicines were not always managed safely to ensure they received the medicines they were prescribed. A recent internal audit of medicines completed by a new staff member showed multiple errors were identified. There was confusion by night staff as to which medicines they were permitted to give. They were not clear about the protocols at night if people needed medicines.

The service had allocated a staff member to undertake activity with people during the day. However, records showed this was not always meeting people’s individual needs. Additionally, if care staff needed assistance to help with people’s personal care needs, this took priority over the delivery of activity.

People did not always feel that staff were respectful. Some feedback from people indicated that the approach of staff varied. We also observed a varied approach; some staff were helpful and kind towards people, others did not interact when helping with a task such as assisting people to eat.

Improvements were seen in how the service assessed people’s capacity to consent, but we found further improvements were still needed to ensure the views of relevant people were sought. People were however supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 10 April 2019) and there were multiple breaches of regulation. At this inspection we found that whilst some improvements had been made, the provider remained in breach of six regulations.

Why we inspected

The inspection was carried out to assess if improvements had been made following our previous inspection In April 2019. 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clarence Lodge on our website at www.cqc.org.uk.

Enforcement

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 until we 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 therefore 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 of 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.

People’s experience of using this service:

¿ The systems for checking the quality and safety of the service had again failed to identify where improvement was required. Audits were not sufficiently robust to identify concerns we found during this inspection. This put people at risk of potential harm.

¿ Medicines were not managed safely and people did not always receive their medicines as prescribed. Auditing processes were ineffective at identifying and resolving medicine issues.

¿ There was not always sufficient staff available to people due to other tasks they had to complete in addition to care duties, such as cooking and delivering activities.

¿ Records in relation to hydration, nutrition, and healthcare needed improvement.

¿ Care records were contradictory in places and did not always contain accurate information. This meant care and support may not be delivered effectively.

¿ The service was not following the principles of the Mental Capacity Act 2005. Best interest decisions were not always in place where people lacked capacity to consent to their care.

¿ We received positive feedback from people about the caring approach of individual staff. However, we also found that the provider’s systems did not always support the service to be fully caring

¿ People did not always receive responsive care. Where people needed support on end of life care, information was not being gathered sufficiently to ensure people's wishes could be met.

¿ Staff were not always safely recruited; the provider did not always make sure checks were completed to ensure staff were suitable for the role.

¿ There was a lack of stimulation for people using the service. Several people said they would like to see improvements in this area.

¿ Some equipment and aspects of the premises were not clean. Some environmental risks had not been identified.

Rating at last inspection: At the last inspection the service was rated ‘Inadequate’ (Report published December 2018.)

Why we inspected: We inspected this service in line with our inspection schedule for services in special measures.

Enforcement: 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 service remains in special measures. We will continue to monitor this service according to our inspection schedule in line with services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

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

At our last inspection on 14 and16 February 2018 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of registration regulations.

Following the last inspection, we took enforcement action to impose conditions on the providers registration. These conditions mean the provider has to inform us of actions which have or are being taken to mitigate identified risks. We also met with the provider and registered manager to discuss our expectations going forward.

At this inspection on 2 and 4 October 2018, we found that although some improvements had been made, the service remains in breach of four regulations in relation to safe care and treatment, staffing, governance, and person centred care. We also found a new breach in relation to nutritional and hydration needs. The service had informed us of serious injuries which had occurred in the service, and is therefore no longer in breach of this associated registration regulation.

Clarence Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Clarence Lodge accommodates 28 people in one adapted building. At the time of our inspection there were 16 people using the service.

There was not a registered manager in post. The previous registered manager had left the service in July 2018. 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. An acting manager had been appointed in the service, though they were not registered with the CQC.

Some new auditing processes had been implemented. However, these had failed to identify all of the concerns that we found during this inspection. People's health and safety were at risk because the provider had failed to identify where safety was being compromised in the environment.

Risks in relation to falls, malnutrition, and pressure area care were not being adequately reviewed or monitored to ensure people were cared for in a safe way. There was not always accurate guidance in place for staff about how to manage or reduce risk.

Staff knew how to recognise abuse or potential abuse and how to respond and report these concerns appropriately. However, the acting manager had not reported an incident to the local authority safeguarding team which should have been.

Medicine administration was not always observed as safe. Stock levels were not always accurately recorded to determine if people had received their medicines as prescribed.

The re-organisation of care plans meant that people’s health needs were included in some care plans, and subsequent input from health professionals. However, further work was needed in this area to ensure records were accurate and person-centred. Records were not always completed consistently.

End of life care plans were not in place. Staff had still not received training in this area.

Food and fluid charts were not always completed fully or totalled to ensure people were receiving adequate nutrition and hydration. Feedback from people and relatives indicated that the quality of the food provided had not improved.

The acting manager and staff were not receiving regular supervision, and some staff had not received training updates. The acting manager had started to introduce observed practice of staff, however, their time was limited due to other on-going priorities.

The previous registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, care plans did not include information on how any restrictions would be managed. Some people had not signed to consent to their care where assessed as being able to do so.

The dining experience was not conducive to an enjoyable mealtime and opportunity for social interactions; the recommendation we made at the last inspection had not been followed.

We saw that staff were kind and caring when supporting people, however, staffing levels were not sufficient to ensure people's safety at all times. Staff were not always able to be responsive to people's needs.

There was a complaints procedure in place, however, the log of complaints did not always include outcomes, and actions taken in response to complaints. We were therefore not able to ascertain if complaints had been dealt with effectively.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role. We did however find in one case that a full employment history had not been completed.

The provision of activity was still not sufficient to meet individual and specialist needs.

The provider had begun to consider how to maximise the suitability of the premises for the benefit of people living with dementia, though more work was necessary. Some carpets and chairs had been replaced, and a ‘quiet room’ was now available if people did not want to sit in the main lounge area.

The overall rating for this service remains 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection of 14 and 16 February 2018, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to staffing, governance, safe care and treatment, and person centred care. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, for not informing us of a serious injury which had occurred in the service.

We took enforcement action to impose conditions on the providers

registration. This condition means the provider has to inform us of actions which have or are being taken to mitigate identified risks. We decided to impose these conditions on the providers registration because people may be exposed to the risk of harm.

Clarence Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Clarence Lodge accommodates 28 people in one adapted building. At the time of our inspection there were 24 people living in the service.

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.

There were gaps in how the service assessed and monitored the quality of its provision. While there were some quality assurance mechanisms in place, these had proved ineffective at identifying areas for improvement, and not all aspects of the service were being effectively monitored. The registered manager had not notified us of a serious injury which had occurred in the service, which is required by law.

People's health, safety and well-being were at risk because the registered manager and provider had failed to identify where safety was being compromised. Infection prevention and control procedures were ineffective and we found that hygiene in the service was poor in some areas. This included in areas where food was prepared.

People did not always receive timely healthcare support. The organisation of care records meant that it was not always possible to case track people’s medical history and subsequent input from health professionals.

Staffing levels were not sufficient to ensure people’s safety at all times. Staff were not always able to be responsive to people’s needs. Staff were not receiving regular supervision, and some staff had not received training updates.

The registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, we did not see that a capacity assessment had been carried out in advance to determine that this was required, or how any restrictions would be managed. Additionally we saw some capacity assessments that had been carried out were generic in nature and not decision specific.

People received their medicines safely, however, improvements were required in relation to recording of some documentation and the security of medicines.

Risks in relation to falls, malnutrition and pressure area care were not being adequately assessed or monitored to ensure people were cared for in a safe way. There was not always guidance in place for staff about how to manage or reduce risk.

Food and fluid charts were not always completed fully or totalled to ensure people were receiving adequate nutrition and hydration.

Care plans for people were not always reflective of people's current needs. Information held in people's care plans was not consistent across the service and there was a risk that staff did not have the most appropriate information to enable them to tailor the care they provided to people. The service needed to develop their practice in supporting people in relation to their end of life care planning.

The provision of activity was not sufficient to meet individual and specialist needs.

The provider needed to consider more fully how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role. Staff knew how to recognise abuse or potential abuse and how to respond and report these concerns appropriately.

There was a complaints process in place, and people felt confident that they could raise any concerns with staff.

The dining experience was not conducive to an enjoyable mealtime and opportunity for social interactions, and we have made a recommendation about improving the dining experience for people.

We saw that staff were kind and caring when supporting people, however, we saw there were missed opportunities for staff to interact more fully with people throughout the day.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

Clarence Lodge provides accommodation and care for a maximum of 28 people. At the time of our inspection there were 23 people living in home, 13 of whom were living with dementia.

A registered manager was 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.

Medicines were not always managed in a safe way. There were errors in the records of administration and in stock levels. This meant that we could not determine if people had been administered their medicines as the prescriber had intended.

Risks to people’s health and welfare were being identified and assessed. Action plans were put in place to mitigate these risks. Staff knew how to reduce the risk of harm and what to do if they had concerns about a person’s safety and welfare.

Care was delivered by sufficient numbers of staff who were subject to robust recruitment procedures and provided with training to carry out the duties of their role. Supervision and team meetings were not held as frequently as staff would have liked.

Staff had received training in the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards. They understood how to support people who lacked capacity to consent to their care and acted correctly when they identified that a person may be deprived of their liberty.

People were being supported with their nutritional needs and were provided with a choice of good home cooked food. Sufficient fluids were provided and people’s fluid and food intake was monitored to ensure that they were eating and drinking enough.

People told us that staff were caring and treated them well. However, there were times when staff did not always treat people with respect or give them the attention that they needed.

Visitors to the home were welcomed by staff and made to feel comfortable. They were invited to stay for meals and encouraged to spend time with their loved ones.

People were involved in planning and reviewing their care to ensure that it remained centred on their needs. However, care records were not always complete and kept up to date when needs changed. The service supported people to stay well and to access community health professionals when needed.

There was good information about people’s interests and hobbies. However, there was a lack of meaningful activity for people. Staff did not spend time engaging with people in a way that promoted their psychological wellbeing.

The service had a complaints procedure that was accessible within the home. People knew who to talk to if they had a complaint. Complaints were handled in accordance with the procedures and the manager analysed the complaints to check for any common themes or trends.

The service had quality assurance systems in place and carried out audits to check the quality of care in specific areas. However, the systems in place were not always effective as they had not identified and made improvements in some of the areas highlighted in this report.

People were asked for their feedback about the quality of the service provided and involved in discussions about how the service could be improved.

As part of this inspection we spoke with six people who used the service, the manager, and two members of staff. We reviewed records relating to the management of the home which included, four care plans, daily care records, training records, support/supervision records of staff and quality information.

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.

Is the service safe?

The six people who used the service told us that they were happy with the care and support provided. Three people told us that they felt safe, and one person said, 'I would shout very loudly and then tell (the manager).' They went on to tell us about a recent incident that they had reported to the manager and was currently under investigation. Appropriate action had been taken to ensure the safety of the person concerned although the incident was not reported to the Care Quality Commission in accordance with the regulations.

We looked at four sets of care records. These included risk assessments to minimise risks to people's health such as malnutrition and to people's well-being for example road safety. Care plans detailed the support required by people and how this was safely delivered.

We found that the environment did present some risks to people's safety and improvements were needed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The new manager of the service was aware of the procedures and explained a recent occasion where such an application had been considered. We were satisfied that people who used services would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

We discussed staffing rotas which showed that there were sufficient numbers of trained and competent members of staff employed to provide people with safe and appropriate care as identified in their assessment and care plans.

Is the service effective?

During our inspection we saw that people who used the service were treated with dignity and respect. We observed staff as they carried out day to day duties and saw that they spoke appropriately at all times.

Quality assurance measures were in place to identify the quality of the service offered. However some improvements were needed to ensure they were effective and identified potential risks to people's safety.

Is the service caring?

We saw that people were cared for in an appropriate manner. People we spoke with told us that, 'We are well cared for, there is always someone to talk to. They (the staff) have time to sit with us and make sure we are alright."

We looked at four sets of care records. These detailed how the care should be provided and the planned outcomes.

Is the service responsive?

The four sets of care records we looked at showed that people's needs, choices and personal preferences had been assessed and planned for. There was information about the person's life and on three of the four records. This was detailed and provided staff with information about people's likes and dislikes and this information was used to plan activities.

We saw that the service had responded quickly to an allegation of abuse although not reported it to all parties as required by the regulations.

Is the service well-led?

There were monitoring and reviewing systems in place to measure the quality of the care and support provided but these were not always effective. Audits of the premises were not in place to identify and rectify potential risks to people who used the service.

Records showed that staff had received support and supervision and staff we spoke with confirmed this. Training was monitored by the registered manager to ensure all staff were suitably equipped to meet the needs of people they supported.

We found that improvements had been made.

Risks to people's safety had been assessed and actions for staff to take to reduce these risks were recorded and were being implemented. This meant that the service had taken steps to keep people safe.

We had received a concern that there was not enough food for people to eat at the service and that the fridge was often poorly stocked. We found that there was sufficient food available to meet people's needs and that they had a choice of food and drink. The people we spoke with told us that they were happy with the food.

The service was clean and hygienic and there were no unpleasant odours. This meant that people lived in a clean environment to protect them from the risk of the spread of infection.

The majority of people told us that they were happy living at Clarence Lodge. One person said, 'I like living here, it's good.' Another person told us, 'I'm well satisfied.' A further person said, 'I would recommend this place, the food is very good.'

An assessment of people's needs had been made prior to them using the service and plans of care were in place to assist staff in providing care to people on an individual basis. Risks to people's safety had been assessed. However, actions to reduce these risks from occurring had not always been identified or they were not being followed. This meant that the risks to people's safety were not always being managed effectively.

The communal areas of the service were clean on the day of our inspection. However, there were offensive odours in some areas and some equipment was not clean. These presented an infection risk.

Recruitment checks had been conducted before staff started working at the service. There were enough staff to meet people's needs on the day of our inspection.

People told us that they did not have any complaints. The complaints procedure had been brought to the attention of people who used the service. There was a system in place to respond and manage complaints effectively.

Care plans identified how people should be supported and cared for. A visitor told us, "They look after my relative very well. They cared for them during a recent illness."

The service was clean and the staff followed the correct procedures for ensuring that people using the service were protected from the risk of infection.

Staff were well trained and undertook annual refresher sessions to maintain their knowledge and skills.

The provider asked people using the service and others for their views on improving the service, and made changes based on their suggestions.