Archived: Sholden Hall Residential Retreat

Sholden Hall Residential Home is a residential care home providing personal care to up to 27 older people who may be living with dementia. At the time of our inspection there were 20 people using the service. The service accommodates people in one large adapted building.

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

Relatives told us, they thought people were safe and happy living at Sholden Hall. People told us they were happy and felt safe living at the service. We observed people relaxed in the company of staff, smiling and laughing with them. People respond positively when asked if they were happy.

However, medicines were not always managed safely. People had not always received their medicines as prescribed and records were not accurate. Potential risks to people’s health and welfare had not been consistently assessed. There was no guidance for staff about how to support people to minimise risks and keep them safe.

When incidents had occurred, action had been taken to keep people safe. However, the registered manager had not always recognised when these incidents needed to be reported to the local safeguarding authority. The registered manager had not consistently notified the Care Quality Commission of incidents as required.

There was a system of checks and audits in place, including regular provider visits, but these were not effective and had not identified the shortfalls found at the inspection. People and relatives had not been asked for their opinion of the quality of the service.

Some areas of the service needed redecoration and could not be cleaned effectively. Visitors to the service were required to provide a negative Covid-19 test before coming into the service.

Accidents and incidents had been analysed and action taken to reduce the risk of them happening again. Staff were recruited safely; people were supported by enough staff to meet their needs.

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 11 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We undertook a focused inspection to review the key questions of safe and well-led only. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement 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 Sholden Hall Residential 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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, mitigation of risks, checks and audits and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Staff had access to and used personal protective equipment (PPE) as advised. There were PPE stations around the service to ensure that staff could access these easily. Posters which gave guidance about how to use PPE were displayed for staff to use as a reminder when required.

¿ People were supported to maintain contact with family and friends via the phone or video calls. When in lockdown people had window visits from loved ones and at other times appointments could be booked for socially distanced visits.

¿ When people were isolating in their rooms the registered manager had increased staffing levels. This allowed staff the time to spend with people in their rooms to reduce loneliness and improve their well-being.

Further information is in the detailed findings below.

Sholden Hall 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. Sholden Hall accommodates up to 27 people in one adapted building. At the time of the inspection, 22 people were living at the service.

We inspected Sholden Hall in February 2017, the service was rated Requires Improvement overall and Inadequate in the safe domain. There were breaches of Regulations and we issued warning notices relating to safe care and treatment and the need for consent. We carried out an inspection in September 2017, to check what action the provider had taken and to confirm they met legal requirements. The provider had met the legal requirements but further improvement was needed and the service was rated Requires Improvement overall. This inspection was carried out to check that the provider had continued to make improvements. The provider had made improvements and the service is now rated Good overall.

There was a registered manager working at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and Associated Regulation about how to run the service.

Potential risks to people’s health, welfare and safety had been assessed and there was detailed guidance for staff about how to mitigate the risk. Improvements had been made to the guidance when people were moved using equipment. Environmental risks had been assessed, however, the service did not have equipment to evacuate people who were not mobile from the upper floor of the service. People who were not mobile currently lived on the ground floor, during the inspection the provider purchased appropriate equipment for staff to use.

Previously when people’s capacity to make decisions fluctuated, this had not been consistently assessed. Improvements had been made. People were encouraged to plan their care and express their views. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to make decisions about their care and support.

There were sufficient staff on duty to meet people’s needs, staff had been recruited safely. Staff received training appropriate to their role, their competency was checked to make sure their work met the required standard. Staff told us they felt supported, they received one to one supervision and appraisal. Staff were trained to administer medicines and medicines were managed safely.

Staff knew how to recognise the signs of abuse and knew how to raise concerns, they were confident the registered manager would deal with them appropriately. The registered manager had worked with the local safeguarding team when concerns had been raised. Incidents and accidents had been recorded, analysed to identify trends and action had been taken to reduce the risk of them happening again.

The provider or registered manager met with people before they moved into the service to make sure that staff could meet their needs. People’s needs were assessed using recognised tools and following current guidance. Each person had a care plan, the plans contained detailed guidance about people’s choices and preferences. People’s end of life wishes had been recorded, staff supported people at the end of their lives according to their choices and preferences.

People were supported to eat and drink a balanced diet, snacks and drinks were available throughout the day. Staff monitored people’s health and welfare and referred people to healthcare specialists as needed and followed the advice given. People were encouraged to lead a healthy lifestyle including exercise, when able. People had access to professionals such as dentists to keep them as healthy as possible.

People were treated with dignity and respect. Staff supported people when they were anxious with compassion and promoted their independence. People were supported to take part in activities. People and relatives told us they knew how to complain and were confident that any complaints would be taken seriously.

There was an open and transparent culture within the service, people knew the registered manager and were comfortable with them. The provider and registered manager completed checks and audits on all aspects of the service and any shortfalls were rectified. People, relatives and staff were asked their opinions of the service and any suggestions they may have to improve the service.

The registered manager attended local forums and registered manager meetings to keep up to date and continuously improve the service. The registered manager worked with other agencies including the local commissioning groups.

The service had been adapted to meet people’s needs, improvements to the building were ongoing. The service was clean and odour free.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating is given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. The rating was displayed at the service and on the provider’s website.

Sholden Hall provides care for up to 27 older people some of whom are living with dementia. At the time of the inspection there were 24 people living at the service. Sholden Hall offers residential accommodation over two floors, has two communal areas and is located in the village of Sholden. There is a small conservatory on the ground floor for people to use; there is a secure garden at the rear of the premises.

There was a registered manager working at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 2 and 3 February 2017 and Sholden Hall was rated ‘Requires Improvement’ and ‘Inadequate’ in the ‘Safe’ domain. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. We issued warning notices relating to safe care and treatment and the need for consent. We issued requirement notices relating to staffing and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had met the previous breaches of regulations.

At the last inspection, the registered persons had not acted in accordance with the Mental Capacity Act (MCA) 2005, had failed to deploy sufficient numbers of suitably qualified staff to meet people’s needs, had failed to assess, monitor and improve the quality of the service provided and monitor the risks relating to the health, safety and welfare of people using the service. The registered persons had not provided staff with sufficient guidance and checks to make sure risks were mitigated. Records were not accurate or fully completed.

Risks related to people’s health, care and support had not always been assessed or mitigated. At this inspection, improvements had been made. There were risk assessments in place for people who needed support to mobilise, staff were given guidance on the equipment to use but not how to position the slings, to support the person safely. This was an area for improvement. Staff were observed using equipment to move people safely.

There were detailed risk assessments to give staff guidance to reduce and mitigate risks people had behaviour that may challenge and health conditions. All accidents had now been analysed and an action plan had been put in place to help reduce future accidents. The registered manager had increased the number of night staff on duty and the number of falls had reduced following this action.

At the last inspection, there had not been sufficient staff deployed to meet people’s needs. At this inspection, there were sufficient numbers of staff to meet people’s needs. Staff met with the registered or deputy manager to discuss their practice and development. Staff had been recruited safely and received training appropriate for their role, this included training for specific health care needs so that they were able to support people when they became unwell.

At the last inspection, regular audits of some of the service had been completed but these had not been effective in identifying the shortfalls found at the inspection. There were now regular audits of all areas of the service. The registered manager and provider had produced action plans when shortfalls were identified and checked to ensure the action had been completed.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people using services by ensuring that if they were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. At the last inspection, the registered manager had not applied for DoLS authorisations for people who were under constant supervision. At this inspection, each person had been assessed and where appropriate DoLS applications had been submitted in line with guidance.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular on behalf of people who may lack capacity to do so for themselves. The Act requires, that as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and least restrictive as possible. Staff sought people’s consent before giving care and support. Any decisions made in a person’s best interest were recorded in people’s care plans. However, there had not been consistent recording of people’s capacity, especially if their capacity fluctuated.

The registered manager and staff knew people well and supported them in their preferred way, giving them choices about what they would like to eat and drink or how they would like to spend their time. Each person had a care plan. These were detailed with people’s preferences and choices.

People received their medicines safely and when they needed them. Some medicines had been prescribed on an ‘as and when’ basis such as laxatives. There was no guidance for staff about when these medicines should be given. This was an area for improvement.

At the last inspection, records were not always stored securely or were not accurate and up to date. At this inspection, records were stored securely in the registered manager’s office; people’s records were accurate and up to date.

Staff knew how to recognise and protect people from abuse. Staff knew about the whistle blowing policy and were confident that any concerns raised with the registered manager would be dealt with appropriately. Staff understood they could take concerns to outside agencies if they felt they were not being dealt with appropriately.

When people were unwell staff contacted their doctor and specialist healthcare professionals and followed their guidance. Care plans had been reviewed regularly and had been up dated to reflect people’s changing needs. The registered manager or the provider met with people before they moved into the service to ensure they were able to meet the person’s needs.

People told us they enjoyed their meals, people were offered a choice of drinks and snacks throughout the day.

People had access to organised activities during the week; people had one to one time with staff and enjoyed chatting with them. People enjoyed reminiscence and hand massages.

People and relatives told us they knew how to complain and felt that the registered manager would take the complaint seriously. There had been no complaints since the last inspection. There was a quality assurance system in place, the registered manager had asked for the views of people, relatives, staff and professionals. The results had been analysed and action had been taken to make improvements to the service.

There was a warm relationship between people, relatives and staff. People were relaxed in the company of staff and were laughing and smiling when chatting with staff. People and relatives told us that staff treated them with dignity and respected their privacy. People were encouraged to remain as independent as possible.

The registered manager had an open door policy. People, relatives and staff were encouraged to express their views. The registered manager and the provider were known by people and relatives and were knowledgeable about people’s needs. People and relatives told us that the registered manager and deputy manager were approachable. Staff told us they worked well as a team and felt supported by the management team.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating is given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. The rating was displayed at the service and on the provider’s website.

Sholden Hall provides care for up to 27 older people some of whom maybe living with dementia. At the time of the inspection there were 20 people living at the service. Sholden Hall offers residential accommodation over two floors; has two communal areas and is located in the village of Sholden. There is a small conservatory on the ground floor for people to use; there is a secure garden at the rear of the premises. The registered manager’s office is located in part of the dining area.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 14 July 2016. We issued requirement notices relating to safe care and treatment, the provider did not have sufficient guidance and checks to make sure risks were mitigated. The provider had failed to have proper and safe management of medicines. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. During the focused inspection we identified other areas of concern within the service; we decided to complete a full comprehensive inspection to investigate these concerns.

There were two breaches of regulation identified at the previous inspection and at the time of this inspection the provider had complied with one breach and part of the other breach. The provider had not fully met the legal requirements. Risks to people’s safety had not been consistently assessed and did not contain the information for staff to mitigate risks and keep people as safe as possible. This was a continued breach of regulation.

At the last inspection we reported that there was opportunity to improve some areas of the service including the plan to evacuate people safely at night, updating mental capacity assessments and completing risk assessments; some of the improvements had been made including the night evacuation plan but others had not.

At the last inspection medicines were not managed as safely as they should be. At this inspection improvements had been made. However, hand written instructions had not been signed by two members of staff to check that the instructions were accurate. This was an area for improvement.

Accidents and incidents had been recorded but had not been analysed to identify any patterns or concerns to reduce the risk of them happening again.

People said that they felt safe living at Sholden Hall. Staff received safeguarding training and they were aware of how to recognise and protect people from abuse. Staff knew about the whistle blowing policy and were confident to raise any concerns with the registered manager or outside agencies if needed. However, after the first day of the inspection, we found a person was a risk of neglect and this had been not been recognised by the registered manager. A safeguarding alert was raised with the local safeguarding authority about the care and treatment of one person.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people using services by ensuring that if there were any restrictions to their freedom and liberty, these had been agreed by the local authority as being required to protect the person from harm. At the time of the inspection the registered manager had applied for DoLS authorisations for some people and some had been granted. There were still other people within the service who were under constant supervision but DoLS authorisations had not been applied for.

Staff sought people’s consent before giving care and respected their decision if they refused support; going back to them later, to offer support again. Staff knew people well and supported them in their preferred way, giving them choices about what they would like to do or eat and drink.

The registered manager completed checks and audits each month. The provider completed regular audits of the service; however, these checks did not include medicines or care plans and had not identified the shortfalls found at this inspection. Checks on the equipment and the environment had been carried out. The checks had identified the water temperature in two rooms were higher than recommended placing people at risk of scalding; no action had been taken. The provider adjusted the water temperature in the rooms on the second day of the inspection. There were emergency plans in place, in case of fire or flood; fire drills had been completed so staff knew what to do in an emergency.

Records were not accurate and up to date; documents were not always stored safely, as the registered manager’s office was not secure. The provider and registered manager had not identified shortfalls within the service; they had not promoted and driven improvements within the service.

Before people came to live at Sholden Hall; the registered manager met them to ensure they were able to meet their needs. One person had recently moved into Sholden Hall, the registered manager had not completed an assessment of their needs and wishes to establish if the service could meet those needs. The care plan that was in place for the person was not complete so staff had very little information and guidance to care for the person safely.

There were sufficient staff on duty, however, the deployment of staff was not consistent. On the first day of our inspection there were long periods of time when there were no members of staff in the lounge with people and interaction between people and staff was limited. On the second day staff did spend time with people in the lounge enjoying conversations and activities. People were relaxed in the company of staff. People smiled and they were reassured with a hug when they were anxious.

On the first day of the inspection people’s dignity and privacy was not always maintained; staff were not always available to support people.

Staff were recruited safely. Staff received an induction when they started working at the service, which included shadowing more senior staff and core training. There was an on-going training and refresher programme, however, there were gaps in training covering specific care areas such as diabetes and challenging behaviour.

Staff received support from the registered manager through supervisions and yearly appraisals to identify their training and development needs. There were regular staff meetings so that staff could discuss any issues or ideas they may have.

Each person had a care plan, these were detailed with people’s preferences and choices; staff were able to support people in their preferred way.

When people became unwell staff contacted their doctors and specialist services and followed their guidance. Care plans had been reviewed but had not been consistently updated to reflect people’s changing needs.

People told us they enjoyed their meals, at lunch time people were offered a choice of drinks. The meals looked appetising and the portions were adjusted for people’s appetite.

People had access to organised activities during the week; people had one to one time with staff and enjoyed manicures and reminiscence.

People and relatives told us they knew how to complain and felt that it would be taken seriously by the registered manager, there had been no complaints since the last inspection. A quality assurance system was in place, the registered manager had asked the views of people, relatives and professionals; these had been analysed and action had been taken.

The registered manager had an open door policy. People, relatives and staff felt that they were able to approach the registered manager and would be taken seriously. People, relatives and staff were encouraged to express their views and suggestions.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported.

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

Sholden Hall provides care for up to 27 older people some of whom may be living with dementia. On the day of the inspection there were 25 people living at the service. Sholden Hall offers residential accommodation over two floors and has two communal areas and is located in the village of Sholden. . There is small conservatory on the ground floor which is the registered managers office. There is a secure garden at the rear of the premises.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 11 and 16 June 2015. We issued requirement notices relating to safe care and treatment, fit and proper persons employed, consent, person centred care and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. There were five breaches identified at the previous inspection and at the time of this inspection the provider had complied with three breaches and parts of the other two breaches. The provider had not fully met their legal requirements.

Risks to people’s safety were assessed but the guidance on how to keep risks to a minimum varied. Some assessments identified people’s specific needs, and showed how risks could be minimised but other risk assessments did not contain all the information to make sure staff had all the guidance to mitigate risks. During the inspection a person had been left at risk as the power supply to a special mattress had been turned off. There was a continued breach of the regulation.

People received their medicines when they needed them. They were monitored for any side effects. Some people received medicines ‘when required’, like medicines to help people remain calm or for pain. There was limited guidance for staff to tell them when they should give these medicines. One medicine had no pharmacy label to identify who the medicine was for. One person's medicine was signed for on the medicines administration record before the person had actually received them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. There was a continued breach of the regulation.

At the previous inspection areas of the service needed cleaning and refurbishment and there was a risk that infections might develop. At this inspection the service was clean and refurbishment and redecoration had taken place. The regulation had been met. The service was fresh and clean. There were maintenance plans in place to continue improving.

The registered manager and staff carried out regular checks of the premises and equipment including the fire safety system and water temperatures. The fire exits door were now all managed safely. The regulation had been met. There was an evacuation plan for people during the day but not a night. This was an area for improvement.

At the previous inspection the provider was not ensuring that person centred care and treatment was meeting the needs of people and plans had not all been regularly reviewed or updated. At this inspection improvements had been made. Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People said and indicated that they were satisfied and happy with the care and support they received. People received care that was personalised to their needs. People’s care plans contained information and guidance so staff knew how to care and support people in the way they preferred. The regulation had been met.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs.

People were offered choices and were supported to be independent whenever possible. Staff were familiar with people’s likes and dislikes and supported people with their daily routines. Staff knew how people preferred to be cared for and supported and respected their wishes. There was calm atmosphere throughout the day and some people were busy engaged in activities. Staff were kind and thoughtful. There were meaningful interactions with staff who gave people time to respond, showing consideration and treating people with dignity.

People were supported to have a nutritious diet. Their nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required.

Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.

The registered manager and staff monitored people’s health needs and asked for professional advice when it was required. Assessments were made to identify people at risk of poor nutrition, skin breakdown and for other medical conditions that affected their health. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

People told us that they felt safe living at Sholden Hall. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken.

At the previous inspection the provider had not carried out all the necessary staff checks. At this inspection a system to recruit new staff was in place. This made sure that the staff employed to support people were fit to do so. The regulation had been met

There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. Staff were supported to gain the appropriate knowledge, skills and competencies to perform their job role. People told us that they had confidence in the skills of the staff. Staff were receiving support from their manager through one to one meetings. Yearly appraisals were used to ensure staff had the opportunity to develop and identify their training needs. There were regular staff meetings so staff could discuss any issues and share new ideas with their colleagues to improve people’s care and lives.

At the last inspection the provider had not made sure that care and treatment was provided with the consent of the person and had not acted in accordance with the Mental Capacity Act 2005.The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation for people who were at risk of having their liberty restricted. They were waiting for the outcome from the local authorities who paid for the people’s care and support. Peoples mental capacity had been assessed but not always reviewed when it fluctuated. This is an area for improvement. When people were unable to make important decisions for themselves, relatives, doctors and other specialists were involved in their care and treatment and decisions were made in people’s best interest. The regulation had been met.

People, relatives and staff felt comfortable in complaining and when they did complain they were taken seriously and their complaints were looked into and action was taken to resolve them.

Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. Staff were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance. They told us they were listened to and their opinions mattered and counted.

The registered manager was committed to driving continuous improvement and involving people and staff in this process. Feedback on the service was collected through a variety of methods including through meetings, questionnaires, reviews and individual meetings. This information was analysed to inform improvements. At the previous inspection the quality assurance audits were not effective to ensure that all shortfalls in the service were recorded and appropriate action was taken. Records were not up to date. At this inspection there were quality assurance systems in place and these were being used to monitor and improve standards of care delivery. Shortfalls were identified and action was taken. On the whole records were up to date. The regulation had been met.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

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

All staff showed a good level of knowledge and understanding of people's needs. We observed a change of approach used with different people throughout the visit.

All people who used the service spoken with were very complimentary and stated things like, 'They look after me very well, they're all brilliant'. Another stated, ' the food is very good, we can have what we want'.

When asked about what they would do if they had concerns people using the service stated, 'I would talk to X' and another said, 'I would talk to any of the staff, they are all lovely' while another felt they would talk to their relative.

All staff spoken with stated they were very settled at Sholden Hall, and that the team was very supportive. All felt comfortable that if they had any problems or concerns they would be able to address these with the manager or the home owner. All staff showed a good level of understanding of safeguarding issues and what to be aware of and how to report.

People received support to maintain a healthy lifestyle. Staff encouraged people to be active so that they maintained their mobility. People were supported to attend health care checks and community health professionals were involved to provide advice and support when needed. There was a clear and safe system for checking and giving medicines. A healthy balanced diet was offered to people. People were able to choose the food they ate from the menu just before it was prepared. People with and without dementia were supported to maintain their independence and familiar routines which included making their snacks and drinks, ironing and washing up.

There was a stable staff team and a clear recruitment process. People and their families were helped to express themselves if they had a complaint and were encouraged to air their views and give suggestions for improvement.