Archived: Meadow Dean

Meadow Dean is a ‘residential 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. The service is registered to provide accommodation and personal care to 26 older people who may be living with dementia, in one adapted building. At the time of this inspection there were 13 people living at the service.

We last inspected Meadow Dean in October 2017 when we found continued shortfalls and non-compliance of the regulations. The overall rating was requires improvement however well led remained inadequate, therefore the service also remained in special measures. The provider sent us an action plan to demonstrate 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 failed to implement the action plan and make the necessary improvements to the service.

The service did not have a registered manager in post. Although the provider had made some efforts to recruit a new manager this had been unsuccessful. The registered provider had decided to apply to CQC to be considered for the registered manager position. 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 recognised that additional support for the management team was required and had sought advice from a consultant who had visited the service two weeks ago so it was too early to see what impact this had on the service to drive improvement.

The audits and systems in place to check the quality of the service being provided were not regularly carried out or fully effective as they had not identified the ongoing shortfalls identified in this report.

The management of the service remained unstable and the deputy manager left the service the day after the inspection leaving the provider with no other management support.

The provider, deputy manager and the team leader were not aware of the current methodology of how we inspect using the key lines of enquiries.

The provider had not sought advice from the local safeguarding team or raised a safeguarding alert in line with guidance when an incident occurred where special lotions was left on people’s hair for too long which resulted in sores to their scalp. The provider had not informed CQC of this safeguarding incident in line with current legislation.

Accident and incident forms had been completed but had not been analysed to look for patterns and trends to reduce the risk of them happening again.

At the last two inspections risks assessments to support people with their behaviour and mobility did not always contain sufficient information to guide staff on how to mitigate risks and keep people safe. At this inspection some risk assessments had been completed to support people with their behaviour however there remained no guidance for staff of how to support people with their mobility.

People did not always receive the support they needed with their healthcare. Although referrals were made to health care professionals, such as dieticians and dentist, these were not always followed through to ensure that people were receiving the care they needed.

People’s care plans were not always personalised to reflect the care being provided. Care plans had been regularly reviewed but not always updated to reflect people’s changing needs.

People’s dignity was not always maintained as staff did not respond promptly when people needed to go to the bathroom. People’s independence was promoted.

Staffing levels were sufficient at the time of the inspection, however there were times when people who needed help and support from two staff had to wait to go to the bathroom. A review of the deployment of staff was therefore needed to ensure that two members of staff were available to respond to this person in a timely manner.

Staff had not been recruited with all the necessary checks in place as the provider had failed to ensure potential staff full employment history was recorded.

Although staff were receiving training to give them the right knowledge and skills to support people, records were not up to date or accurate to confirm this. The provider had a programme of supervision and appraisal in place to support staff.

At times, during the inspection, the provider was unable to produce the records we needed to complete the inspection. At the last inspection records were not always accurate or up to date and these shortfalls remained the same.

People were supported to be involved in their care. Although at times some people felt they were not being listened to as staff did not come promptly when they called.

People were asked for their consent when staff were supporting them and staff had an understanding of people’s mental capacity.

The management of medicines had improved since the last inspection and people were now receiving their medicines as prescribed and at the correct times. However, risk assessments were not in place to reduce the risks when using paraffin based inflammable creams. Medicine records were also an area for further improvement.

The provider had made some improvement to the premises, peoples bedrooms had new flooring, the conservatory had been refurbished and people and relatives could now meet in private. The communal lounge and dining room had been re-arranged and this had improved the space for people to sit and relax. However, the provider told us that they did not have enough resources at the time of the inspection to complete the maintenance programme.

People told us they enjoyed the activities and were able to join in with quizzes, playing board games, and singing. There was also outside entertainment such as singers. At the last inspection the provider told us that they intended to employ an activities co-ordinator but at this inspection they said this was no longer the case.

People and relatives knew how to complain and were encouraged by the provider to discuss any concerns or issues.

People told us they enjoyed the food and said there were able to choose to have a cooked breakfast if they wished. Drinks and snacks were available during the day to make sure they had enough to eat and drink.

People’s needs had been assessed when they moved into the service and people told us that they had been asked about their health and social care needs.

Infection control systems were in place together with deep clearing schedules to ensure the home was clean. Checks to the premises had been made, such as fire safety checks, health and safety and environmental risk assessments.

The provider had introduced a programme of supervision and appraisal to support staff. T hey had attended workshops to improve their practice and had links with the skills network to keep up with current ways of working. Staff told us that the provider was supportive and worked with the staff to provide person centred care.

The provider was trying to forge links with the community and had held an ‘open’ day to encourage local people to visit the service.

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

Although some improvements had been made, the progress was slow and there were still many areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of regulations and additional breaches at this inspection and there remained no registered manager in post. The service will therefore remain in special measures. We will continue to monitor Meadow Dean to check that improvements continue and are sustained.

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 and 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.

The service is registered to provide accommodation and personal care to 26 older people who may be living with dementia. On the ground floor, there are two communal lounges, a dining room and a small conservatory. Bedrooms are situated on the ground and first floor. The service is situated in a quiet, picturesque area of River, Dover, with easy access to local shops. At the time of this inspection there were 11 people living at the service.

The service did not have a registered manager in post. The registered provider had recruited to this post but this was unsuccessful and a new manager had started on Friday 27 October 2017. 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.

We last inspected Meadow Dean in May 2017 when we found significant shortfalls and the service had an overall rating of Inadequate. 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. In some areas the service had improved but there remained other areas where the provider had failed to become compliant with the regulations and there were continued breaches of the regulations.

Although audits and systems were in place to check the quality of the service being provided and improvements had been made, these were not fully effective as they had not identified the ongoing shortfalls identified in this report.

The management of the service remained unstable since the last inspection, although the provider had made efforts to appoint a new manager, one manager left the service after a very short period of time and a new manager had been recruited. Care staff and some senior staff had also left the service.

People, relatives and health care professionals had concerns that the service did not have a registered manager in post. They said this created confusion regarding who was in charge and leading the service.

Accident and incident forms had been completed but some of these had not been added to the audit or analysed to look for patterns and trends to reduce the risk of them happening again.

Checks to the premises had been made, such as health and safety and environmental risk assessments but there remained outstanding actions in the recent fire risk assessments. The fire alarm system was tested during the inspection and staff did not report immediately to the identified area to assess the situation as required. The provider told us that further training would take place to ensure that all staff knew what to do in the event of a fire.

At the last inspection staff had not been recruited safely and this remained the case. Staff files did not always have the correct documentation in place to show staff had the necessary checks in place, this included missing application forms and in some cases there was no reference from the previous employer to confirm the applicant’s conduct. Although some staff supervision had taken place this had not been regular and staff had not received an annual appraisal to discuss their ongoing training and development needs.

At the last inspection staffing levels were not adequate to ensure people’s needs were fully met and they were receiving safe care. At this inspection many of the people with high needs (people with complex health and mobility needs) had left the service and the dependency of the people now living at Meadow Dean had reduced. People were responded to promptly by staff, who were not rushed and were available when people needed support.

Risks to people had been assessed but risk assessments did not always contain sufficient information to guide staff how to mitigate risks and keep people safe. Since the last inspection people with high risks relating to their care, such as the risk of choking or displaying behaviour that challenged no longer lived at the service.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. In some cases people’s mental capacity assessments were contradictory and did not give staff clear guidance of how to support people

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People did not always receive the support they needed with their healthcare needs as staff had not always followed recommendations made by health care professionals. Staff had checked and changed the filters in people’s oxygen machines weekly and the tubes every fortnight.

The management of medicines had improved since the last inspection and people were now receiving their medicines as prescribed and at the correct times. Medicine records were also in good order.

Although he provider told us that the staff had completed training to give them the right knowledge and skills to support people, the training matrix was not up to date and there was a lack of certificates on file to confirm this. The provider told us that new staff would be completing the Care Certificate, (an identified set of standards that social care workers adhere to) but this had not been implemented at the time of the inspection.

People’s care plans were not always personalised with enough detail to show their individual choices and preferences. Care plans had been regularly reviewed to reflect people’s changing needs.

The programme of activities had improved and people told us they had bingo, music sessions and were preparing for a Halloween party.

People and relatives told us they did not have any complaints but would speak with the staff, however, they were not sure who the manager was as there had been changes to the management team.

Staff had a good understanding of safeguarding procedures and knew how to report safeguarding concerns. They had an understanding of the whistle blowing policy and were confident that if bad practice was raised the provider would take the required action.

People told us that sometimes their dignity was not always maintained. People were not kept waiting if they needed support or wanted to go to the bathroom. Staff encouraged people to remain as independent as they could.

The conservatory was in the process of being refurbished and people were now using the dining room for their meals. People were supported to eat and drink enough, with drinks available throughout the day. People told us they were not entirely satisfied with the quality of the meals being provided.

There had been no admissions to the service since the last inspection; therefore we were unable to assess the care needs assessments at this time.

At the last inspection the premises were dirty and some people’s rooms smelt of urine. Infection prevention and control procedures had improved and there were systems in place to prevent unpleasant smells in bedrooms, such as deep cleaning schedules. The provider also told us that they were in the process of replacing the flooring in some bedrooms to eliminate odours.

The laundry system had improved and plans indicated that a new building would be erected to improve the laundry process. The cleaning mops were colour coded to reduce the risk of infection and the hazardous waste bins were locked in line with the Department of Health guidance.

The manager had informed CQC of any important events that occurred at the service, in line with current legislation.

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

Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of regulations and there remained no registered manager in post. The service will therefore remain in special measures. We will continue to monitor Meadow Dean to check that improvements continue and are sustained.

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 measur

The service is registered to provide accommodation and personal care to 26 older people who may be living with dementia. On the ground floor, there are two communal lounges, a dining room and a small conservatory. Bedrooms are situated on the ground and first floor. The service is situated in a quiet picturesque area of River, Dover, with easy access to local shops. At the time of this inspection there were 21 people living at the service.

The service did not have a registered manager in post. We wrote to the registered provider about this before the inspection. The provider told us the manager was going to apply to be the registered manager, then told us that this would not now happen and they would recruit a manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager led the day-to-day running of the service and was supported by the provider. The manager was on holiday at the time of the inspection.

We last inspected Meadow Dean in November 2016 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to the need for consent, safe care and treatment, good governance and staffing. There was an additional breach of the Care Quality Commission (Registration) Regulations 2009. We issued a requirement notice relating to notifications of other incidents as the provider had failed to notify CQC as required.

The service was rated 'Requires Improvement' and ‘Inadequate’ in the ‘well-led’ domain. 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 not met the previous breaches of regulations and further breaches were found.

There was not enough staff to keep people safe. The manager had completed dependency assessments to work out how many staff were needed, but these did not show people’s true levels of need. People who had a high level of need, for example, they required the assistance of two members of staff to assist them with moving, had been assessed as having a low level of need. Staffing levels were unsafe as a result. People’s dignity was compromised due to the lack of staff. The lack of staff meant people had to wait up to twenty minutes to have their call bells answered. They were unable to go to the toilet when they wanted and had to wait to receive support. Staff were not always recruited safely.

People did not always receive their medicines as prescribed. Some people had not received medicine to help keep their bones healthy for over a month. Some people needed to take their medicine at the same time each day to help them stay healthy and well. These medicines were given to people too late. One person needed to take medicine before they ate to stop them being sick and to ease their discomfort. Staff were unaware that this was the case and regularly gave the person their medicine after they had eaten.

Risks relating to people’s care and support had not been adequately assessed and staff did not follow guidance from health care professionals. One person, at risk of choking, needed to have their drinks thickened to reduce this risk. Staff had run out of the person’s prescribed drink thickener and had not ordered any more. The person’s GP told us that a prescription for thickener had not been ordered since November 2016.We saw staff giving the person drinks that had not been thickened. . Staff did not follow Speech and Language Therapy advice when assisting this person to eat safely.

There had been occasions when people displayed behaviours that may challenge. There were no step by step guidelines in place to explain to staff how to support people in a way that suited them best. Some people required staff support to clean and change the filters in their oxygen machine weekly and the tubes every fortnight. This had not been completed for over a month.

Assessments of people’s needs had not been completed when people moved into the service or returned from hospital. One person had returned from hospital and there had not been a full handover between staff. Their condition had deteriorated and they had been re-admitted to hospital as a result. Staff did not have access to the necessary guidance to ensure people could be moved from the service in the event of an emergency.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. 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. The provider had made one DoLS application; however, they told us this was due to ‘the person’s behaviour.’ They did not understand that people’s liberty was restricted if they were under continual supervision and unable to consent, and had not made DoLS applications as result to ensure this supervision was lawful.

Staff did not always treat people with respect. We observed staff moving a person sitting a wheelchair, without explaining what they were doing. The provider had made decisions on people’s behalf, such as changing the access to the conservatory, without consulting with them.

There was a task orientated culture at the service, staff were busy doing different chores rather than spending time with people. Staff did not have the time to spend with people to give them person-centred care. Meal times were arranged around staff and not when people wanted to eat. There was not enough staff to engage people in activities. An entertainer was present on the afternoon of the first day of the inspection, and people enjoyed this, however, the rest of the time people sat in their rooms or the lounge in front of the television with no interaction from staff.

Staff had not received the training and supervision necessary to complete their roles effectively.

The premises were dirty and some people’s rooms smelt of urine. Infection prevention and control procedures were not adequate. Staff had left soiled laundry on the ground in the garden on top of dirty but unsoiled laundry. Hazardous waste bins were unlocked and overflowing, which is against Department of Health guidance.

There was no registered manager in post, as required by the provider’s registration. The provider did not have a background in care and had not identified the serious concerns that we raised at this inspection.

The manager had informed CQC of any important events that occurred at the service, in line with current legislation. The manager of the service had raised safeguarding concerns. We asked the provider to inform the local safeguarding team of the concerns we identified. This happened on the second day of the inspection.

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

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.

The service is registered to provide accommodation and personal care to 26 older people who may be living with dementia. On the ground floor there are two communal lounges, a dining room and a small conservatory. Bedrooms are situated on the ground and first floor. The service is situated in a quiet picturesque area of River, Dover, with easy access to local shops. At the time of this inspection there were 21 people living at the service.

The service did not have a registered manager in post. The provider told us that they had been interviewing for this position but had not appointed a new manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A deputy manager led the day to day running of the service and was supported by the provider.

We last inspected Meadow Dean in October 2015 when three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. The service was then rated ‘Requires Improvement’. The provider sent us an action plan telling us what they would do to meet the requirements of the regulations. At this inspection we followed up on these previous breaches of regulations. Only one breach had been met with two breaches of regulations continuing. There was breaches found of a further three regulations.

Potential risks to people had not always been identified to guide staff how to support people with their behaviour. Associated risks with regard to the use of oxygen and smoking were not detailed to give the staff guidance about how to ensure people received the support they needed to keep them as safe as possible The systems to prevent the risk of infection were not effective.

Accidents and incidents were recorded and appropriate action had been taken but the events had not been analysed to look for patterns or trends to prevent further occurrences. The provider needs to seek advice from the Fire and Rescue service with regard to the use and safety of the fire door on the ground floor. Plans were in place in the event of an emergency and to evacuate people safely in the event of a fire. Checks were done to ensure equipment, such as hoists, and lifts were safe and the gas boilers had also been checked.

There was a plan to improve the environment but there were areas of the premises which needed attention such as the front door and windows. The provider told us that repairs were not always timely as there were restrictions by the council as the premises were in a conservation area. People’s rooms were personalised to their individual tastes.

The provider had not ensured there were sufficient staff on duty at all times to meet the needs of the people living at the service. Staff received regular supervision and a yearly appraisal to support them in their role.

There had been no recent recruitment, previous staff were recruited safely and there was a training programme to ensure that staff had the skills and competencies to carry out their roles. New staff had received an induction and shadowed experienced staff until they were confident to perform their role.

People felt safe in the service and staff understood the importance of keeping them safe. Staff knew how to protect people from the risk of abuse and how to raise any concerns they may have.

Staff were confident to whistle-blow to the deputy manager if they had any concerns and were confident appropriate action would be taken.

People received their medicines safely and medicines were stored and recorded in line with current guidelines. Staff had received medicines training.

Staff supported people to make decisions and respected people’s choices. There had been no formal assessments of people’s capacity about specific decisions that might affect their health and welfare. Staff supported people to maintain good health, people received support from healthcare professionals, such as, specialist nurses, district nurses, chiropodists and opticians.

People’s nutritional needs were monitored and appropriate referrals to specialists were made when required. People were given a choice of meals, any special dietary needs were catered for, and people received food that was suitable for them.

People were relaxed in each other’s company; there was a warm relationship between people and staff. Staff treated people with kindness and respect and they knew each other well. People told us the staff were polite and respectful.

People’s care had been planned with their involvement. Care plans were personalised and kept up to date with people’s current care and support needs. Staff informed relatives of changes to their relative’s care. There was a complaints procedure and complaints were responded to.

Relatives told us that they visited when they wanted and were always made to feel welcome. There was an activity programme and people were encouraged to live their preferred lifestyle.

People, relatives, staff and other stakeholders had been given the opportunity to voice their opinions about the service through meetings and quality assurance surveys. The last survey was sent in March 2016 with positive results. Any issues raised were actioned by the provider to improve the service.

The provider visited the service most days, the provider and deputy manager had completed environmental and service quality checks. These checks had not always been accurate, and did not always show what, if any, action was needed to continuously improve the service.

Staff were clear about their roles and responsibilities. Staff felt supported by the deputy manager and were confident that they could approach them for advice and guidance.

Records were not always available, accurate, or detailed with information to guide staff how to care for people safely.

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

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. This was confirmed by our observations.

Care records showed that people had been involved in planning their own care and had consented to having support. Staff told us how they seek consent each time they give support to a person.

We spoke with people who told us that their health needs were given high priority; this was supported by information on people's records which confirmed appropriate support had been sought from medical professionals.

We saw that the home manager had taken appropriate steps to ensure that staff had the necessary skills and knowledge to carry out the required work. Both staff and residents confirmed that the number of staff was good, allowing responsive working practices to take place. There were good procedures in place to ensure that staff sickness and leave was adequately covered.

Record keeping throughout the home was of a good standard. Records relating to the service and to people living at Meadow Dean were updated contemporaneously with sufficient detail.

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 their meals from a menu with alternatives offered.

The were protected from abuse and there were systems and procedures to keep their belongings safe. People said they liked living at the service and felt safe. One person told us, 'I feel safe here because the staff are good.'

There was a stable staff team and a clear training and support system. Staff spent time with people and supported people where needed in a positive way. Staff said they enjoyed working in the home and were well supported by the manager. One person using the service talked about the manager and said, "She's a nice person." A visitor to said, "My mother is alright here, it's a nice home."