Archived: Wordsworth House

We found the following examples of good practice.

The manager had established effective infection prevention and control procedures which were understood and followed by the staff. A screening process had been implemented for all visitors entering the building, which included temperature checks and lateral flow device tests. Visiting professional staff were also asked for proof of their COVID-19 vaccinations.

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate in line with current guidance to reduce the risk of introducing infection. People’s health and well-being was carefully monitored during this time. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken when any positive results were received.

There were plentiful supplies of Personal Protective Equipment (PPE) and stocks were carefully monitored. Staff had ready access to PPE when supporting people with personal care. PPE was disposed of safely to help reduce the risk of cross contamination. Staff had been trained in infection control practices and posters were displayed around the home to reinforce procedures. We observed staff were using PPE appropriately.

The communal areas were suitable to support social distancing. The premises had a good level of cleanliness and was hygienic throughout. Housekeeping and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was cheerful and calm. We observed staff were attending to people’s needs throughout our visit.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. The policies and procedures were updated regularly following any changes in national guidance. Detailed infection prevention and control audits were carried out on a regular basis.

Wordsworth House is a residential care home and is registered to provide accommodation and personal care for up to 40 older people and people living with dementia. At the time of our inspection, 23 people were using the service.

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

People told us they felt safe and were happy with the service they received. They said staff were kind and they were treated well. Relatives we spoke to were also satisfied with the service. One told us, “It’s well managed and there is always plenty of staff around. They are helpful and seem to enjoy their job. You get the feeling it’s a good place, staff are happy. I can’t fault them.”

Staff understood how to protect people from abuse and recruitment processes ensured new staff were suitable. People’s safety was at the centre of care delivery. Risks were assessed and carefully monitored, and people received their medicines safely. Infection control was well managed, and the home was clean and free from hazards. Improvements were being made inside and outside the home; there was a plan to support this. There were sufficient staff to meet people’s care and support needs. Additional staff were being employed to support people with increased activities and going out.

A new manager had been in post since August 2021 and was part way through registering with CQC. The manager was already providing clear leadership to ensure an enabling and person-centred culture was being embedded at the home. People’s views and opinions of the service were sought and acted on. People and their relatives were happy with the way the service was managed and told us the new manager was very approachable.

The manager and staff team were committed to providing people with high-quality care. Staff reported goodteam work and found the new manager supportive and open to ideas. The provider had systems in place to monitor the quality of the service.

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

Rating at last inspection

The last rating for this service was good (published 17 April 2019).

Why we inspected

The inspection was prompted in part due to the home not having a registered manager for some time. We looked at Safe and Well-led at this inspection. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all 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.

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.

People’s experience of using this service: We found improvements had been made since our last inspection.

People told us they felt safe at the service. There were enough staff available to provide care and support; staffing arrangements were kept under review. The provider followed safe processes were in place to make sure appropriate checks were carried out before staff started working at the service.

Staff followed some good processes to manage people's medicines safely. Some improvements were made during our visit and the registered manager agreed to ensure checking systems were developed.

The provider had arrangements in place to promote the safety of the premises, this included maintenance, servicing and checking systems. People were protected by the prevention and control of infection.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on safeguarding and protection matters.

People's needs were being assessed, planned for and reviewed. Each person had a care plan which was designed to ensure their needs and choices were met. People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.

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 at the service supported this practice.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

There were opportunities for people to engage in a wide range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service.

There was a suitable standard of décor and furnishings to provide for people's comfort and well-being.

People said they were satisfied with the variety and quality of the meals provided at the service. Their individual needs and preferences were catered for. People were supported to enjoy the mealtime experience.

People had an awareness of the service's complaints procedure and processes. They indicated they would be confident in raising concerns. Some complaints records were unclear and lacked detail. We have made a recommendation about complaints management.

Arrangements were in place to encourage people to express their views and be consulted about Wordsworth House. They had opportunities to give feedback on their experience of the service and suggest improvements.

Improvements had been made with checks on quality. A variety of systems and processes were in place, to regularly monitor and improve the service. There were management and leadership arrangements in place to support the effective day to day running of the service.

Rating at last inspection: Requires Improvement. (6 March 2018) At this inspection the overall rating has improved to Good.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

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

Wordsworth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 40 people across two separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of the visit there were 32 people who received support with personal care. There is no nursing care at this service.

At the time of our inspection there was no registered manager in post. The registered manager had recently left. A new manager had been appointed and was in the process of completing an application to become the registered manager. A registered manager is a person who has registered with the 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.

At the last inspection in December 2016, we found shortfalls in the safe management of people’s medicines. This was breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the provider sent us an action plan, which set out what actions they intended to take, what they would do and by when to improve the key question, ‘Is the service safe?, to at least good.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the breach in regulations identified in December 2016. We found necessary improvements had not been made in relation to the safe management medicines. We also found improvements were required in relation to the control and prevention of infection and good governance at the service.

During this inspection we found breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured the safe management of people’s medicines and there was a failure to establish effective measures for the prevention and control of infections. You can see what action we told the registered provider to take at the back of the full version of the report.

This is the second consecutive time this service has been rated Requires Improvement.

There was mixed feedback from people and their relatives regarding the quality of care at the home. Visiting professionals we spoke with also gave us mixed feedback about the service. People who lived at the home told us that they felt safe. There was mixed feedback about the staffing levels in the home. There had been a high staff turnover. We found in majority of the cases, cover had been provided using agency staff. However, there were times when adequate cover had not been provided. The manager was in the process of recruiting new staff in order to address this matter.

We found there was a negative culture and low morale within some of the staff team. This had impacted on the quality of care provided and necessary improvement needed in the home had not been achieved. Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. However improvements were required to the risk management procedures.

Staff had received safeguarding training and knew how to report concerns to safeguarding professionals. Accident and incidents had been recorded. However, unwitnessed falls that involved head injuries had not always been referred to medical professionals. There were improvements in the safe recruitment of staff and checks were carried out to ensure suitable people were employed to work at the home.

The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. Staff and the manager had knowledge and understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s consent to various aspects of their care was considered and where required DoLS authorisations had been sought from the local authority.

Risks associated with fire had been managed and fire prevention equipment serviced in line with related regulations.

Care plans were in place detailing how people wished to be supported. People’s independence was promoted. People’s privacy and confidentiality was respected.

The provider had sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings and surveys had been undertaken to seek people’s opinions.

During the inspection we observed that regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People who lived in the home, staff and relatives informed us there were times when food stocks had not been adequately monitored. However, on the days of the inspection we found food stocks had been maintained and people had sufficient food. Risks of malnutrition and dehydration had been assessed and monitored.

We found people had access to healthcare professionals and their healthcare needs were met. Relevant health care advice had been sought so that people could receive the treatment and support they needed.

We observed people being encouraged to participate in activities of their choice. People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaint’s procedure was available and people said they were encouraged to raise concerns.

Staff had been provided with ongoing training and development. Supervision and appraisal was provided.

The manager and representatives of the registered provider used a variety of methods to assess and monitor the quality of care at the home. However, governance and management systems in the home needed improvements. There were checks in various areas such as medicine, care plans, health and safety. The quality checking systems were effective in identifying faults and areas of improvement. However we found these findings had not been acted on.

Wordsworth house is a residential care home registered to provide care for up to 40 people. Facilities were provided over two floors. The first floor was a unit that cared for people who were living with a dementia. All of the bedrooms were single occupancy and benefited from ensuite facilities. People who used the service had access to outside gardens with raised planters and seating.

The service had a registered manager in post. 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.

At the last inspection on 19, 20 April and 20 May 2016, we identified 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding, safe administration of medicines, managing risk, staffing, infection control, premises and equipment, staff skills, nutrition, Deprivation of Liberty, consent, person centred care, dignity and respect, complaints, records, good governance and failure to notify the Commission. We asked the provider to take action to make improvements and to send us an action plan. The provider complied with our request. During this inspection we found the required improvements had been made.

During this inspection we found one continuing breach of the Health and Social Care Act 2008 (regulated Activities) Regulation 2014 in relation to medicines. You can see what action we told the provider to take at the back of the full version of the report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Whilst improvements had been made in the safe administration and handling of medicines since our last inspection on this occasion we identified some concerns relating to the recording and administration of medications.

There was a new computerised system in place to record and monitor medicine administration. Whilst this would ensure regular checks of stock and administration could be easily monitored we saw one person had not received their medication in a timely manner and another person’s medication had not been administered according to the directions for use.

People who used the service and relatives told us they felt people were safe in the home. There were policies and procedures in place to guide staff in the event of a concern. Staff demonstrated their understanding of the signs and types of abuse and what actions they would take if abuse was suspected.

We saw risk assessments had been completed since our last inspection. These included individual risk assessments as well as environmental risk assessments.

There was an emergency contingency plan and personal evacuation plans were in place and up to date. This would ensure the emergency service had access to information about the needs of people in the event of an emergency. Essential environmental checks such as water temperatures, radiators and room checks had been completed.

Staff had undertaken the training required to enable them to meet the needs of people who used the service.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Staff we spoke with demonstrated an understanding of MCA and DoLS and the impacts on people who used the service. Records confirmed applications for DoLS had been submitted to the supervisory body and were waiting for authorisation.

People had access to nutritious meals of their choice as well as adequate hydration. Records confirmed weights and food and fluid intakes were monitored by staff.

People had access to health care professionals and services when they required them. Care delivered to people was provided in a dignified way. Privacy when undertaking care was provided at all times by staff.

People who used the service told us they were happy with the care they received in the home and we observed positive caring relationship between staff and people who used the service. There was information available on advocacy services where people required support to make decisions about their care.

Since the last inspection the provider had introduced new documentation for each person’s care file as well as records relating to daily care delivery for people who used the service.

Since our last inspection a detailed programme of activities had been developed. There was evidence of varied activities taking place; these included a number of activities to celebrate the Christmas festivities.

A system to monitor and analyse complaints had been introduced. People told us they were able to raise any concerns and were confident these would be acted upon.

We also saw evidence of positive feedback from visitors and people who used the service.

Since our last inspection the registered manager had introduced regular audits in the home to ensure people were receiving safe and monitored care.

We received positive feedback about the registered manager and the changes implemented since our last inspection.

Since our last inspection appropriate notifications had been submitted to the Commission.

Wordsworth House is registered to provide care for up to 40 people. The home is registered with the Commission to provide accommodation for persons who require nursing in a care home without nursing for older people, people with a mental health diagnosis, younger adults or people living with a dementia related condition. At the time of our inspection there were 38 people in receipt of care from the provider.

The registration requirements for the provider stated the home should have a registered manager in place. There is no registered manager for this service. The home manager told us they had started the application process for registered managers with the Commission. 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.

Systems to monitor and review concerns were inadequate. During our inspection we identified a number of concerns relating to allegations of abuse that had not been reported in a safe and appropriate way. We asked the home manager to refer the concerns that had been identified during our inspection to the Local Authority safeguarding team.

The system to record, investigate and monitor allegations of abuse was inadequate. The home manager showed us a safeguarding file. However this contained only a cover sheet and no record of the any current or previous investigations.

There was a risk assessment file which indicated a general risk assessment had taken place recently. Areas included; kitchen equipment, housekeeping and maintenance. However we identified some concerns relating to individual risk assessments for people living in the home.

Observation of medicines administration identified concerns relating to the length of time it took to administer all the medicines. Some medicines that were required before breakfast were not given as directed. We noted gaps in Medicines Administration Records (MAR) and the coding system lacked clarity on why medicines were not given.

Monitoring of room and fridge temperatures did not take place in line with guidance to ensure safe storage of medication. We saw on two occasions that the medicines trolley was left in the lounge on one of the floors and it had not been secured to the wall.

We looked at the training matrix and saw evidence of training taking place. However there was also some gaps in training.

Some staff we spoke with raised concerns about the staffing numbers in the home. Examples of comments received were, “We are falling behind. We keep having to do medicines on both floors if there is sickness.” Another said, “Staff morale is low”. However one person said it was a, “Good staff team”. Senior management and the home manager told us they were in process of recruiting senior staff for the home.

We asked about how people were assessed when a Deprivation of Liberty Safeguards (DoLS) was required. We saw DoLS applications that did not reflect people’s individual and current needs. Evidence of training for DoLS and Mental Capacity Act (MCA) identified that not all staff had completed the required training.

Systems to protect people from the risks of infection were ineffective. We saw evidence of an outbreak of diahorrea and vomiting that had not been referred to the relevant authority. We observed staff entering the kitchen without using appropriate personal protective equipment. We saw a sling in a bathroom that was stained and dirty.

We identified some concerns relating to maintenance checks in the home. For example the monthly room checks had not been completed since February 2016 and had identified areas that had ‘failed’ the check. Eight rooms had been identified as having no buzzers in the bedroom and two records had identified broken radiator covers. There was no reference to any actions that had been taken as a result of the concerns. We checked these rooms and identified three rooms did not have access to a call bell system.

We looked at care records including two short term care plans. We could only see reference to obtained consent in one of the file we looked at. This meant records did not reflect agreed care delivery.

People did not receive adequate fluids and care records did not reflect current individual diets. Weight recording lacked consistency and gaps in recording were seen. We saw evidence of weight loss for a number of people in receipt of care who had not been weighed for three months prior to the inspection.

During our inspection we spoke with people who used the service about the care they received in the home. We received positive feedback. Examples of some of the comments received were, “The staff are lovely, I have no concerns. You will not find a better place to live if you need a bit of help.” However we noted occasions where we were concerned about the care provided to people living in the home and the response of staff to them.

During a tour of building we saw there were picture cards on people’s bedroom doors which contained confidential information about them. We were told the content on the cards had also been raised prior to our visit by a professional visiting the home. However no action had been taken.

We observed activities taking place in the home and people we spoke with confirmed activities were offered. There was evidence of activities recorded in peoples care file. However one of these we looked at recorded an activity when they were in hospital.

We saw some evidence of involvement and review in the care files we looked at. However on checking information in peoples care files we identified concerns relating to the response of staff relating to changes in their condition and appropriate referrals to a professional for one person who used the service.

All the people we spoke with confirmed staff discussed their care with them. The home manager told us, “I would speak with the family and gain opinions of other family members and carers. I follow the processes and document outcomes. Documentation is the key for every area. We are waiting for new paperwork to arrive.”

We asked about the reviews of care files taking place in the home. We saw two audits for care plan reviews in the office. We spoke with home manager about this who told us she had completed more reviews; however, she was unable to locate them during our inspection. We saw on the third day a care plan matrix had been updated to reflect the reviews that had taken place.

During our inspection we reviewed a number of care files for people currently in receipt of care along with two files for people who no longer lived in the home. We identified some evidence of care plans in place and included reviews of care and identified needs; however, there were gaps and inconsistencies in them. Systems to ensure records reflected people’s individual care were inadequate.

Staff told us they felt supported by the provider during the takeover of the home. However, staff we spoke with provided conflicting information about the management in the home.

Systems to monitor incident and accidents were inadequate. Records indicated that four records had not been signed as reviewed by the home manager. We found evidence of some incident reports relating to people who used the service; however, these had been left on the desk with other records. There was no evidence that any analysis of the concerns had taken place.

We were shown an action plan for the home. There was some evidence of audits for nutrition observations; however, there were some inconsistencies and gaps in other records. For example we saw pressure relief turn charts, accident and incident audits; however, none of these had been completed.

We asked the home manager about how they received feedback from people living in the home and their relatives. There was an evidence file which had sample records for feedback from visitors, staff and people who used the service; however, these had not been completed.

We looked at the records relating to staff meetings. We saw records relating to regional home managers meetings which included dates, attendees and topics covered for example; weekly reports, health and safety and impact audits.

During our inspection we discussed the responsibility of the provider to notify the Commission of notifiable incidents such as deaths, serious injuries and allegations of abuse. We identified a number of concerns that required a notification; however, we saw these had not been sent to the Commission.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding from abuse, safe care and treatment, staffing, premises and equipment, nutrition, person centred care, dignity and respect, receiving and acting on complaints, good governance and fit and proper persons. We also found a breach of the Health and Social Care Act 2008 (Registration) Regulations 2014 in relation to notifying the commission of notifiable incidents.

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 wit

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This a summary of what we found:

Is the service safe?

There was evidence of enough skilled staff in place to care for people living in the home. We were told regular assessments of people's needs were carried out to ensure the staffing numbers reflected people's care and support needs

The manager told us there had been no application for a deprivation of liberty safeguard. We were told the home was in the process of implementing new paper work to ensure all people living in the home received appropriate assessments in relation to mental capacity. Some of the staff spoken with were able to discuss appropriate procedures to take if there were concerns about a person's mental capacity. (The Mental Capacity Act provides a legal framework to protect people who need to be deprived of their liberty for their own safety).

We saw evidence of comprehensive and appropriate care planning in place to ensure people living in the home received safe and effective care.

Is the service caring?

We spoke with people living in the home who told us staff were caring and kind. We observed positive interactions between staff and people living in the home and we saw staff sat chatting in a kind and respectful way in the public areas of the home with people who used the service.

We saw there were ongoing upgrades in people's bedrooms and the public area. All the bedrooms we looked at were decorated with personal items and mementoes. We observed reminiscence items and textured objects for example hats and coats on the dementia unit. Public areas, toilets and bathroom had pictures to help people living in the home to identify them. Evidence of activities equipment for example books were available for people in the lounges.

The four care files we looked at contained all the relevant information to enable staff to care for people living in the home safely and effectively.

Staff had received training to meet the needs of people who used the service including, mental capacity and safeguarding. We were told there was an ongoing training programme in place and we saw evidence of plans for future updates.

Is the service responsive?

We saw evidence of completed questionnaires by people living in the home. The manager told us people who used the service received questionnaires on different topics for them to complete for example cleanliness.

We looked at the complaints and incident file and saw that no complaints had been recorded since the last inspection. All the staff we spoke with were able to tell us the appropriate procedure to take if a complaint was received. People living in the home and their families all told us they were happy with their care and had no complaints.

Is the service effective?

There was evidence in people's care files that their care needs were being met and reviewed regularly. There was evidence of people being involved in the care files and people we spoke with confirmed they had discussed their care with the staff.

We saw evidence of people's health being monitored and appropriate intervention by professionals such as the district nurse or the GP. A visiting professional we spoke with confirmed staff requested visits from them appropriately.

There was a comprehensive activity programme for people living in the home. We observed activities taking place on the day of our inspection. We saw evidence of activities recorded in people's care files and people living in the home confirmed they took part in the activities.

Is the service well led?

The manager is registered with the Care Quality Commission. The staff we spoke with were positive about the manager and told us they received more support from him since our last inspection. However we received some comments from staff that the manager did not respond to their concerns. We received positive feedback about the manager from people who used the service and relatives that we spoke with.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence of regular and recent audits taking place for example, medication, care plans, accident and weights. There were notes on actions seen.

There was evidence of supervision taking place with evidence of notes and feedback from staff seen.

We saw the manager had recently introduced care file audits each month and we saw completed copies of these with notes and actions seen. The manager told us each month a quality audit was completed and within this care files were also reviewed.

We spoke with two people who used the service who were complementary about the manager and staff at the home. One person told us, 'X (the manager) is good I have no complaints'. Another said, 'He is always around if you want to ask him questions he is there for you. I am looked after properly the staff check me in the night. It is like a home from home'.

We spoke with four people living in the home who told us they were happy with the care and support they received. Comments included, 'It's a lovely place; I'm very comfortable" and 'They look after us so well'.

We looked at the records of six people who used the service and saw there were procedures in place to ensure their consent was gained in relation to the care provided.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. We saw staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions.

People told us there were sufficient staff to look after them and made positive comments about the staff team such as, 'The staff love us and we love them' and 'I'm very well looked after'. A relative spoken with told us, 'The staff are wonderful here. I can't fault them at all'.

We found some auditing systems in need of improvement which meant the systems to monitor the outcomes for people who use the service were not effective and did not help to identify non compliance with the regulations.

We spoke with two people who used the service. They told us they were happy with the care and support they received and commented that they were treated well by the staff. Comments included, "They're very good to me" and "The staff are lovely". People told us they were able to express their views and opinions and could influence the way their care was delivered.

During our visit we looked at three care plans that belonged to people who used the service to ensure their needs were fully met and their rights were protected. People spoken with told us they could raise any concerns with the manager or the staff and were confident they would be listened to.