Nazareth House - Lancaster

Nazareth House is a residential care home registered to accommodate up 43 people in need of personal care. Accommodation is provided over four floors with 43 single rooms, all with en-suite facilities. On the days of the inspection there were 39 people living at the home.

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

People received their medicines as prescribed by health care professionals. Some medicinal cream use and some stock holding practices required attention but these were addressed at inspection.

People were safe and protected from the risk of harm. Risks were appropriately identified, assessed and managed. Staff were safe to work with vulnerable people and appropriate safety checks had been made.

Staff were competent with safeguarding processes and knew how to protect people from the risk of abuse. People said they felt safe in the home and were trusting of staff and management. We observed good practices and interactions between management, staff and people during the inspection.

Staff supported people to have access to healthcare professionals and specialist support and the service worked with external specialists.

People and their relatives were confident in the management team at the home and praised how approachable they were. The service made appropriate notifications to CQC and other authorities of safety incidents to ensure these incidents received appropriate oversight.

Infection, Prevention and Control (IPC) processes were in place and we were assured about the service's ability to mitigate the transmission of infections.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 November 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider improved the recording of people's care and support needs, planning of staffing levels and its engagement with people and relatives. At this inspection, we found the provider had acted on the recommendations and noted improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Nazareth House - Lancaster' on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nazareth House is a care home providing personal care for up to 41 people with a range of physical and mental health needs. At the time of the inspection there were 36 people living in the home.

The care home accommodates people across three floors, each of which has separate adapted facilities.

We found the following examples of good practice.

The provider had established systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting including a comprehensive questionnaire to ensure they were safe to visit. Visitors were also screened for symptoms and their contact details were recorded to support the NHS Test and Trace service. Each resident had an 'essential care giver'. This meant an identified visitor participated in a comprehensive COVID-19 testing regime and could visit the home to help with support even during periods where the home is isolating people to prevent the spread of infection.

Social media platforms were used to facilitate contact between people and their relatives where physical visiting was not possible. Where appropriate, people were supported by staff to use this technology and this included the use of handheld devices.

The provider had established safe admission procedures for staff to follow. This included requiring new people to have a negative COVID-19 test before moving into the home, a further test during residency and to self-isolate in their bedrooms for 7 days after moving in.

During our visit we observed staff using Personal Protective Equipment, (PPE) safely. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had also supported staff and people to receive COVID-19 vaccines and boosters.

The home was clean and hygienic. Comprehensive cleaning schedules were in place.

The provider had an up-to-date infection prevention and control policies and procedures. They sought and acted on advice to further improve infection prevention and control procedures. They were aware of appropriate agencies to contact in the event of an outbreak of COVID-19.

The home had spacious sitting areas. This allowed staff to ensure, where possible, people were socially distanced.

The provider could adapt the layout of the building to support cohorting in the event of an outbreak.

Nazareth House is a residential care home registered to accommodate up 43 people in need of personal care. Accommodation is provided over four floors with 43 single rooms, all with en-suite facilities. On the days of the inspection there were 38 people living at the home.

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

We found failings within medicines processes and practices in the service. We could not be sure people always received topical medicines as prescribed and some good practice issues needed to be addressed. The provider’s systems and processes for the oversight, quality monitoring and safety of the service had not been effective in anticipating and addressing some concerns we found during the inspection. This placed people at risk of harm.

There had been times when there were insufficient numbers of staff deployed on each shift to meet people’s needs in line with assessed dependency. There were times when staff support was delayed due to a reduction in the numbers of staff available. The registered manager had recruited new care and activity staff and used agency staff if needed to address this.

We have made recommendations regarding effective recording systems, organisation values and transparency, as well as staffing reviews.

Checks of suitability for new staff had been completed before commencing work with vulnerable people. Staff told us they had received training relevant to their roles and when they commenced employment. Staff supported people to have access to health professionals and specialist support.

Safety needed to be promoted more consistently through the layout and hygiene practices within the service.

The need for improvement in some areas of practice and some risks in relation to fire and environmental safety had already been identified by external audits. The provider had acted promptly to change practices, organise necessary work and make improvements to mitigate those risks.

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 25 July 2018).

Why we inspected

We received concerns regarding governance, management oversight, risk management, medicines management, person-centred care and record keeping. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 reviewed the information we held about the 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

The provider acted during and immediately after the inspection to mitigate risks found. This included improved monitoring and clinical supervision and medicines management and developing an action plan in response to the inspection findings. Actions to improve were already underway following external audits in key areas.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nazareth House 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines and the systems used to oversee the quality and safe running of the service at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Nazareth House is registered to accommodate 43 people in need of personal care. Accommodation is provided over four floors with 43 single rooms, all with en-suite facilities.

Established in 1899 by the Sisters of Nazareth, the home is set in landscaped gardens, which

includes a wildlife pond. There is also a greenhouse for people who like gardening and a sensory

garden area for people to relax in. On the days of the inspection there were forty people living at

the home.

There was a registered manager in place. 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.

The last comprehensive inspection of the service took place in June 2017. At this time, we found the service was not meeting all the fundamental standards. The registered provider failed to ensure sufficient numbers of suitably experienced persons were deployed to meet the needs of people who lived at the home. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014, and enforcement action was taken.

We also found people were not consistently treated with dignity and respect. This was a breach of Regulation 10 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The registered provider had failed to ensure the proper and safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At the last inspection, we found the registered provider failed to ensure systems or processes were established and operated effectively to ensure compliance. They failed to maintain accurate records in respect of each person, including a record of the care and treatment and decisions taken in relation to the care and treatment provided. These were breaches of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

After the last inspection on 22 and 28 June 2017, we asked the provider to act to make improvements and this action has been completed.

At this inspection, we looked at staffing levels at Nazareth House Lancaster. Staff were effectively trained and able to deliver care in a compassionate and patient manner. However, we have made a recommendation the registered provider review staffing levels at busy times.

Care plans we looked at highlighted risk, however, not all care plans we looked at detailed how to minimise the risk. We have made a recommendation about this.

The service had systems to record safeguarding concerns, accidents and incidents and acted as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the commission when required.

Staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at Nazareth House Lancaster.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

Staff delivered end of life support that promoted people’s preferred priorities of care.

We observed lunch time and noted people had their meal in one of two dining rooms or in their bedroom. People told us it was their choice.

We observed only positive interactions between staff and people who lived at Nazareth House Lancaster. There was a culture of promoting dignity and respect towards people. We saw staff had time to sit and chat with people. People who lived at the home told us staff treated them as individuals and delivered personalised care that was centred on them as an individual. Care plans seen confirmed this. One relative wrote, ‘A wonderful place, thank you for everything you do.’

People told us there were a range of activities provided to take part in if they wished to do so. There was a comprehensive daily and weekly activities schedule at the home. We observed activities taking place and saw these were enjoyed by people who participated.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided. People told us the management team were approachable and the registered manager took regular walks around the home to assess the environment.

Nazareth House is registered to accommodate 43 people in need of nursing and personal care. Accommodation is provided over three floors with 43 single rooms, all with en-suite facilities. Established in 1899 by the Sisters of Nazareth, the home is set in landscaped gardens, which includes a wildlife pond. There is also a greenhouse for people who like gardening and a sensory garden area for people to relax in. On the days of the inspection there were forty people residing at the home.

There was a registered manager in place. 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.

The last comprehensive inspection of the service took place on 04 June 2016. At this inspection we found the service was not meeting all the fundamental standards. The registered provider did not consistently treat people with dignity and respect and people’s nutritional needs were not always suitably managed. We carried out a focussed inspection on 08 December 2016 to check if the required changes had been made and found suitable improvements had been made.

At this comprehensive inspection visit carried out on 22 and 28 June 2107, we found breaches relating to staffing, dignity and respect, safe care and treatment and good governance.

The service was not meeting all the fundamental standards. People who lived at the home and relatives told us they did not think staffing levels were adequate to meet people's needs. From our observations we found this was the case and staff were not always suitably deployed. Deployment of staffing in communal areas was inconsistent and people were left unsupported despite us being there was a staff member in communal areas at all times. Similarly, at meal times deployment of staffing was poor. This resulted in people having to wait and not always receiving the meal of their choice. We found errors in paperwork. Staff told us they had not been able to fulfil all their duties due to the workload pressures. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2013 as the registered provider had failed to ensure suitable numbers of staff were deployed to meet the needs of people who lived at the home.

People were not always treated with dignity and respect. We observed one person trying to leave a communal lounge in their wheelchair. Staff intercepted the person and brought them back into the lounge. They did not speak with the person to find out their wishes and left them in the lounge without any stimulation. This was a breach of Regulation 10 of the Health and Social Care Act 2008, (Regulated Activities) 2014 as the registered provider failed to ensure people were consistently treated with dignity and respect.

Arrangements were in place for managing and administering medicines. Medicines were secured in line with current guidance. Regular audits of medicines took place. However we observed that good practice guidelines were not consistently followed. This was a breach of Regulation 12 of the Health and Social Care Act 2008, (Regulated Activities) 2014 as the registered provider failed to ensure suitable systems were in place for the administration of medicines.

People who lived at the home were consulted with on a regular basis. However we found evidence to suggest people’s views were not always listened to and acted upon. We have made a recommendation on effective communication and consultation.

People who lived at the home told us that person centred care was not always provided. We looked at care records to establish if this was the case but were unable to make any judgement as care records were not fully completed and accurate. This was a breach of the Health and Regulation 17 of the Health and Social Care Act 2008, (Regulated Activities) 2014 as the registered provider failed to ensure people were consistently treated with dignity and respect.

Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. Suitable recruitment procedures were in place to ensure people employed to work at the home were of a satisfactory standard for working with vulnerable people.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

A visiting health professional told us they were confident the service met the health care needs of people who lived at the home. People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed.

Staff had received training in The Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) We saw evidence these principles were put into practice when delivering care. Consent was gained wherever appropriate.

There was a training and development plan in place for all staff. We saw evidence staff had been provided with relevant training to enable them to carry out their role. Staff praised the training opportunities provided by the registered provider. Staff told us they received supervisions.

We received mixed feedback about the staff who worked at Nazareth House – Lancaster. We were told that some of the staff were kind and caring.

We observed the activities coordinator carrying out activities taking place on the first day of our inspection visit. People told us they were supported to remain busy with activities if they wished.

The service had a system in place for managing complaints. People told us they were confident if they raised any complaints they would be dealt with professionally. We saw evidence that formal complaints were taken seriously and acted upon.

The service had systems in place for on-going monitoring of the quality of service. Monthly audits of care records, medicines and health and safety audits took place. Although audits were in place, they were ineffective as they had not identified the concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008, (Regulated Activities) 2014 as quality audits were ineffective.

The service had implemented a range of quality assurance systems to monitor the quality and effectiveness of the service provided. Feedback we reviewed was mixed.

Staff described teamwork as good. They told us they were regularly consulted with through team meetings.

You can see what action we have asked the provider to take at the back of the main body of the report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We carried out this unannounced focused inspection on 08 December 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nazareth House on our website at www.cqc.org.uk'.

Nazareth House is registered to accommodate 41 people who require nursing and personal care. Accommodation is provided over four floors with one double room and 39 single rooms, all with en-suite facilities. Established in 1899 by the Sisters of Nazareth, the home is set in landscaped gardens, which include a wildlife pond. There is also a greenhouse for people who like gardening and a sensory garden area where people can relax. Amenities are within easy reach, such as shops, pubs, library, cafes, museums, leisure facilities and public transport links. At the time of our focused inspection, 38 people lived at Nazareth House.

The service had a registered manager in place. 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.

The home had a Sister Superior, who is in charge of delivering spiritual support to people who live at Nazareth House. However, the home accepts people from all religious backgrounds. The home holds a daily Catholic Mass and other services are held by visiting clergy. There are several nuns who live at Nazareth House who provide social care and spiritual guidance.

At our focused inspection on the 08 December 2016, we found improvements had been made. We observed people being supported and treated with dignity and respect. Staff had received training that had helped them reflect on how they engaged with people.

We observed lunchtime at Nazareth House. We noted staff provided effective support to people. There was a variety of food available, which was checked and served at the appropriate temperature.

We could not improve the rating for effective and caring from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Nazareth House is registered to accommodate 41 people who require nursing and personal care. Accommodation is provided over four floors with one double room and 39 single rooms, all with en-suite facilities. Established in 1899 by the Sisters of Nazareth, the home is set in landscaped gardens, which include a wildlife pond. There is also a greenhouse for people who like gardening and a sensory garden area for people to relax in. Amenities are within easy reach, such as shops, pubs, library, cafes, museums, leisure facilities and public transport links.

The service had a registered manager in place. 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.

The home had a Sister Superior, who is in charge of delivering spiritual support to people who live at Nazareth House. However the home accepts people from all religious backgrounds. The home holds a daily Catholic Mass and other services are held by visiting clergy. There are several nuns who live at Nazareth House who provide social care and spiritual guidance.

At the last inspection on 23 September 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, we observed people being supported with their lunch. People did not always receive the appropriate support at mealtimes.

This was a breach of Regulation 14 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Meeting nutritional and hydration needs.) You can see what action we told the provider to take at the back of the full version of the report.

During our lunchtime observation staff did not always treat people in a caring way that ensured their dignity and respect was maintained.

This was a breach of Regulation 10 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Dignity and respect.) You can see what action we told the provider to take at the back of the full version of the report.

We found there were concerns regarding staffing levels to meet the needs of people who used the service.This was in relation to people being supported on the residential side of the home.

We have made a recommendation that the provider reviews staffing levels at the home.

We saw staff had received training in abuse and understood their responsibilities to report any unsafe care or abusive practices. Staff we spoke with told us they were aware of the safeguarding procedures. One person told us, “ I feel happier here because I’m never on my own at night. I'm safe.”

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received demonstrated people were satisfied with the care they were given. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive and approachable and would listen and act on concerns raised.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people they supported and their relatives for input on how the service could continually improve. The registered manager had regularly completed a range of audits to maintain people’s safety and welfare.

We asked the registered provider to provide us with an action plan demonstrating what they were doing to address the issues of non-compliance. We received their action plan in June 2014. This detailed the procedures put in place to address the shortfalls. We used this inspection to see what actions had been taken to address the areas of non-compliance.

Is the service safe?

At this inspection we found the service had made improvements in their care planning processes. We found that the service was safe because people were protected against the risks associated with use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were administered and recorded appropriately, and were kept safely.

Is the service effective?

We found that care plans for managing medicines were much improved and staff had guidance available to them to make sure that people received appropriate care.

Is the service well led?

We saw that audits, or checks of medicines, were done to assess the way medicines were managed. Care plans were being reviewed by a specialist clinician and staff were receiving training in care planning and record keeping.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We saw that staff had attended safeguarding training. Safeguarding was discussed at staff meetings. All newly appointed staff received safeguarding training as part of their induction training. A copy of the local safeguarding policy and procedure was available for staff for guidance and information. There were financial systems in place to protect people from risks of financial abuse.

Is the service effective?

We spoke with several people who lived at the home and their relatives. Relatives told us they valued being involved in care plan reviews and felt that they were listened to. If they felt improvements or changes could be made with the care and support, they saw that action was taken. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns. This helped to reassure them regarding their family`s welfare

Is the service caring?

We spent time with people in the communal areas of the home. This helped us to observe the daily routines and gain an insight into how people`s care and support was being managed. We observed staff to be caring and responsive to people who required support.

Is the service responsive?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. We spoke with several visiting professional(s) to the home. They told us they felt the home was responsive to people`s health care needs. When they spent time in the home they observed people to be well cared for. They told us staff took action when advice was given and specialised equipment was provided.

Is the service well led?

Since the last inspection a new manager was in post and she had submitted her Registered Mangers application to the Commission. During her time in post she told us she had developed a new management team and they were working to support their staff team to develop their skills and knowledge. A range of routine audits were in place including care plan records, medication, financial records and staffing levels within the home. People using the service and their relatives had been given opportunity to complete a satisfaction survey. Regular staff and resident meetings took place.

'I get it [their painkiller] when I need it, I get it pretty regularly'.

'I am well cared for. I get my eye drops and tablets every morning and every night'

'The place is lovely and the carers are very good. I have a special carer who knows all about me. I sometimes get aches in the night and I ring my bell and the girls come quickly to give me painkillers'.

'I have problems with my eyes and get drops every night. The carers do it for me'.

'I get my painkillers twice a day and my blood pressure tablets in the morning. The girls give them to me in a little pot and stand with me while I take them'.

'I have cream on my feet every morning before they put my socks on. They rub it in nice and softly'.

Whilst people who we spoke with were happy with the way their medicines were managed, we saw that medicines were not always handled safely. Overall, we found that the handling of medicines had improved since our last inspection. However, further improvements in medicines handling was needed in order to fully protect the people who use the service.

'I get my tablets regularly'.

'I have no pain. We have a good system. I have painkillers four times a day'.

'The nurses come no problem in the night for pain-killers'.

'I have my own eye drops. They change them every 28 days'.

'My legs are dry. I am supposed to have my cream twice a day but I only get it

as and when. Sometimes I don't get it at all'.

Overall, we found that medicines were not managed in a safe way. Whilst people who we spoke with were mostly happy with the way their medicines were managed, we saw that medicines were not handled properly. In particular we saw records and care plans relating to medication that were poor. This meant that the care that was provided was not always safe or appropriate.

We observed the care and support at lunchtime. The dining room was set out to a high standard with crockery and condiments on the tables available. People were supported to eat a healthy and nutritious diet.

We looked at the staffing rotas over a four week period to see if there were sufficient staff on duty to meet the needs of people who lived at the home. We saw there was a skill mix of qualified nurses, experienced and newer members of the staff team on the duty rota.

The home had a range of audits and systems in place to monitor the quality of the service being provided. We saw that people were encouraged to give their feedback regarding living at the home in a variety of ways. People we spoke with told us they felt they could raise any concerns they had.

'I go out to the hairdressers and the Deepdale centre and have lots of visitors'.

'We checked out a few homes and this was the best. I like it here, it is very quiet'.