Updated 5 March 2025
Date of Assessment: This assessment took place between 2 April to 7 April 2025. The service is a care home providing care to older people, all of whom live with dementia. At the time of our assessment there were 15 people using the service.
The provider had made improvements and was no longer in breach of regulations. The service was now working within the principles of the Mental Capacity Act (MCA) and legal authorisations had been obtained to deprive people of their liberty, where this was deemed necessary to ensure their safety.
Information about people’s needs and risks to their safety had improved. The provider made sure information about people’s needs and risks to their safety was obtained and made available to staff, from the moment people started using the service. Risks to people were now managed well.
Governance systems were now more effective and used to check the safety and quality of the care and support provided to people, at regular intervals. Records were, on the whole, maintained well but some records would benefit from having out of date information removed to ensure these remained current and up to date.
The provider maintained the safety of the environment through regular servicing and maintenance of safety systems and equipment. Measures were in place to reduce risks posed by the environment. We identified a potential trip hazard during our site visit which was addressed immediately by the provider to reduce potential further risk to people. The provider had made improvements to the environment and was in the process of purchasing new soft furnishings to replace older, more dated items at the service.
Medicines arrangements had been improved. There was better information about how people should receive their medicines which was reviewed at appropriate intervals. The provider worked proactively with others to make sure people received medicines that met their needs, with positive outcomes being achieved for people in relation to their health and wellbeing.
Recruitment arrangements had also been improved and were now more robust. Only suitable staff were employed to work at the service.
The environment was clean and hygienic and staff followed best practice to minimise infection risks at the home.
People were protected from the risk of abuse. Staff understood their responsibilities to safeguard people and systems were in place to support timely reporting and recording of safeguarding concerns and other safety events and incidents.
Managers led well and were highly regarded by people, relatives and partners that worked closely with the service. They were suitably experienced and understood the needs of people using the service. Managers encouraged and supported staff to deliver safe, high quality care to people. Staff were valued and well supported with their learning and development to help them meet the range of people’s needs.
People, relatives and staff were encouraged to speak up and raise concerns and these were listened to. There was a culture of improvement and inclusivity focused on people experiencing positive outcomes and enhancements to the quality of their lives.