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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed all quality statements within caring. The rating for caring has improved to requires improvement. Although people and relatives told us staff were kind and caring. We observed that people did not always receive person centred care and people were not always given choices.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received some positive feedback about staff from relatives. One relative told us staff are, “Absolute, friendly polite and helpful.” Another said, “Yes they are lovely. Never had a problem with any staff there. They have always been lovely.”

A further relative told us, “When my [partner] died the carers were very, very good. [Person’s name] was close to [family member]. The carers talk about [family member] and tell [person] [family member] would be proud and pleased with [person]. This helps me and [person].”

Staff were mindful of people’s dignity. Staff told us about one person who could undress in public places. They said, “[person] strips so we need to make sure we have a bag with [person's] clothes. If [person] strips in the house we use their dressing gown in the bathroom.”

We did not receive any feedback from partners for this quality statement as part of this assessment.

We observed in some of the supported living settings we visited that people were comfortable in the presence of staff. We also found since our initial visit to some settings in April that staff had learnt from our feedback and were now ensuring that one person received their personal care more frequently which meant they were being treated in a more dignified way by staff.

However, we did observe some instances of a lack of respect from staff. We saw one person’s breakfast being interrupted so gel could be placed in their eyes. This was in front of everyone else at the breakfast table. We also saw one person’s spoon being used to give another lady a spoonful of their breakfast to help wash their medicine down.

Some people were treated as individuals by staff. One person told us, “I love routine, I think staff understand that.” Other people were supported to find work placements which they had expressed a wish for.

However, a relative told us, “When CQC got involved (previously) staff took [person] to see the trains which they never done in the whole time [person] was there. But they (staff) stopped within 2 weeks because CQC had been.”

One of the registered managers told us, “We follow the principles of person-centred care and do things that people want to do. We support people to go out to different activities and have arranged for one person to have a tutor come into them.” We found this approach has not been consistently embedded in practice.

We did not receive any feedback from partners for this quality statement as part of this assessment.

We did not see people always being treated as individuals. Despite care notes for people stating that they had been given a choice of where they had their medicines, we observed this not to be the case. At one setting, we saw two people being given their medicine at the breakfast table. They had not been asked if this is where they wished to have their medicine.

Process did not ensure that people were treated as individuals.

The care notes we reviewed often demonstrated a routine approach and the lack of variety. For example, we found staff had recorded identical wording on multiple days. This duplicated information made it difficult for the provider to ensure people were being treated as individuals that may have different reactions to care each day.

Some people were supported to remain independent. For example, one person was able to shower themselves without staff involvement and staff encouraged this. A relative told us, “[Person] is not good with their cleanliness which is why they have gone there to learn to look after themselves more than [person] was at home and gain independence and the staff are always on at [person] to shower.” A second relative said, “Most importantly [person] is independent. [Person] can now even make a cup of tea!”

However, this was not always consistent as a relative told us, “They don’t encourage [person] to cook and staff are reluctant to take [person] on public transport.”

We found some improvements in staff supporting people with activities. For one person it was important to them to access the community on a daily basis. We reviewed their notes from 1 May to 29 June and although there were 9 days when they did not go out, we read of numerous and various activities they attended on the remaining days. However, one relative explained that staff did not always facilitate activities that engaged the person. They described an activity that the person “loved” but stated staff only took the person to this activity for a short time and then stopped. Another relative told us, “There isn’t enough input into little things like playing games.” However, some relatives stated their loved one had lots of activities and engagement.

Staff felt they supported people with making choices. One staff member told us, “We give them more choices now, for food, lunch, dinner, you will see. We give them more choices.”

Some people were supported to be able to make their own choices. We saw a staff member knock on one person’s door and remind them that it was medication time. The person chose to have their medicines in the kitchen and we observed staff administer this person’s medicine there.

Systems and processes to ensure people had choice and control over their lives was not always effective in identifying concerns or areas of improvement. The issues found with inconsistencies in activities had not been identified prior to the assessment. Therefore, no action had been taken to improve this for some individuals.

Some people received the support they needed. One person became anxious as they were uncomfortable with the additional noise in their home as well as new people visiting. Staff spoke with the person and asked if they would like to go for a walk to have some time outside and to enable them to settle. Staff supported the person out and when they returned, they appeared more contented and were happy to speak with us. A relative had fed back carers supported their family member when they had medical appointments and needed to stay in hospital. However, there were times people’s needs were not responded to when needed.

The registered manager’s told us, “We have always focussed on people when they are feeling unwell. We will contact the GP, 111 or pharmacy services.”

However, we found staff were not always contacting health care professionals when needed.

Our observation showed people were not always promptly supported to meet their needs. One person was supported to go out when they requested, another person received a cup of tea and biscuits as requested and another person asked to go shopping with staff and staff sat with them to make a list of what was needed. We however saw the notes reflected that a person had not been promptly assisted with their continence aids when needed. We saw from care records that the person woke up most morning where their continence aid had leaked. Notes suggested this person’s aids were not checked through the night.

Although, staff told us they felt supported in their roles and felt confident that management had their wellbeing at heart. The issues we identified during our review of staff rotas, identified some staff worked long hours. For example, one staff member worked over 60 hours in one week and other staff worked during a day shift as well as a night shift. This meant staff may be tired and not able to fulfil their duties properly. It would also be detrimental to their well-being.



A staff member told us told us, “From the office they always support me.”

Systems and processes were not effective in ensuring staff wellbeing was considered. We could not be assured that the provider had considered the impact on staffs wellbeing in relation to working excessive consecutive days