St Brelades

Medicines management had improved. Further improvement was needed to ensure people were always offer medicines overtly before they were administered covertly. Medicines records were now accurate and medicated patches were applied in line with the manufacturer's guidance.

Care plans have been improved to provide guidance to staff about how to manage risks. However, information was not always stored in the same place so staff could refer to it quickly in an emergency. Action had been taken when accidents and incidents happened, but systems were not in operation to look for patterns and trends.

Further improvements were required in relation to quality assurance processes, acting on feedback and planning improvements to ensure the quality of the service continued to develop. Relatives continued to tell us laundry was not always well managed and items continued to go missing. New checks and audits were being implemented but time was needed for these to be imbedded to ensure any shortfalls were identified and action taken to address them.

Development plans were in place but did not cover all the plans the registered manager had to improve the service. Detailed plans would support the registered manager and provider to assure themselves the service was continuing to develop.

The culture at the service had improved. People were no longer discriminated against because of their needs and were free to use all areas of the building. The dementia environment had improved, but further work was needed to ensure people are empowered to understand and interact with their environment as much as possible.

People were protected from the risk of infection. A relative told us "It's always been excellent, clean and tidy. It's just like walking into somebody's home".

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. The provider's quality rating was now clearly displayed. Notifications had been submitted as required.

People were protected from the risk of abuse because all staff had now completed safeguarding training. Staff were confident to raise concerns with the registered manager and were assured she would act.

Staff recruitment had improved. There were enough staff who know people well and have the skills and competence to meet people's needs. Staff now felt supported, appreciated and motivated. Staff were confident to make suggestions and these were acted on.