The Laleham

The provider was in the process of implementing an electronic care planning system, and therefore care plans and risk assessments did not always contain the level of detail for staff to be informed of how best to support people. Staff we spoke with had the skills and experience to support people and knew people well. Risks to the environment had not always been identified by the provider, for example uncovered radiators which could place people at risk of burns. Once these were identified they were addressed by the provider.

There were sufficient staff to meet people's needs, and improvements had been made to the recruitment process. People and their relatives told us they felt confident staff had the knowledge and training to protect them from the risk of abuse. When accidents and incidents occurred, there was a clear process to learn and improve.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We found toilets had been locked without considering restrictions to people. Once we identified this the provider unlocked the doors. The service is in need of updates; there were areas where wallpaper was coming away from the walls, and where improvements could be made to make the service more dementia friendly. People were involved in their assessments and review of their care plans. When people's needs changed people and their relatives told us staff were responsive and booked appointments for them to see a wide range of healthcare professionals. One person told us, "If we get appointments they put it straight in the diary so you always have transport. And I always have someone with me, it's usually a senior." However, we found improvements were needed in relation to oral care and people accessing a dentist.

Staff told us the culture of the service had improved with the registered manager. One staff said, "When [registered manager] came it was the best thing that ever happened. So much wasn't getting done and we weren't a team. Now things run smoother." People and their relatives felt engaged in the service and we received positive feedback about the care people received. Staff worked with a range of healthcare

professionals to provide joined up care. Although we found improvements in some areas, other areas continue to need improvement.