Laura Cares

Assessments relating to peoples' care and support needs did not fully factor the needs of people living with dementia and did not identify all of peoples' protected characteristics as identified in the Equality Act 2010. People received care and support from staff who were not always inducted, suitably qualified, skilled and supported to meet their care and support needs. Appropriate referrals were made to relevant health and social care professionals to ensure people received timely care. We have made a recommendation in relation to staff supporting people with swallowing difficulties.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the registered manager did not work in accordance with the Mental Capacity Act 2005 and its Code of Practice.

People's care was not always personalised and responsive to their needs and their preferences for end-of- life care were not captured. We have made a recommendation about this. The provider did not have effective systems to make sure all complaints were documented, investigated, and to ensure people were always provided with the outcomes. The service worked in accordance with the Accessible Information Standard and documented peoples' communication needs.

The registered manager had lost managerial oversight of the service and failed to follow policies and procedures which, if followed, would have helped them to be compliant with the relevant legislations. Quality assurance systems were ineffective because the service's internal audit processes were not able to identify when things went wrong and were completed by staff who did not have the skills to understand the significance of them. The service did not promote a culture that encouraged candour, openness and honesty at all levels when incidents happened. We have made a recommendation about this. Verbal feedback was sought but was not used improve the quality and delivery of care. The service did access external partners when necessary to improve the care outcomes for people.

People and relatives were very positive about the caring nature of staff. Comments included, "Very polite and helpful" and "They (staff) love her, they are so kind to her, they joke with her, we have a lovely relationship." People and relatives told us they were treated with respect and dignity and their independence was promoted.

The registered manager was aware they needed additional support and had brought in another registered manager to assist them, as well as was seeking support from a local association, that supported registered providers.