Inspection Report onSt Pauls care home

157-159 Pantbach RoadCardiff

CF14 1TZ

Date Inspection Completed 1st October 2019

Welsh Government © Crown copyright 2019.You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.

Description of the serviceFaiza Rassam is the registered individual registered with Care Inspectorate Wales (CIW) to provide a care home service at St Pauls residential home. The home may accommodate a maximum of 8 individuals. According to the Statement of Purpose, the home can offer a service to Adults who require personal care and have functional mental health needs.The responsible individual for this service (RI) is Faiza Rassam. There is an appointed manager in post who is registered with Social Care Wales in accordance with legal requirements.

Summary of our findings

1. Overall assessmentSt Pauls offers people support with basic care needs, and people appear settled because they have known it as their home for many years. People do not have opportunity to be fulfilled socially or have the right support to enable them to manage their mental health in a way that promotes their well-being.

2. ImprovementsThis was the service’s first inspection since its registration under the Regulation and Inspection of Social Care (Wales) Act (RISCA) 2016. Therefore, any improvements made following this inspection will be considered at our next inspection.

3. Requirements and recommendations Section five sets out areas in which the registered provider is not currently meeting legal requirements.

1. Well-being

Our findings

People’s safety and well-being is not being prioritised. Examination of staff personnel files revealed that most staff were not up to date with their mandatory training. Staffing levels are not determined by people’s needs.At night people are being put at risk by a ratio of 1 staff to 6 people.There is at least one person at the service who requires 2 staff members to assist with their care. Furthermore, we found that management lacked knowledge and guidance to ensure residents received safe care. Our findings indicate that people are not sufficiently protected at St Pauls

Opportunities for people to access education, training and meaningful activity are limited. Staff are provided for people to go to health appointments. Staff are also available for one resident to attend a weekly class in the community; however, we could see no provision of staff for providing support with activities within the home or any spontaneous community support. Some residents at the home are able to access the community and resources independently and we saw one person during inspection come back and forth from a local cafe. Another person was accompanied by a staff member to attend a health appointment but when we asked them if they were supported to do anything other than health appointments, they said they were not. When we reviewed the activity records for people within the home they generally just listed “sat and watched TV” .We saw one resident spent significant time alone in their room. It was unclear if this was their choice. Availability of staff to assist with activities appeared to be limited as there were at most two workers on shift during the daytime and one late evening to early morning. This is not in line with the home’s statement of purpose which states “Our philosophy is to make sure people lead an active and positive life, whilst encouraging our residents to participate and engage in activities with the support that they wish to do so. We will also respect choices if people do not wish to engage in activities whilst continuing to offer opportunities.” Meaningful activities are limited and could be improved to promote positive outcomes for people.

People may not be able to make informed choices about whether they wish to live in the home as their decisions may be based upon inaccurate information in the statement of purpose. People do not always receive the right support for their needs because the registered provider has not provided appropriate training for staff.

Peoples’ physical and mental health and wellbeing has been compromised in some instances because of a lack of timely referral to other professionals. Further details of this are included in other sections of this report.

2. Care and Support

Our findings

We found that staff at the care home work hard to support people living at St. Pauls. However, they do not always have access to the support they need to promote the best outcomes for people.

We arrived at the home at 7am and found there was two residents already awake and having their breakfast. There was only one staff member on duty. The Responsible Individual (RI) did not attend the home until 7.45, and stated they had been back and forth at the home throughout the night although we did not find evidence to support this. Staff interaction we saw was kind and appropriate. One resident was a little distressed by having strangers in the home and we saw the staff member respond appropriately and offer them reassurances. Throughout the inspection, we saw staff have nice and friendly interactions with people and there appeared to be genuine fondness between staff and people living at the home. One person told us “I like the staff we have a little joke I like living here.” However, another person told us “staff are ok, they never have time though”. We observed people having choices for breakfast and appeared to get up at times that suited them. We spoke to staff who confirmed that they enjoyed working at the home but all said being left work alone with six people could be difficult. One person told us;

“It’s hard on weekends if we are the only worker on shift, we have to cook meals and then we can’t be offering support, particularly to the residents who need a lot of support.” They went on to say, “I feel bad for the residents we should be supporting them to go out and do more but it’s impossible with one person”.

Staff we spoke to demonstrated a genuine fondness for people at the home however; they appeared to lack insight into people’s needs. We received conflicting information about one person’s physical health, and another person we discussed with staff had no knowledge about a significant traumatic event that may have been affecting their well- being. We reviewed staff training records and saw that none of the staff had any mental health training.

We looked at the home’s staff rotas and saw there were many occasions, particularly weekends and night times, where the staffing arrangements were recorded as one person and the RI. We were told by staff that the RI, when on shift, was mostly more of an ‘on call’ arrangement as they lived next door. The RI confirmed that they were not present always when on shift but constantly came back and forth to check on staff. We informed the RI that as previously discussed the staffing ratio of one person alone at night does not comply with safe fire evacuation protocol. We further found evidence that people’s needs were compromised by inadequate staffing levels. We saw there was very little time for staff to support people in personal care routines. A number of people at St Pauls lack insight into the ability to meet their personal care tasks, and need a level of prompting and encouragement to dress in appropriate clean clothing, wash and groom. We could see nothing in place where staff had guidance in a care plan or time allocated to promote and encourage hygiene routines with people. When we asked staff the only strategies they had in place were to ask people if they wanted a shower / wash where most refused. We saw a number of people were unkempt in appearance, clothing was stained and hair and fingernails were dirty.

We include further evidence in the attached non-compliance report. We conclude that staff are not always able to support people in a way that promotes their dignity and well-being.

We found that residents were happy with the quality of food provided and they told us the meals were “good.” We viewed the home’s weekly menu and saw that a good variety of meals was available each day. We were at the home over a lunchtime and saw residents enjoy a home cooked meal. Staff served snacks as required. Staff were also required to prepare meals for residents during their shift, which when there was only one staff member available meant they were spending additional time away from residents. We were not confident that staff had a good understanding of people’s specialist dietary requirements. We saw that advice from dietician services was not being followed leading to one person having continued weight loss. Staff monitored residents’ weight, but no assessment was in place around risk of malnutrition. Food charts were kept but only for lunch and dinner.We conclude that the service is not fully meeting residents’ dietary needs, and therefore could compromise their physical health and wellbeing.

Staff do not always deliver care in a safe and timely way, or plan it effectively. Through examination of care files, we found that personal plans were not always in place to address residents’ specific needs. There was an absence of specific care plans and risk assessments for residents at risk of pressure sores, for individuals prone to falls, and for those with mental health needs. Although we found that staff referred residents to their GP or to other appropriate multi-disciplinary professionals when they presented with obvious acute illnesses or problems, they did not always follow up with subsequent referrals. Furthermore, we found there were a number of residents who were not being supported with conditions related to functional mental ill health, such as self-neglecting and distress. We include further details in the attached non-compliance report. We conclude that the service does not consistently provide residents with the correct support required to promote their physical and mental health.

3. Environment

Our findings

People can feel secure, as the home protects against unauthorised visitors. A staff member allowed us into the home, and asked us to sign the visitors’ book. External areas at the rear of the property were enclosed for additional safety. The home is on a residential street with occupied properties either side. The manager informed us there were no concerns or conflicts with neighbours at present. CCTV was also installed at the entrance and external areas of the home. Therefore, we conclude that the service has appropriate monitoring of visitors to keep people safe.

People do not always have an environment that is well maintained, clean and free of hazards. The home is small and domestic in nature; we saw some cosy homely areas like the lounge where there were pictures on the walls and various ornaments. There was some craftwork from one resident on display in the dining area. We undertook a walk around the home and listed a number of areas where the environment needed improving, where the home appeared dirty in some areas and we notified the RI of a faulty electrical socket in one person’s bedroom and a light that was making a ‘buzzing sound’. Furthermore, a patio area where people went to smoke was cracked and uneven causing potential for people to fall. There was also a leak in the prefabricated roof covering the dining area. We include further details in the attached non-compliance report. Overall, we conclude that the home environment does not enhance the comfort of residents and the RI has failed to appropriately identify and safeguard people from hazards.

4. Leadership and Management

Our findings

We considered the home’s Statement of Purpose. This is an important document, which should provide people with detailed information about the services and facilities offered and should outline the home’s underpinning philosophy and approach to care delivery. Although we saw that the document provided information about staff and services, the overall quality was poor and lacked the usual presentation of a formal document. Whilst the document outlines that the homes philosophy is;“We provide support which promotes well-being, safeguards people and which is delivered in a person-centred manner - which focuses on outcomes and individual choices. To do so we work closely with community health services to ensure people’s physical and mental health needs are met. We provide support to enable people living at St Pauls to develop their life skills and opportunities both in and away from the care home. You will be supported by a key-worker who will meet with you to review how support is being provided and to review your goals regarding lifestyle and how we can work with you to achieve any additional goals/access activities of your choosing.”We found practices were not consistent with this and the service did not have the skill level or resources to deliver care in line with this. The service provider must take steps to ensure the service is provided in accordance with the statement of purpose.

Although staff are safely recruited, people cannot be assured they have sufficient training to undertake the role they perform. We saw evidence care staff had completed some training in regard to areas like food hygiene, manual handling, infection control and adult safeguarding We could not see if this training was in date or which staff had training due, because there was no oversight of training by the manager. We found no evidence of training that would equip staff to manage some of the complexities of people’s care needs. In addition, when we reviewed the three staff member files we found their prior care experience was not in the field of mental health. Given the needs of residents and staff experience, we would expect the provider to ensure staff have access to specialist training and support to undertake their role. The statement of purpose (SOP) states;

“Our staff are trained in supporting people with functional mental health support needs and as such are aware of how to promote well-being and dignity at all times. And to ensure support is delivered by skilled and knowledgeable staff, they complete a detailed induction and regular training updates in key areas such as infection control, food hygiene, and fire safety, protection of vulnerable adults, first aid and supporting people with a functional mental illness.”

We did not find this to be the case. We therefore conclude staff are not trained in a way that promotes positive outcomes for people, and not all staff have the necessary knowledge and skills to deliver care and support. We informed the manager the service did not meet regulatory requirements with regards to this.

5. Improvements required and recommended following this inspection

5.1 Areas of non compliance from previous inspections

Not applicable. This was the service’s first inspection since its registration under RISCA (2016).

5.2 Areas of non-compliance from this inspection

During this inspection, we identified areas where St Paul’s residential home is not meeting the legal requirements and this is resulting in potential risk and poor outcomes for people using the service. Therefore, we have issued a non-compliance notice in relation to the following:

Regulation 21 (1). The service provider must ensure that care and support is provided in a way which promotes, protects and maintains the safety and well-being of the individuals

Regulation 34 (1) (b) and (c). The provider (registered person) must ensure that there are sufficient numbers of staff on duty to (b) meet the care and support needs of people and (c) support people to achieve their personal outcomes

Regulation 36(2) (d) and (e).The service provider must ensure that any person working at the service receives core training appropriate to the work to be performed

Regulation 44 (4) (g) (h) (i).The service provider must ensure that premises must be- (g) free from hazards to health and safety of individuals(h) properly maintained (i) Kept clean to an appropriate standard

Regulation 6. The service provider must ensure that the service is provided with sufficient care, competence and skill, having regard to the statement of purpose.

These are serious failures in care for which non-compliance notices have been issued. We expect the provider to take prompt action to meet compliance by the date specified on the attached non-compliance report.

In addition, we identified areas where the service provider is not meeting legal requirements but notice has not been issued, as there was no immediate or significant impact for people living at the home:

Regulation 7 (1) The service provider must provide a service in accordance with the statement of purpose.

Regulation 7 (2)(a) The service provider must keep the statement of purpose under review. The document does not accurately reflect the service provided at the home

Regulation 16 (4) – Reviews of personal plans must involve the individual or their representatives

5.3 Recommendations for improvement The provider must ensure references sought meet regulatory requirements Paperwork used at the home should be consistent

6. How we undertook this inspection

This was a full inspection undertaken as part of our inspection programme. We made an unannounced visit to the home on 1 October 2019 between 07:00 and 15:00.

The following were used to support our findings for this report: review of information about the service held by CIW. This included records of

notifiable events and concerns received since the last inspection; discussions with people using the service; observations of care practices and interactions between staff and residents; discussions with RI/manager and deputy manager; discussions with three care staff; review of four residents’ care documentation; review of three staff personnel files; review of the staff training and supervision records; consideration of the arrangements to review the quality of care provided; review of the home’s statement of purpose; examination of staff rotas; and observation of the home environment

Further information about what we do can be found on our website: www.careinspectorate.wales

About the service

Type of care provided Care Home Service

Service Provider Faiza Rassam

Responsible Individual Faiza Rassam

Registered maximum number of places

8

Date of previous Care Inspectorate Wales inspection

First inspection following registration under RISCA

Dates of this Inspection visit(s) 01/10/2019

Operating Language of the service English

Does this service provide the Welsh Language active offer?

No

Additional Information:

This is a service in an English speaking part of Cardiff that does not currently provide an 'Active Offer' of the Welsh language. It does not anticipate, identify or meet the Welsh language needs of people who use, or intend to use their service. We recommend that the service provider considers Welsh Government’s ‘More Than Just Words follow on strategic guidance for Welsh language in social care’.

Date Published 27/02/2020

Care Inspectorate Wales Regulation and Inspection of Social Care (Wales) Act 2016

Non Compliance Notice Care Home Service

This notice sets out where your service is not compliant with the regulations. You, as the registered person, are required to take action to ensure compliance is achieved in the

timescales specified.

The issuing of this notice is a serious matter. Failure to achieve compliance will result in Care Inspectorate Wales taking action in line with its enforcement policy.

Further advice and information is available on CSSIW’s website www.careinspectorate.wales

St Pauls care home

St. Pauls Residential Home157-159

Pantbach RoadCardiff

CF14 1TZ

Date of publication: 27/02/2020

Welsh Government © Crown copyright 2019. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.

Well-being Our Ref: NONCO-00008910-DVJS

Non-compliance identified at this inspection

Timescale for completion 15/01/20

Description of non-compliance/Action to be taken Regulation number

The service is non-compliant with Regulation 21(1) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. This was because the provider (registered person) did not ensure that care and support was provided in a way that protects, promotes and maintains the safety and well-being of individuals.

Evidence

The service is non-compliant with Regulation 21(1) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. This was because the provider (registered person) did not ensure that care and support was provided in a way that protects, promotes and maintains the safety and well-being of individuals. The evidence to support this is as follows:1. When we entered at 7am there was one staff member on duty and we were informed

that his person had been alone at the home all night. We viewed the rota and saw that the RI / manager was named as a second person on duty for that shift but they were not at the home. The registered person has previously been notified that in line with South Wales Fire and Rescue service recommendations one staff member is not adequate as would not be able to evacuate all residents. We saw at least one person in the home required support of two staff members. When the RI/ manager came to the home at 7.45 they advised that as they live in the property next door they are on call 24 hours and ‘pop’ back and forth as needed. This arrangement is not adequate to keep residents safe at night time.

.2. Personal plans in relation to peoples’ mental health and wellbeing were basic and did not

represent an understanding of how to support people with complex care and support needs. We saw no evidence of instruction to staff to; identify possible relapse signatures and triggers to escalating distressed behaviour, advise staff how best to support people who become mentally unwell, instruct staff to identify at what point further advice and support is required from health professionals and to review and revise properly agreed strategies to manage adverse risks and associated behaviour.

Daily observations also lacked detail to pr reflect people’s emotional or mental wellbeing and were simply descriptive of tasks and people’s daily routines. We saw no correlation between peoples ‘behaviours’ and their mental health. A number of people living at the home were non –compliant with personal care, however we could not see any evidence that the home beyond asking people to comply had made any progress with supporting individuals in this area. We saw that a number of people at the service were unkempt in appearance and it was difficult to establish when people had last received support with their personal care. We were told by staff

that another person became very distressed during personal care however we did not see that any advice had been sought in regard to managing this. We were told that one person hadn’t consented to personal care in around ‘3 months’ staff had some indication why this was but again we could not see evidence that any guidance had been sought.As a result we were not confident people living at St Pauls were getting the right support in regard to their mental health.

3. There was inadequate oversight of the health needs and weight management of people in the service. We identified one person who required an urgent referral to a dietician as they had low body weight with consistent weight loss. The person had been seen by a dietician in August 2019, however the service was not following advice on food fortification or offering the prescribed supplements. No follow up with dietician had been sought by the home.

Records of peoples’ food and fluid intake were being completed but only for lunch and dinner, and there was no analysis of this information leading us to lack confidence in the services understanding of the purpose of keeping these records.

4. The management of pressure care for one individual was inadequate. We saw in this persons records that they had treatment for pressure areas from the district nursing service through July, August and September 2019. We saw advice from the district nursing service in regard to pressure relieving equipment and follow on care. However we found the service had not put in place a care plan or risk assessment in relation to skin care. We found no on going monitoring of this persons skin integrity in place. Meaning that potentially they could develop further pressure areas

5. During inspection, we observed that one person was incontinent of urine whilst in the communal area. Staff did prompt this person to change but no assistance or encouragement was given to prompt a wash or shower. When we asked about this persons continence management both the manager and deputy manager stated ‘they forgot to go sometimes” again no further advice from a medical professional had been sought, neither was there any basic plan in place around promoting this person to manage their continence.

6. We discussed the needs of one individual with the RI / Manager and were told that the person was at end stages of life. There was no indication of this in the persons care records or any plan of care in place around specific end of life care. We then discussed the person with the deputy manager who informed us that they were not end of life, or did not have any life limiting diagnosis. This evidences that there is not clear understanding within the service on what residents needs are and subsequent support they require.

7. Not all people are enabled nor encouraged to pursue activities and work and leisure opportunities to stimulate them and give them a sense of achievement and worth (although we acknowledge that there are good examples of some residents being able to). Records show several people simply ‘watching television’ as an activity and a number of people told us that they were often bored. Staff ratios we viewed on rotas did not allow staff to support most people with accessing community activities.

The impact for people living at the service is that they have been exposed to the risk of harm in relation to their physical and mental health and wellbeing and their fundamental rights and choices have, at times, have been compromised.

Care and Support Our Ref: NONCO-00008911-QKBW

Non-compliance identified at this inspection

Timescale for completion 15/01/20

Description of non-compliance/Action to be taken Regulation number

The service is non-compliant with Regulation 34 (1) (b) and (c) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. This was because the provider (registered person) did not ensure that there were sufficient numbers of staff on duty to (b) meet the care and support needs of people and (c) support people to achieve their personal outcomes

Evidence

The service is non-compliant with Regulation 34 (1) (b) and (c) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. This was because the provider (registered person) did not ensure that there were sufficient numbers of staff on duty to (b) meet the care and support needs of people and (c) support people to achieve their personal outcomes. The evidence to support this is as follows:

8. We inspected at 7 am when we arrived one person has been there all night, when we reviewed peoples fire evacuation plans we saw some people needed equipment to support safe evacuation which one staff member would not have been able to support.

9. Staff Rotas we viewed were not an accurate reflection of staffing at the home. This was because on discussion with RI and manager they advised that when they were placed on as a second person they were not always at the home. This meant there were many times such as nights and weekends when the home is run by one staff member with the RI / manager ‘on call’. This is not adequate to manage the support needs of people at the service. A number of people seemed disengaged and bored during our visit. Personal appearance of a number of residents was unkempt and the cleanliness and hygiene of home was poor. Feedback from staff indicated they were frustrated by the lack of planning for staff arrangements. Staff told us they felt they couldn’t support people in a way that promoted well-being because time was taken up with residents who needed more support and the practical tasks within the home. We spoke to a number of service users one told us “ staff have very little time as there’s often only one on duty and resident XXXX takes up their time”

The Impact for people living at the home is that they are not getting the right support at the right time because there are not enough staff to meet their needs.

Care and Support Our Ref: NONCO-00008912-MMVM

Non-compliance identified at this inspection

Timescale for completion 15/01/20

Description of non-compliance/Action to be taken Regulation number

The service is non-compliant with Regulation 36(2) (d) and (e) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.The service provider must ensure that any person working at the service receives core training appropriate to the work to be performed.

Evidence

The service is non-compliant with Regulation 36(2) (d) and (e) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.The service provider must ensure that any person working at the service receives core training appropriate to the work to be performed. Our evidence is as follows:-

10. We did not see evidence that employees at the service had a suitable induction or essential training to equip them to be safe and confident in their care delivery with people living at the home.

11. Oversight and management of staff training needs was adhoc and poorly organised. We could not see which staff required refresher training in compulsory areas such as manual handling, infection control and food hygiene.

12. Staff did not receive any specialist mental health training, considering all the people living at St Pauls have a diagnosed mental health condition and staff did not have the necessary skills to support people without some training in this area.

13. The homes statement of purpose document states – “To ensure support is delivered by skilled and knowledgeable staff, they complete a detailed induction and regular training updates in key areas such as infection control, food hygiene, fire safety, protection of vulnerable adults, first aid and supporting people with a functional mental illness. “ We did not see evidence of this during inspection.

On this basis, we determined that care workers are not given access to suitable training which in turn impacts their ability to meet the needs of the residents at St Pauls

Environment Our Ref: NONCO-00008913-BDPG

Non-compliance identified at this inspection

Timescale for completion 15/01/20

Description of non-compliance/Action to be taken Regulation number

The service is non-compliant with Regulation 44 (4) (g) (h) (i) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.The service provider must ensure that premises must be- (g) free from hazards to health and safety of individuals (h) properly maintained (i) Kept clean to an appropriate

Evidence

The service is non-compliant with Regulation 44 (4) (g) (h) (i) of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.The service provider must ensure that premises must be-(g) free from hazards to health and safety of individuals(h) properly maintained(i) Kept clean to an appropriate standardOur evidence is as follows:-

14. During a walk around the home we observed the followingThere was a leak in the roof of a lean to type structure off the kitchen / dining area. Water was coming into the communal area potentially causing risk.

15. We had to notify the responsible individual of a faulty light In the living area and to point out to the deputy manager an exposed plug in a residents bedroom

16. Furniture and fixtures in the home tended be old and some in need of replacement.

17. Areas of the home (downstairs bedroom) (bathroom upstairs) had malodour

18. Floor areas were dirty and were sticky underfoot; railings on stairs were sticky to touch.

19. Bathrooms upstairs had cracked tiles , rust / lime scale on metal areas and were generally poorly maintained

20. Externally paving was uneven and cracked, people frequently accessed this area for smoking, and the potential for people to fall was high

We concluded that people at St. Pauls did not have access to a standard of accommodation that was safe and clean.

Leadership and Management Our Ref: NONCO-00008914-YRQM

Non-compliance identified at this inspection

Timescale for completion 15/01/20

Description of non-compliance/Action to be taken Regulation number

The service is non-compliant with Regulation 6 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. The service provider must ensure that the service is provided with sufficient care, competence and skill having regard to the statement of purpose.

Evidence

The service is non-compliant with Regulation 6 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. The service provider must ensure that the service is provided with sufficient care, competence and skill having regard to the statement of purpose.

The evidence.

21. We found there was a lack of quality assurance audits aspects of care provision and those undertaken by the manager and deputy manager relating to other areas were not effective in improving standards of care in the home.

22. We found that no staff had received specialist training appropriate to their roles. In addition core training was not in place for a number of staff

There was no oversight and management of staff training needs by management and they were unable to identify which staff training needed updating.23. There is no tool in place to assess the dependency needs of the service users at the

home, staffing is determined by the services financial situation leaving service users without the appropriate care they need. The service provider has continually disregarded advice in regard to fire safety at night by not increasing staffing levels.

24. The service being delivered is not as outlined in the statement of purpose25. There is a lack of effective oversight of the service.

The service provider had not identified the above-mentioned areas for improvement. Although quality monitoring visits had been undertaken by the RI, there was no care improvement requirements recorded or clear plans for improvement.

- The impact on people using the service:Failure of management to ensure there are sufficient staff levels and they are appropriately trained for the work they undertake places people at significant risk of harm. Where effective and robust monitoring of care is not in place and accurate information about the service is not

recorded in the statement of purpose, people's well-being and the quality of care they receive has been compromised. We found that people did not have sufficient access to support with personal care, opportunities to develop social skills or access to a good standard of accommodation.