Last updated: 10 February 2026
"Good tailored activities and an empowering culture, but heavy night agency use, missing supervisions and ineffective governance hold it back."
Our last inspection had highlighted some concerns regarding the management of risks relating to people's care and how these were to be mitigated. This inspection found some similar concerns.
The leadership team understood the importance of developing an empowering and inclusive culture amongst the staff team. This was still a work in progress and some staff felt that morale and teamwork were areas which needed to be improved.
At night there continued to be a heavy reliance on agency staff to cover gaps in the rotas on night shifts. Every night between 8 February 2021 and 7 March 2021, three of the five required night care staff were agency workers. On two nights, all of the care staff were agency workers.
The registered manager had not embedded a programme of supervision. For example, neither of the permanent night registered nurses had had a supervision for six months.
The governance arrangements in place were not yet being fully effective at driving improvements throughout all areas of the service.
Per 2019 comprehensive inspection: The home employed an activity coordinator who described how they had tailored the activities to meet people's individual needs; these included balloon tennis, skittles, visits to local attractions and shopping trips.
Heavy agency use on night shifts, often three out of five or even all, means less stable teams and less familiarity with residents.
At night there continued to be a heavy reliance on agency staff to cover gaps in the rotas on night shifts. Every night between 8 February 2021 and 7 March 2021, three of the five required night care staff were agency workers. On two nights, all of the care staff were agency workers.
Managers not fully spotting risks like poor nutrition monitoring or choking from wrong foods, so oversight feels patchy.
One person's nutrition plan did not reflect their known risks regarding weight loss. Two people's food and fluid charts did not always provide assurances... Records showed that two people had been offered foods that were not in keeping with their prescribed diet.
Staff missing regular one-on-one meetings to check skills and support development.
The registered manager had not embedded a programme of supervision. For example, neither of the permanent night registered nurses had had a supervision for six months.
AI Generated
Last inspected: April 2021
Management Quality
Well-led: Requires improvement
Direct feedback from current and former employees

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